1. COMMUNICATION
WORSHOPS FOR Evidenced-
CAREGIVERS OF Based Nursing
Practice
PATIENTS WITH
DEMENTIA

2. EVIDENCED-BASED NURSING PRACTICE
University of Wisconsin, Green Bay
Lorene Jaggi
December 12, 2011

3. INTRODUCTION
Dementia is a complicated and involved disease
process that includes behavioral changes and
impaired language skills. As a result, it can make
communication difficult.
Some caregivers may be familiar with good
communication techniques but may not know how to
use them efficiently in practice.
According to studies, ineffective communication can
lead to high levels of expressed emotion, agitated
behavior, loss of companionship, support from loved
ones and eventually burn out.

4. ABSTRACT
 If caregivers were able to learn at the very
beginning of the disease process what to expect
(signs and symptoms) according to the diagnosis
(type of dementia), they would be better prepared for
what would be waiting ahead.
 Communicating with someone with dementia is not
an easy task and needs to be learned in order to
avoid frustration and psychological morbidity as well
as delaying institutionalization of the dementing
person.

5. EVIDENCED-BASED PRACTICE PICO
QUESTION
 Can kin caregivers of patients with dementia
lessen their stress level as well as enhance
the quality of their relationship with their
loved ones by improving their communication
skills compared to caregivers that lack
effective communication skills?

6. REVIEWED RESEARCH ARTICLES
 Article: Optimal management of Alzheimer’s disease
patients: Clinical guidelines and family advice.
(Haberstroh, Hampel & Pantel, 2010)
 Purpose: To review current and internationally relevant
guidelines to the given recommendations concerning
caregivers and family advice.
 Design: Systematic review
 Subjects and sample size: Sample =125 unique articles
published in English within the last five years describing
clinical guidelines for the treatment of patients with AD.
 Method: Quota sampling method.

7. REVIEWED RESEARCH ARTICLES (CONT.)
Results:
 All of the considered guidelines agreed on the potentially
positive ef fects of family advice on dementia patients and
their family caregivers with medium range levels of evidence .
 Guidelines are often not applied in practice due to the lack of
practitioners with special skills. For example, leading a
psychoeducational training group.
 There is a clear need for research that addresses the
implementation part of the clinical guidelines and evidence -
based interventions in order to improve the management of
patients with AD and their family caregivers.

8. REVIEWED RESEARCH ARTICLES (CONT.)
 Ar ticle: Training in communication skills for informal carers
of people suf fering from dementia: a cluster randomized
clinical trial comparing a therapist led workshop and a
booklet. (Done & Thomas, 2001).
 Purpose: The objective of the study was to evaluate whether a
short training workshop in communication techniques is more
ef fective than an information booklet for improving
communication skills in informal carers of people suf fering
from dementia.
 Design: Cluster randomized trial
 Subjects and sample size: N= 45 participants informal
caregivers sharing specifics characteristics.
 Method: Weighted block randomization.

9. REVIEWED RESEARCH ARTICLES (CONT.)
Results:
 This studies concluded that the workshops were valuable
when used at an early stage of the disease process when
verbal communication occurred frequently as opposed to late
stage of the disease.
 Outcome measures to specific issues to training targets
showed clear benefits as opposed to general measures
outcome such as quality of life and stress .
 After 6 weeks, caregivers following the workshop
demonstrated a significantly greater awareness of
communication strategies than the booklet -only caregiver
group. However, both strategies (booklet and workshop)
improved communication techniques.

10. REVIEWED RESEARCH ARTICLES (CONT.)
 Ar ticle: Communicating with persons with A lzheimer's
disease: experiences of family and formal caregivers.
(Bottenberg, Richter & Roberto, 1995)
 Purpose: Examined the communication processes used by
caregivers in managing behavioral problems that commonly
occur when caring for persons with Alzheimer's disease, to
identify successful communication strategies.
 Design: Descriptive comparative
 Subjects and sample size: Two groups of participants: 23
family informal caregivers and 22 certified nursing assistant
caregivers.
 Method: Purposive sampling.

11. REVIEWED RESEARCH ARTICLES (CONT.)
Results:
 Strategies of fered by family and formal caregivers for
communication with persons with Alzheimer's disease (AD)
suggest that strategies must be individualized as strategies
can change and are not applicable for every individual with AD.
 The need to communicate continues throughout the course of
the disease.
 Many of the caregivers don't have the training necessary to
understand and take care of AD clients, which leads to a high
turnover of healthcare personal in long -term facilities. As a
result, there is a need for formal training programs to improve
communication and care of persons with AD and other forms of
dementia.

12. “KOTTER’S PHASES OF CHANGE MODEL”
 Establish Urgency
 Create Coalition
 Develop Vision
 Communicate Vision
 Empower Action
 Generate Short-Term Wins
 Consolidate Gains/Produce More
 Anchor Approaches (Schmidt & Brown, 2009)

13. INNOVATION TO BE IMPLEMENTED
 Speech/language therapist led workshop
for caregivers of Alzheimer patients will be
implemented.

14. STAKEHOLDERS IDENTIFIED
 Caregivers of Alzheimer patients.
 Family members
 Speech language therapist
 Experts in old age psychiatry, geriatric
medicine and clinical psychology
 Nurses

15. POLICY AND PROCEDURES IDENTIFIED
AS NEEDED OR UPDATED
 Clinical Practice Guidelines for Alzheimer’s
disease and Related Dementia: as soon as a
diagnosis of dementia is obtained, caregivers
and loved ones would have the possibility of
following a therapist led workshop in order to
understand and learn how to communicate
effectively with their loved ones.

16. NATIONAL GUIDELINE CLEARINGHOUSE
 Major Recommendations: Support and Interventions for the
Caregivers of People with Dementia: “Care plans for caregivers
of people with dementia should involve a range of tailored
inter ventions. These may consist of multiple components
including:
 Individual or group psychoeducation.
 Peer-support groups with other caregivers, tailored to the needs
of individuals depending on the stage of dementia of the person
being cared for and other characteristics
 Support and information by telephone and online
 Training courses about dementia, services and benefits, and
communication and problem solving in the care of people with
dementia
 Involvement of other family members as well as the primary
caregiver in family meetings.” (NGC, 2011)

17. “KOTTER’S PHASES OF CHANGE MODEL”
Student Name __Lorene Jaggi_________________________
Project Name Establish Create Develop Communicate Empower Generate Consolidate Anchor
Urgency Coalition Vision Vision Action Short- Gains/Produce Approaches
term More
Wins
Pilot: Develop a Assemble How does Develop a Team Survey Expand pilot Evaluation
Speech/language Power Team: this affect: Powerpoint work: available to additional monthly of
therapist led Point Speech Caregivers of showing speech for clinics and caregivers
workshop for presentation language Alzheimer procedures to therapist caregivers hospitals after satisfaction
caregivers of as well as a therapist, patients, follow after with and 3 months. of the
Alzheimer training experts in family the diagnoses nurses family workshop
patients will be manual and old age members, of Alzeihmer for the member by speech
implemented. other psychiatry patients, has been. first day to therapist
materials and support staff Training of pilot. evaluate and trained
supplied. geriatric and nurses. manuals. Audio- the nurses.
medicine, Quality of Educational taping or usefulness Caregivers
clinical life. forum. video- of the stress test
psychology, Psychological taping sessions scale after a
and nurses. well-being. group as well as month of
sessions the worshop.
and using instructor
training of the
manuals workshop.
for the
first
month of
the pilot.

18. REFERENCES
 Bottenberg D. J., Richter J. M., Roberto K. A . (1995).
Communicating with persons with A lzheimer's disease:
experiences of family and formal caregivers. Archives of
Psychiatric Nursing, 9 279-285.
 Done D. J., Thomas J. A . (2001). Training in communication
skills for informal carers of people suf fering from dementia: a
cluster randomized clinical trial comparing a therapist led
workshop and a booklet. International Journal of Geriatric
Psychiatr y, 16 816-821.

19. REFERENCES (CONT.)
 Haberstroh J., Hampel H., Pantel J. (2010). Optimal
management of Alzheimer’s disease patients: Clinical
guidelines and family advice. Neuropsychiatric Disease and
Treatment Dove Press Journal, 6 243-253.
 National Guidelines Clearinghouse (NGC). (2011). U.S.
Department of Health & Human Services. Guideline Summary.
Retrieved from
http://www.guidelines.gov/content.aspx?id=10178&search= d
ementia
 Schmidt, N. A ., & Brown, J. M. (2009). Evidence-based
practice for nurses: Appraisal and
application of research. Sudbury, MA: Jones and Bartlett.