205: Alzheimers and Therapeutic Communication

Alzheimers: from Lemone and Burk [pgs 1617-19

A type of dementia or senility

‘Progressive, irreversible deterioration of intellectual functioning’

Patients can live 8-20 years after diagnosis

Usual cause of death is aspiration pneumonia due to dysfunctional swallowing

Begins with memory loss, ends with total inability to perform ADLs

Pathophysiology:

Loss of nerve cells in brain

Tau is a protein that comprises microtubules in nerve cells; this protein becomes distorted and the microtubules can no longer distribute nutrients and molecules [probably neurotransmitters.] Communication is lost btwn neurons and neurons die off. Plaques form from degenerative neurons, starting in the memory and cognition centers of the brain. Plaques may be the problem or they may be a by-product.

Circulation to the affected areas decreases, atrophy occurs and the holes [ventricles and sulci] get bigger, creating hydrocephalus.

Stage 1: Memory loss and mild disorientation with time and place, grouchiness

Stage 2: becomes deficiency with everyday tasks, then loss of language and judgment, then disorientation and emotional outbursts. Sundowning is a term for late-afternoon time disorientation and wandering.

Stage 3: loss of ADL skills, total dependency, inability to communicate, incontinence, etc. Seizures and paranoia may occur, along with complications from lack of self care and disinterest in food. Cannot recognize self or family.

Risk Factors of Alzheimer’s

wAge: ½ of all people over 85 have AD

wFamily History: familial AD follows genetic lines, ‘sporadic AD’ does not

wFemale

wGenetics

wHeart disease

wHead injury

Communication [ch 26 KE]

Sender/encoder

Message

Receiver/decoder

Response Message/Feedback

Verbal communication: simple non-technical terms, concise and precise, relevant and well timed. Create credibility and be honest when you can’t answer questions. Humor is a “positive and powerful tool” but must be used with caution and good timing.

Nonverbal: posture and dress are big as nurses, reading clients’ posture is also important. Non verbal gestures can communicate more accurate information than verbal—nurses’ non verbal signals will also be watched by clients.

Therapeutic Communication:

Responding both to verbal and non verbal cues [both words and emotions] when the patient is in a position to cope with the feelings you might dig up

Attentive Listening: listening to all messages until the client closes the conversation, without interruption.

Physical attending: posture, eye contact, relaxation, availability

How you’ll screw this up: misunderstanding the message, listening selectively, putting attention on your own needs.

Common vs Expert advice or commentary: “I would move into a nursing home where you’ll have meals cooked for you,” or, “You’ll feel much better soon,” are common, less professional, and less intimate responses.

Helping Relationships: 4 phases

1: Preinteraction: planning phase—especially on the nurse’s part

2: Introductory/Orientation/Pre Helping: judgments are made by each party

1. Opening the relationship: resistive behaviors on the patients part may arise in reaction to ‘neediness’
2. Clarifying the problem
3. Structuring and formulating the contract

3: Working Phase

1. Helping to explore thoughts and feelings: empathic listening, respect, genuiness, therapeutic specificity [you’re not clumsy, you tripped on the rug], confronting incongruence in the client
2. Facilitating taking action: assist the client in making decisions and taking action

4: Termination Phase: say bye bye and deal with any feelings of loss

Group Dynamics

Effective groups: are comfortable, honest and creative, and center leadership flexibly around expertise and not position.

Ineffective groups: display fear of authority and subsequent dilution of creativity, feedback, communication, and therefore problem solving.

Task Groups:

Most nursing groups [dyads or more] will be task groups. These are finite-term groups with specific goals to complete, after which the group will disband. Leaders should be chosen for their expertise in the area of task setting and group coordination.

Teaching groups: need leadership skilled in the teach-learn process

Self-Help Groups: centered around problems

Self-Awareness/Growth Groups: centered around training for interpersonal relationships

Therapy Groups: similar to growth groups, but centered around a professional leader with therapy as their expertise

Work-Related Social Support Groups

Support given between medical professionals casually outside the work environment

Communication Among Professionals

w Assertive: Honest, direct and appropriate, open to feedback. [safety] minimizes confusion between staff. Clear, concise, I-statements

w Non-Assertive

w Submissive: Allowing rights to be violated by others, avoiding conflict or punishment

w Aggressive: Asserts speaker’s needs and rights without regard to needs and rights of others: it humiliates, embarrasses, dominates, or controls the other person. Sarcasm, yelling, rudeness, and personal insults.

w American Assoc of Critical Care Nurses Communication Standards

w Skilled Communicators Find solutions to achieve desirable outcomes

w Skilled Communicators Advance collaborative relationships

w Skilled Communicators Hear all perspectives

w Skilled Communicators Use goodwill & mutual respect

w Skilled Communicators Demonstrate congruence between words & actions

w Skilled Communicators Use appropriate communication technologies