THERAPEUTIC COMMUNICATION WITH OLDER STRUCTURAL MODEL OF COMMUNICATION

ADULTS

If the interaction facilitates growth,

development, maturity, improved functioning, or
improved coping…it is considered therapeutic.

DEFINITION of COMMUNICATION

• Imparting, conveying or exchange of ideas,

knowledge, meanings, etc. among
individuals through the medium of a sign of
some kind
• “A process by which two or more people
exchange ideas, facts, feelings, ‘common
understanding’ of meaning, intent, and use
of a message’ (Paul Leagens)
• Communication of ideas, facts, feelings, and ANATOMY &PHYSIOLOGY OF COMMUNICATION
information is very vital for facilitating The Cortex
human interactions • Primary repository of cognition
ELEMENTS • Language production - ability to speak

Consists of 6 small messages: The Speech Center – cortical center

• What do you mean to say? • Language development

• What do you actually say? • Speech production
• What the other person hears?
• What the other person thinks that he hears?
• What the other person says?
• What you think the other person says?

OBJECTIVES

• Awareness of information
• Action information
• Continuing information Aphasia - an acquired loss or impairment of language
• Updating information
• Broca’s aphasia
PURPOSES o characterized by non-fluent speech;
speech perception is not affected,
• It has to be expressed in terms of human and language comprehension is
behavior. normal
• It should be specific enough able to relate it • Wernicke’s aphasia
to actual communication behavior. o deficits in the comprehension of
• It should be consistent with the ways in language; speech is fluent, but it may
which people do communicate appear to not make sense to
COMMUNICATION PROCESS listeners

THREE ELEMENTS OF COMMUNICATION PROCESS Speech Structures

• Perception – activation of receiver’s sensory • Diaphragm

end organs • Intercostal muscles
• Evaluation – results to cognitive • Larynx
(informational part) & effective ( relationship • Vocal cords
aspect) responses • Tongue
• Transmission – feedback • Facial & oral muscles

Dysarthria – difficulty in producing sounds or words

KINDS OF COMMUNICATION

• Verbal Communication
o communication that involves speech
and language
 • Non-verbal Communication
o behaviors or gestures that conveys a
message without the use of verbal
language
Verbal Communication
• All words a person speaks
• Communicates
o Beliefs and values
o Perceptions and meaning
• Can convey
o Interest and understanding
o Insult and judgment
o Clear or conflicting messages
o Honest or distorted feelings
Non-verbal Communication
Can be either of two (2) forms:
• Vocal nonverbal communication
• Non-vocal nonverbal communication
Vocal non-verbal Communication
This refers to:
• Tone of voice
• Pitch
• Speech rate
• Fluency of verbal communication
• Emphasis of certain words
“What we say and HOW we say it is essential for
therapeutic communication.”
Non-vocal Non-verbal Communication
This refers to the use of:
• Physical appearance
• Facial expressions
• Body posture
• Amount of eye contact
• Hand gestures / Touch
“Non-verbal communication speaks louder than
words.”
COMMUNICATION IN HEALTH CARE
Types of communication in health care (patient
perspective)
• Instrumental or task-focused communication
o Behavior necessary for assessing &
solving problems
o Formal & structured (i.e. admission
interviews, health assessment,
discussion of advanced directives, or
patient-family education)
o May include informal conversations
• Affective communication
o Focuses on how the health care
provider is caring about the patient
and their feelings and emotions
o More informal; can develop
emotional & personal relationship
o Important in long term health care
relationships
BASIC PRINCIPLES IN MAKING PATIENT CONTACT
According to Satir (1976), there are 5 principles in
“making contact” in communicating with patients:
• Invite
• Arrange Environment
• Maximize Communication
• Maximize Understanding
• Follow Through
Inviting
This would say to the other person that you are
interested in them & sharing time with them
Strategies:
• Arrange time for a conversation rather than
an assessment
• Greet the elderly by name
• Ask non-threatening open-ended questions
Remember:
Start a conversation and NOT an interrogation.
Arranging the Environment
Prepare a communication-conducive environment
Strategies:
• Provide comfort
• Provide privacy
• Minimize distractions
Can be done in a nurse’s or patient’s space
• Face to face; 3-6 feet apart
• Ask permission to move or touch anything (if
in patient’s space)
• Consider disability of the elderly
Maximizing Communication
Use appropriate language to deliver health literacy
Strategies:
• Assess literacy & comprehension
• Use appropriate language
• Show respect by addressing client with
surname
• Avoid “terms of endearment”
Mistakes occur when we make assumptions and fail
to validate understanding.
Maximizing Understanding Communicating With Older Patients

Learning to listen is essential to good • When possible, give patients time to pack a
communication; listening differs from hearing few personal items before leaving for
hospital.
Strategies:
• Locate hearing aids, glasses, and dentures
• Understand meaning and context in which before departure.
they are spoken
• Be open-minded & provide opportunities to
share thoughts
• Allow time to communicate and focus
attention to conversation

Minimizing distractions not only helps the individual

to whom we are communicating, but also helps us
maintain focus.

Follow Through

Words backed by actions develop trust

Strategies:

• Intend to do what has been said (follow up)

• Build relationship based on trust and
concern

Trust & concern is critical to optimal health outcomes.

CHALLENGES IN COMMUNICATING WITH OLDER

ADULTS

• Memory or Cognitive Deficits

• Speech Deficits or Impairment (Aphasia)
• Speech Impairments (Dysarthria)
• Visual Impairments
• Hearing Impairments / Deaf

TECHNIQUES IN COMMUNICATING WITH OLDER

ADULTS

Communicating With Older Patients

• Identify yourself.
• Be aware of how you present yourself.
• Look directly at patient.
• Speak slowly and distinctly.
Communicating With Older Patients
• Explain what you are going to do before you
do it.
• Listen to the answer the patient gives you.
• Show patient respect.
• Do not talk about the patient in front of him
or her.
• Be patient!
Communicating With Older Patients
Older patients:
• Often do not feel much pain
• May not be fully aware of important changes
in their body systems
o You must be especially vigilant for
objective changes.