Exploring communication strategies for the facilitation of person-centred care: A comparison of three methods for analysis
Issue: Vol 8 No. 2 (2017) .
Subject Areas: Linguistics
This method study compares the results yielded by using three different methods of examining how communication strategies may facilitate person-centred care in longterm residential care. The analysis involved two quantitative coding systems, which rated language-based and person-centred communication strategies, and a qualitative analysis based on Conversation Analysis. The data consisted of a video-recorded conversation that took place between an enrolled nurse and a resident with dementia in a long-term residential care facility in western Sweden. The qualitative analysis sheds light on several shortcomings in the two quantitative coding systems. Although both coding systems revealed that the enrolled nurse used many facilitating strategies, only one of the systems captured problems in the interaction. The conclusion of this study is that context as well as paralinguistic aspects in communication should be considered in the development and use of quantitative coding systems.
Author: Emma Forsgren, Charlotta Saldert
Allwood, J., Traum, D. and Jokinen, K. (2000). Cooperation, dialogue and ethics. International Journal of Human-Computer Studies 53 (6): 871–914. https://doi.org/10.1006/ijhc.2000.0425
Antaki, C. (2013). Two conversational practices for encouraging adults with intellectual disabilities to reflect on their activities. Journal of Intellectual Disability Research 57 (6): 580–588. https://doi.org/10.1111/j.1365-2788.2012.01572.x
Atkinson, J. M. and Heritage, J. (1984). Structures of Social Action: Studies in Conversation Analysis. Studies in Emotion and Social Interaction. Cambridge: Cambridge University Press.
Atkinson, J. M. and Heritage, J. (1999). Structures of social action: Studies in conversation analysis. Aphasiology 13 (4–5): 243–249. https://doi.org/10.1080/026870399402073
Bayles, K. A. (1985). Communication in dementia. In H. K. Ulatowska (Ed.) The Aging Brain: Communication in the Elderly, 157–173. London: Taylor and Francis.
Beeke, S., Maxim, J., and Wilkinson, R. (2007). Using Conversation Analysis to assess and treat people with aphasia. Seminars in Speech and Language 28 (2): 136–147. https://doi.org/10.1055/s-2007-970571
Brooker, D. and Surr, C. (2005). Dementia Care Mapping: Principles and Practice. Bradford: Bradford Dementia Group, University of Bradford.
Burke, C., Stein-Parbury, J., Luscombe, G., and Chenoweth, L. (2016) Development and Testing of the Person-Centered Environment and Care Assessment Tool (PCECAT), Clinical Gerontologist 39 (4): 282–306. https://doi.org/10.1080/07317115.2016.1172532
Chappel, N. L., Reid, R. C. and Gish, J. A. (2007). Staff-based measures of individualized care for persons with dementia in long-term care facilities. Dementia, 6 (4): 527–547.
Charles, C., Gafni, A., and Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science and Medicine 44: 681–692. https://doi.org/10.1016/S0277-9536(96)00221-3
Chatwin, J. (2014). Conversation analysis as a method for investigating interaction in care home environments. Dementia 13 (6): 737–746. https://doi.org/10.1177/1471301213485231
Clark, C. M. and Ewbank, D. C. (1996). Performance of the dementia severity rating scale: A caregiver questionnaire for rating severity in Alzheimer Disease. Alzheimer Disease and Associated Disorders 10 (1): 31–39. https://doi.org/10.1097/00002093-199601010-00006
Douglas, J. M., Bracy, C. A. and Snow, P. C. (2007). Measuring perceived communicative ability after traumatic brain injury: Reliability and validity of the La Trobe communication questionnaire. Journal of Head Trauma Rehabilitation 22 (1): 31–38. https://doi.org/10.1097/00001199-200701000-00004
Edvardsson, D. and Innes, A. (2010). Measuring person-centered care: A critical comparative review of published tools. The Gerontologist 50 (6): 834–846. https://doi.org/10.1093/geront/gnq047
Edvardsson, D., Fetherstonhaugh, D., Gibson, S., and Nay, R. (2010). Development and initial testing of the person-centered care assessment tool (P-CAT). International Psychogeriatrics 22 (1): 101–108. https://doi.org/10.1017/S1041610209990688
Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., Stigbrant Sunnerhagen, K. (2011). Person-centered care: Ready for prime time. European Journal of Cardiovascular Nursing 10 (4): 248–251. https://doi.org/10.1016/j.ejcnurse.2011.06.008
Forsgren, E., Hartelius, L., and Saldert, C. (2016) Improving medical students’ knowledge and skill in communicating with people with acquired communication disorders. International Journal of Speech-Language Pathology Published online 31 August. https://doi.org/10.1080/17549507.2016.1216602
Forsgren, E. and Saldert, C. (2017). Implementation of communication routines facilitating person-centred care in long-term residential care facilities. Manuscript submitted for publication.
Goodwin, C. (2003). Conversation and Brain Damage. New York: Oxford University Press.
Grosch, K., Medvene, L., and Wolcott, H. (2008) Person-centered caregiving instruction for geriatric nursing assistant students: Development and evaluation. Journal of Gerontological Nursing 34 (8): 23–31. https://doi.org/10.3928/00989134-20080801-07
Guendouzi, J. and Müller, N. (2006). Approaches to Discourse in Dementia. Mahwah, NJ: Lawrence Erlbaum Associates.
Gumperz, J. (1992). Contextualization revisited. In P. Auer and A. di Luzo (Ed.) The Contextualization of Language, 39–53. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.22.04gum
Jansson, G. and Plejert, C. (2014). Taking a shower: Managing a potentially imposing activity in dementia care. Journal of Interactional Research and Communication Disorders, 5 (1): 27–62. https://doi.org/10.1558/jircd.v5i1.27
Jansson, G., Wadensjö, C., and Plejert, C. (2017). Managing complaints in multilingual care encounters. Multilingua 36 (3): 313–345. https://doi.org/10.1515/multi-2016-0043
Kim, H. and Woods, D. L. (2012). The development of direct-care staff social interaction coding schemas for nursing home residents with dementia. Geriatric Nursing, 33 (2): 113–17. https://doi.org/10.1016/j.gerinurse.2012.01.002
Kitwood, T. M. (1997). Dementia Reconsidered: The Person Comes First. Buckingham; Bristol, PA: Open University Press.
Lann-Wolcott, H., Medvene, L. J., and Williams, K. (2011) Measuring the personcenteredness of caregivers working with nursing home residents with dementia. Behavior Therapy 42 (1): 89–99. https://doi.org/10.1016/j.beth.2010.02.005
Mabire, J-B., Gay, M-C., Vrignaud, P., Garitte, C., and Vernooij-Dassen, M. (2016). Social interactions between people with dementia: Pilot evaluation of an observational instrument in a nursing home. International Psychogeriatrics 28 (6): 1005–1015. https://doi.org/10.1017/S1041610215002483
McCormack, B. and McCance, T.V. (2006). Development of a framework for personcentred nursing. Journal of Advanced Nursing 56 (5): 472–479. https://doi.org/10.1111/j.1365-2648.2006.04042.x
Mead, N. and Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science and Medicine 51 (7): 1087–1110. https://doi.org/10.1016/S0277-9536(00)00098-8
Medvene, L. J. and Lann-Wolcott, H. (2010) An exploratory study of nurse aides’ communication behaviours: Giving ‘positive regard’ as a strategy. International Journal of Older People Nursing 5 (1): 41–50. https://doi.org/10.1111/j.1748-3743.2009.00183.x
Mentis, M., Briggs-Whittaker, J., and Gramigna, G. D. (1995). Discourse topic management in senile dementia of the Alzheimer’s type. Journal of Speech and Hearing Research, 38 (5): 1054–1066. https://doi.org/10.1044/jshr.3805.1054
Müller, N. and Guendouzi, J. A. (2005). Order and disorder in conversation: Encounters with dementia of the Alzheimer’s type. Clinical Linguistics and Phonetics 19 (5): 393–404. https://doi.org/10.1080/02699200400027213
Müller, N. and Wilson, B. T. (2008) Collaborative role construction in a conversation with dementia: An application of systemic functional linguistics. Clinical Linguistics and Phonetics 22 (10–11): 767–774. https://doi.org/10.1080/02699200801948488
Plejert, C., Lindholm, C., and Schrauf, R. W. (2017). Multilingual Interaction and Dementia. Bristol: Multilingual Matters.
Rogers, C. R. (1949). The attitude and orientation of the counsellor in client-centrered care. Journal of Consulting Psychology 13 (2): 82–94. https://doi.org/10.1037/h0059730
Ryan, E. B., Hummert, M. L. and Boich, L. H. (1995). Communication predicaments of aging: Patronising behaviour toward older adults. Journal of Language and Social Psychology 14 (1–2): 144–166. https://doi.org/10.1177/0261927X95141008
Sabat, S. R. (1991). Turn-taking, turn-giving, and Alzheimer’s disease: A case study of conversation. The Georgetown Journal of Languages and Linguistics 2 (2): 161–175.
Savundranayagam, M. Y. (2014). Missed opportunities for person-centered communication: Implications for staff-resident interactions in long-term care. International Psychogeriatrics 26 (4): 645–655. https://doi.org/10.1017/S1041610213002093
Savundranayagam, M. Y. and Moore-Nielsen, K. (2015). Language-based communication strategies that support person-cantered communication with persons with dementia International Psychogeriatrics 27 (10): 1707–1718. https://doi.org/10.1017/S1041610215000903
Savundranayagam, M. Y., Sibalija, J. and Scotchmer, E. (2016). Resident reactions to person-centered communication by long-term care staff. American Journal of Alzheimer’s Disease and Other Dementias 31 (6): 530–537. https://doi.org/10.1177/1533317515622291
Schegloff, E. A. (1993). Reflections on quantification in the study of conversation. Research on Language and Social Interaction 26 (1): 99–128. https://doi.org/10.1207/s15327973rlsi2601_5
Schiffrin, D. (1988). Conversation analysis. In F. L. Neumayer (Ed.), Linguistics: The Cambridge Survey IV. Language: The Sociocultural Context, 251–276. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511620577.015
Small, J., Chan, S. M., Drance, E., Globerman, J., Hulko, W., O´Connor, D. … Ho, L. (2015). Verbal and nonverbal indicators of quality of communication between care staff and residents in ethnoculturally and linguistically diverse long-term care settings. Journal of Cross Cultural Gerontology 30 (3): 285–304. https://doi.org/10.1007/s10823-015-9269-6
Small, J. and Perry, J. (2005). Do you remember? How caregivers question their spouses who have Alzheimer’s disease and the impact on communication. Journal of Speech, Language, and Hearing Research 48 (1): 125–136. https://doi.org/10.1044/1092-4388(2005/010)
Söderlund, M., Cronqvist, A., Norberg, A., Ternestedt, B-M., and Hansebo, G. (2016). Conversations between persons with dementia disease living in nursing homes and nurses – qualitative evaluation of an intervention with the validation method. Scandinavian Journal of Caring Sciences 30 (1): 37–47. https://doi.org/10.1111/scs.12219
Tappen, R., Williams-Burgess, C., Edelstein, J., Touhy, T., and Fishman, S. (1997). Communicating with individuals with Alzheimer’s disease: Examination of recommended strategies. Archives of Psychiatric Nursing XI (5): 249–256. https://doi.org/10.1016/S0883-9417(97)80015-5
Ten Have, P. (2010). Doing Conversation Analysis: A Practical Guide (2nd ed.). London, California, New Delhi, Singapore: SAGE Publications Ltd.
Wang, J-J., Hsieh, P-F., and Wang, C-J. (2013). Long-term care nurses’ communication difficulties with people living with dementia in Taiwan. Asian Nursing Research 7 (3): 99–103. https://doi.org/10.1016/j.anr.2013.06.001
Ward, R., Vass, A. A., Aggarwal, N., Garfield, C. and Cybyk, B. (2008). A different story: Exploring patterns of communication in residential care. Ageing and Society 28 (5): 629–651. https://doi.org/10.1017/S0144686X07006927
Watson, C. M., Chenery, H. J. and Carter, M. S. (1999). An analysis of trouble and repair in the natural conversations of people with dementia of the Alzheimer’s type. Aphasiology 13 (3): 195–218. https://doi.org/10.1080/026870399402181
White, D. L., Newton-Curtis, L. and Lyons, K. S. (2008). Development and initial testing of a measure of person-centred care. The Gerontologist 48, Special Issue I: 114–23. https://doi.org/10.1093/geront/48.Supplement_1.114
Wilkinson, R. (2014) Intervening with conversation analysis in speech and language therapy: Improving aphasic conversation. Research on Language and Social Interaction 47 (3): 219–238. https://doi.org/10.1080/08351813.2014.925659
Wilkinson, R. (1999). Introduction. Aphasiology 13 (4–5): 251–258. https://doi.org/10.1080/026870399402082
Williams, K. N., Kemper, S., and Hummert, M. L. (2003). Improving nursing home communication: An intervention to reduce elderspeak. The Gerontologist 43 (2): 242–247. https://doi.org/10.1093/geront/43.2.242
Williams, K. N., Herman, R., Gajewski, B., and Wilson, K. (2009). Elderspeak communication: Impact on dementia care. American Journal of Alzheimer’s Disease and Other Dementias 24 (1): 11–20. https://doi.org/10.1177/1533317508318472
Williams, K., Harris, B., Lueger, A., Ward, K., Wassmer, R., and Weber, A. (2011). Visual cues for person-centered communication. Clinical Nursing Research 20 (4): 448–461. https://doi.org/10.1177/1054773811416866
Williams, K. N., Boyle, D. K., Herman, R. E., Coleman, C. K. and Hummert, M. L. (2012). Psychometric analysis of the emotional tone rating scale: A measure of person-centered communication. Clinical Gerontologist 35 (5): 376–89. https://doi.org/10.1080/07317115.2012.702648
Wilson, R., Rochon, E., Mihailidis, A., and Leonard, C. (2012). Examining success of communication
strategies used by formal caregivers assisting individuals with Alzheimer’s Disease during an activity of daily living. Journal of Speech, Language, and Hearing Research 55 (2): 328–341. https://doi.org/10.1044/1092-4388(2011/10-0206)