Breaking Down Language Barriers

Hello everyone,

If you’ve ever traveled to a foreign country where you don’t speak the language, you know how difficult it can be to get directions to a museum or order a meal.  Imagine how frightening and depressing it would if everyone around you spoke a different language, but instead of being on vacation, you were in your own home and needed to communicate more vital information, such as the fact that you were in pain or very confused.

Some of you have asked for tips on how staff can more effectively communicate with and engage residents who do not speak English. This can be challenging, especially with residents who have dementia. With some investment of time and extra effort, however, both staff and residents can benefit.

Here are some things to try:

If the resident has family or friends nearby, or if there is a staff member from the same culture who speaks the same language as the resident, they can be a valuable resource and can teach staff (and even other residents!) some basic phrases to use.

  • Create communication sheets or flashcards with simple phrases in the person’s language (Good morning, Please join us, Are you in pain?, etc.) and hang them in the resident’s room for staff to use.
  • Download a free translation application onto your phone to use when you or the resident have something important to communicate. There are apps that focus on medical terminology too.
  • Be mindful of body language. If a person cannot understand your words, they will rely on your body language and facial expression to help determine your intent. A smile and open stance can be a good start to help put the person at ease.
  • Take time to learn about the culture of the person, and invite family members to bring in food, music or activities from their culture to help entice the resident out of his/her room and get others—including staff and residents–involved.

Let us know if any of these suggestions help you, and have a great week!

 

Creating and evaluating the plan for managing behaviors- The DICE model in action

Hello everyone,

This week we’ll finish discussing the four steps of DICE. We hope you had a chance to discuss the “Describe” and “Investigate” parts with your staff, and are finding the process helpful as you work to assess and manage behaviors of your residents with dementia.

The “C” in DICE stands for “Create a Plan.” Once you have described the problem behavior and investigated and determined a probable cause of the behavior (see last week’s tidbit), then next step is to create a plan to address the behavior.

When creating a plan, keep in mind that interventions should be personalized and meaningful. An intervention for one resident may not work for another. In addition, an intervention that worked for a resident 3 months ago may no longer work for that same resident now.

Creating a plan takes in interdisciplinary team to ensure that all are on board with the plan, that it will be communicated to all necessary staff, and the team will work together to see it through.

Some tips when creating a plan of care to address a specific behavior:

  • Be innovative—brainstorm ideas with staff
  • Use what you know about the resident—causes/triggers of the behavior, resident abilities and preferences
  • Minimize environmental change—limit the number of caregivers and reward caregivers that work well with a resident; minimize room and roommate changes
  • Control the amount of stimulation—too little or too much can precipitate behaviors
  • Modify communication techniques—verbal cues, writing things down, communicating “face on”, repetition, role modeling, and providing a vicarious experience with the resident can all aid in communication
  • Enhance sensory experiences and the environment—music, dance, pleasing fragrances, favorite foods, tactile stimulation and supporting physical activity can all help with some challenging behaviors
  • Provide individualized care—be flexible when scheduling functional activities, anticipate challenges, distract, use creative explanations to prevent a catastrophic reaction and let the resident “do her own thing” when safe to do so

The final step—the “E”—is to “Evaluate the Plan.” Did the plan work?

  • Decide upon a time frame for re-evaluation.
  • Use objective instruments for target behaviors: Cohen Mansfield Agitation Inventory; Neuropsychiatric Inventory (short form or nursing home version); Cornell Scale for Depression in Dementia; Resistiveness to Care Scale
  • Review use of PRN medications
  • Listen to staff report

If the approach worked, continue with the plan of care. If not, go back to investigate other potential causes of the behavior and revise your plan.

Be on the lookout for another contest announcement in next week’s tidbit!

Have a great week!