I am a health care assistant (HCA) on an elderly care surgical ward and we nurse many different patients who have had elective surgery and corrective surgery after a trauma. I have a lot of contact with patients who suffer with dementia, ongoing confusion due to urinary tract infections and can often display challenging and aggressive behavior.
I have found on a daily basis that patients become can frustrated when they cannot communicate what they want, and I was sure that with my strong accent I would come across as harsh. This left me feeling worried and sometimes inadequate because it is in my job and personal nature to want to help those in my care. As part of my Personal Assessment Document (PAD) my mentor and I decided that I would I would push myself to speak with patients more and see how they reacted to me. I would read the patient’s purple “This is me†folder to try and engage them on a more personal level.
With this reflective account I will be discussing an experience that I had on my ward and how through reflection I have managed to gain more confidence in my ability to talk to my patients and convey my compassion in the way I communicate with the patients in my care.
I will use the reflective framework devised by Atkin and Murphy (1994) to construct this account. It is the right model of reflection for me to look back and learn from my experiences.
Personally, being a good student and health carer does not just come with reflection in the mind but also reflective practice which, according to the nursing standard “enables a student to develop their skills, increase their knowledge and deal with emotionally challenging situations†(RCN 2012). Reflection is something that should be engaged with on an everyday basis and from very early on in your health care career. It enables you to carry on caring about the patients you treat and how to improve yourself personally and professionally.
I enjoy both the personal rewards and the challenges that go hand in hand with working with patients with dementia. I find that on the drive home I tend re-evaluate everything in my life and be grateful for the now. A patient whom will go by the pseudonym of “Polly†to maintain her confidentiality (The NMC Code of professional Conduct, 2004) was admitted to the ward with a fracture to the neck of her femur. I was advised that the patient was very confused, and would spit at staff and be both physically and verbally aggressive when approached but would constantly cry out that she needed help. She was in the early to middle stages of Alzheimer’s disease and had come from a care home for those suffering with dementia. Alzheimer’s disease is characterised “by the loss of short term memory, deterioration in both behaviour and intellectual performance and slowness of thought†(Dictionary of Nursing 1998).
In handover that morning I found that I would be working with her that day, and as she was post operative I would need to wash her and try to mobilise her to sit out in her chair so that the physiotherapists could help her to walk again and get her on the pathway to being discharged back to her care home. I found that I was nervous in approaching this patient as I did not want to upset her or get hurt. Personally I would always wake patients like Polly who require the attention of more than one member of staff last as it is better to leave the patient to sleep so that they are well rested. That, and from handover I had learned that Polly had experienced a rather active night.
Before waking Polly I had read her personal “This is me†purple file to find out if she had any preferred names, and how she liked to be spoken too. This is me was devised by the Alzheimer’s society and “is intended to provide professionals with information about the person with dementia as an individual. This will enhance the care and support given while the person is in an unfamiliar environment“(Alzheimer‘s society 2011). With this information I could help maintain a similar routine for Polly and I would not confuse her by overloading her with too many questions and instructions.
I woke Polly up gently, and sat myself down in the chair by her bed so that I was not standing over her. I spent almost thirty minutes with Polly getting her up and ready, the patient did not get upset or frustrated with me, and she was able to do most of the washing and dressing herself with help from me. Once this was completed I handed over to physiotherapists that they too should take this approach with Polly.
I spent twelve days in total with Polly. In this time she was aggressive with me, and she would spit at me when I approached her. Yet, once I used her preferred name and tailored my approach to what she needed from me, I found that Polly was a pleasant and wonderful lady, who could be the complete opposite to the patient that was first handed over to me that first morning.
Morris and Morris state that the symptoms of dementia are experienced by each person in “their own unique way†(2010) and this is reinforced by the publication of the “this is me†leaflet. It enables staff to really look at each individual patient and assess what their needs are. In reflection, if I had not read this leaflet and just gone ahead and woke Polly up as I do each patient, the events of the day could have taken a very different path. I found that by talking to Polly as requested in her leaflet that she reacted in a calmer manner and did not get as anxious or frustrated as quickly as my colleagues had prepared me to think.
Reflecting over my first day with Polly, I do not remember struggling to say my words more clearly than what I normally would have done. Polly was not deaf, nor was she a child and I kept it in my mind that this patient was still a scared lady who had broken a big part of her body and was in a large amount of pain. Furthermore, she might not be able to communicate this fact as clearly as someone without dementia. Hobson states that, the HCA will need to “learn to adapt how they attempt to understand what the person is saying to them†and that this can only be achieved by “entering the same world as the person with dementia†(2012, P337). At times Polly would pretend to cry like a child and repeat the words “Oh Mummy, mum, mum. Oh Mummy†but not be able to give an answer when questioned what was wrong and how could we help her. Taking this into consideration, Polly might not be actually asking for her Mum but actually trying to communicate a much deeper need.
My understanding of how patients with dementia communicate lead me to point to Polly’s hip and ask her if she felt pain there when she moved, to which she replied yes she did. In reflection I found this was a much better approach rather than just asking if Polly wanted any pain relief. Elkins has stated that asking the patient with dementia a direct question is almost a waste of time, as the patient does not have the information to give you. Instead it is more beneficial for the patient’s sense of self worth to ask them a question with an optional answer of “yes†or “noâ€. It could also be said that a statement rather than a question is better because it leaves the patient feeling more in control (2011). From this experience, I suggested to the nurses that when doing their drug round that they should lower themselves down to Polly’s eye level and ask her if her hip hurt her, rather than standing at the end of her bed or beside her asking if she wanted any pain relief. This suggestion meant that Polly had more regular pain relief, and as a team we knew when she was in pain. Furthermore, this information could be added to her file and become part of Polly’s future care pathway. Elkins raised the very same argument that “once an effective communication bridge had been achieved, the individual is much more like to remain calm and anxiety free†This would show that dialogue between patient and healthcare professional had been greatly improved and would continue to do so in the future (2011).
In reflection, I have found that I was so focused on the need to be understood through my use of English that at times I under-estimated the importance of non-verbal communication. Now, having taken a step back I see that I am almost in the same boat as the patient suffering with dementia, we are both just “an individual attempting to communicate†(Hobson, 2012) and as a HCA the method of employing “feelings and emotions†should become more “significant than the spoken word†(Hobson, 2012).
Although my confidence in speaking to patients is always growing, I am more appreciative of how much more effective my body language, and the tone of my voice can be when communicating with a patient with dementia. Yes, looking after these patients can be a challenge but getting past the dementia and working in ways that compliment the patient’s mindset will be of more benefit to the patient. By spending some time reading each patient’s information leaflet I am able to help maintain a patient’s well being and create a more anxiety free environment for our patients.
