The document describes a feasibility study that evaluated a dementia communication training intervention for pre-registration nurses based on the VERA framework. The 2.5 hour training included education on dementia, communication principles, and role-playing using the VERA approach. A controlled pre-post study across 7 hospitals found students who received the training showed improved person-centered responses, dementia competence, communication confidence, and knowledge compared to controls. Qualitative interviews found students applied VERA flexibly, used specific techniques like mirroring, and saw it as a useful toolkit. The study demonstrated the training was feasible but more evidence is needed on its impact on behavior.

1. Dementia communication skills
for pre-registration nurses:
A feasibility study
Dr. Corina Naughton, Chloe Beard, Dr Vasiliki Tzouvara, Dr
Rebecca Verity, Rhiannon Eley, Anne Pegram, Carol Fordham-
Clarke, Nicky Hayes, Dr. David Hingley

2. Evidence, evidence, evidence
Alzheimer’s Society (2014) Dementia UK: Update, 2nd ed. [online] Available
from:http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=2323 [Accessed: 14 February
2015]
Alushi L,. Hammond J, Wood J. (2015) Evaluation of dementia education programs for pre-registration
healthcare students—A review of the literature Nurse Education Today 35 (2015) 992–998.
Bate P. and Robert G. (2006) Experience-based design: from redesigning the system around the
patient to co-designing services with the patient. Quality Safety in Health Care 2006;15:307-310
Ballard V. (2005) Exploring the knowledge, understanding and implications for care of adult nurses in
hospital wards working with patients who present with dementia as a secondary condition. Keele
University, Unpublished master’s dissertation.
Barter C. & Renold E. (2000) ‘I wanna tell you a story’: Exploring the application of vignettes in qualitative
research with children and young people. International Journal of Social Research Methodology 3(4), 307-
323.
Blackhall A., Hawkes D., Hingley D. & Wood S. (2011) VERA framework: communicating with people who
have dementia. Nursing Standard 26 (10), 35-39.
Bridges J. Flatley M. and Meyer J. ( 2010 ) Older people’s and relatives’ experiences in acute care settings:
Systematic review and synthesis of qualitative studies. International Journal of Nursing Studies, 47, 89–
107
Braun, V., and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology,
3(2) 77-101.
Brown, J., Nolan, M., Davies, S., Nolan, J. and Keady, J. (2008) Transforming students’ views of
gerontological nursing: realising the potential of ‘enriched’ environments of learning and care: a
multimethod longitudinal study, International Journal of Nursing Studies, 45, 1214-1232.
Brooker D, La Fontaine J, Evans S, Bray J, Saad K (2014)
public health guidance to facilitate timely diagnosis of dementia: ALzheimer's COoperative Valuation in Eur
ope recommendations. Int J Geriatr Psychiatry. 29(7):682-93. doi: 10.1002/gps.4066
Burbank P.M., Dowling-Castronova A., Crowther M.R. & Capezuti E.A. (2006) Improving knowledge and
attitudes toward older adults through innovative educational strategies. Journal of ProfessionalNursing 22,
91–97.
There is a
problem
Poor
standards of
care
Poor care
experience
Inadequate training
Inadequate
staffing
Students & early
career nurses:
‘I like older people, I
just don’t want to
nurse them’
Emotional
& physical
burden
Neglect

3. Older adult placement
What do I
do if she
becomes
aggressive?
How do I
get
through to
her?
She won’t
eat, won’t
drink
She
keeps
asking
to go
home?
Head Down I’ll get
through this !!!!

4. Case Vignettes Quiz
How would you respond?
Caroline Evans is an 86 year old retired school principal. She lives with her husband Reg, they
have no children. Caroline was diagnosed with dementia 5 years ago and Reg is her main
carer. Caroline is in hospital. During the day Caroline is settled but when Reg leaves in the
evening she becomes extremely anxious and rarely sleeps.
It's 1 am in the morning and you hear Caroline shouting at another lady in her
bay. When you get to Caroline she is shaking and repeatedly saying "it's not fair
on the children".
a) Mrs Evans, it's 1 am in the morning, please stop shouting and go back to sleep.
b) You're upsetting the other patients, please calm down and we can talk about
what's worrying you in the morning.
c) Caroline, I spoke to Reg, he said the children are fine and for you to go back to
sleep.
d) Caroline, I can see you're upset. What's worrying you about the children?
2. Caroline walks back to her bedside and sits in her chair. She is restless and is
playing with her cannula which was inserted for IV fluid administration.
a) Caroline I have some papers that need to be marked, I wondered if you could
help me?
b) You have to look after that (the cannula) for me Caroline. That is your job for
tonight.
c) I'm going to bandage up your arm, so you can go to sleep. Reg will be in in the
morning to see you.
d)Caroline, please stop pulling at the needle in your arm, you will hurt yourself.

5. Dementia Education Curricula
Standards (HEE)
• 10 Principles; 3 level of Competency
• Level 1 awareness; Level 2 Frequent contact; Level 3 Extensive
contact;
• Principle 2: Communication
• Level 1
• Demonstrate basic principles of good
communication-to improve self worth, not feel ill at
ease
• Support individuals with communication
• Level 2
• Support person to express views, warm and genuine
relationships
• Demonstrate knowledge , understanding &
application of effective communication strategies

6. Pre-registration Dementia
Communication training
Alushi L,. Hammond J, Wood J. (2015) Evaluation of
dementia education programs for pre-registration
healthcare students—A review of the literature Nurse
Education Today 35 (2015) 992–998.
• 9 studies
• No standardised training intervention
• No RCT- poor methodological quality
• Weak theoretical evidence-base for training
components
• Difficult to deliver at scale
• No evidence of impacts on student behaviour
• No evaluation of impact on patients

7. VERA Framework
•Validation- accept person’s reality
•Emotion- acknowledge emotion
•Reassurance- you are here to help
•Activity – meaningful distraction
Blackhall A., Hawkes D., Hingley D. & Wood S. (2011) VERA framework:
communicating with people who have dementia. Nursing Standard 26 (10), 35-
39.
VERA framework Caring for People with Dementia
https://www.youtube.com/watch?v=craoo582xm0

8. VERA in Action
I want to go home, why
won’t you let me out of
here? I have to pick up
my kids from School,
you are not listening to
me, I don’t want water,
I have to pick up my
children
Rita,
you need to go home?
I can see you are worried, the
children are at School and you
need to pick them up?
Of course you are worried about
them!
Let me try and help you.
Did you always pick up the kids?
What did you do together once
you picked the kids up?
What was their favourite thing to
do after School?
Reframing Rita’s call for
help
• An unmet need
• Your role is to detect
what the physical or
emotional need is?

9. Dementia training intervention
Designed with help from people with dementia &
students
2.5 hours face-to-face
• Small group session (3-12)
• Start of older adult placement
• Start with Emotions*
• feelings about placement, dementia
• Overview of dementia
• Communication principles
• Reality orientations vs Validation
• VERA principles
• Practice
• techniques: mirroring, matching,
rephrasing, redirecting
• distraction activities- reminiscence, 2 min
chat
• Demonstrate (poor & good communication)
• Students Role-play/rehearse
• Role scripts & VERA prompts
• Reflection & Discussion
• Personal resilience
• When it may not work
• Barriers to use
• Commitment to try
Follow-up in practice by Link lecturer
Student Manual
First line of text/heading/intro would go here, remove
bullet (indent x0)
Second line of text would go here (remove
bullet, indent x1)
• First level bullet point (indent x2)
• Second level bullet point (indent x3)
• Third level bullet point (indent x4)
Naughton et al 2018, A feasibility study of dementia communication training based
on the VERA framework for pre-registration nursesthe intervention. Nurse Education
Today; 63:87-93.

10. Study Design
• Control pre-post design, 7 hospitals
Research hypothesis:
Students receiving dementia communication training plus OA
placement (intervention)would have improved recognition
person-centred communication opportunities & confidence
compared to students on older adult placement alone (control)
Eligible population
• Adult Nursing students (BSc and PG Dip) allocated to older adult units
(April 2016 and December 2016)
• 7 London hospitals (2 intervention and 5 control sites)
• 130 eligible students (66 in the control and 64 in the intervention group.
• Mix-methodology evaluation
• Electronic survey
• Case vignettes- person centred response (Crombach’s alpha 8.0)
• Sense of Dementia Competency (Cb a 0.91)
• Dementia communication confidence (Cb a 0.87)
• Dementia knowledge (0.55)
• Focus group interviews

11. Impact of VERA training
7.5
53
27
6.1
10.5
55
27
6.4
0
10
20
30
40
50
60
Person Centred
responses (max 14)
Dementia Sense of
Compedence (max
68)
Dementia
communciation
confidence (max 35)
Dementia knowledge
(max 10)
Instrumentscores
Control n=14
Intervention
(n=38)
p-0.006
40%
response rate

12. Impact of older adult
placement
8.5
43
19.5
6.5
9.8
54
27
6.3
0
10
20
30
40
50
60
Person Centred
responses (max 14)
Dementia Sense of
Compedence (max
68)
Dementia
Communciation
Confidence (max 35)
Dementia Knowledge
(max 10)
Baseline n=70
Post placement
(n=60)

13. Qualitative focus groups
(n=19)
Connecting
with the
person
VERA
in
Practice
Communication
challenges
Learning
environment

14. Connecting with the Person
F3 group 1 Yeah, it’s so
important to build that
relationship because they’re so
terrified already, they don’t
know what’s going on
Affirming
F1 group 2: “So we kind of redirected the
conversation towards, ‘Well, I’m writing some
reports. I know you used to write lots of reports
[patient was a former teacher] ,’ and then it led on
to a discussion about her work and my work so we
kind of distracted her away from her worries at that
moment and got her to talk about herself, which
was really good”.A
Non-Affirming
F4 group 1: “She was just saying really random things and she
started getting really aggressive and as much as I tried to stay calm
and change my tone of voice and go with whatever she was saying
and not going with the reality orientation approach, it just wasn’t
helping. It wasn’t helping the situation, so I ended up having to get a
nurse and I just felt really helpless basically”.

15. VERA in Practice
• Flexible Approach
‘I have tried to just think, ‘Oh yeah, I can use VERA’ and go through
each thing but it doesn’t quite work. Like sometimes, you’ll just
approach it in your own way and you think, ‘Oh yeah, I am using
VERA.’
• Specific Techniques
I’ve done the mirroring quite a few times. Especially with the
patient we’re talking about. Sometimes she’s lost her bag or
something so I’m like, ‘Oh no, you’ve lost your bag!’
Activities was the least likely to be described by students
beyond conversation few other examples, not helped by lack
of materials on units
• Building Toolkit
I think, with VERA, it’s nice to know that you always have a
backup plan. So if what you’re doing isn’t working, you
think, ‘Okay, I can try VERA.’
But it does not work in all situations- need for more training

16. Qualitative focus groups
(n=19)
Connecting
with the
person
VERA
in
Practice
Communication
challenges
Learning
environment

17. Reflections
Public & people with dementia believe we
already teach students these skills!
• ‘I am shocked to learn that the majority of health care trainees do not
receive specialised training in communicating with PWD’.
• ‘An excellent idea! I am pretty shocked that this doesn't happen
already, but having seen my mum's GP trying and failing to ask her
"what was wrong and was she ill" several times, I think education is
long overdue!’
VERA is foundation level (1 or 2nd year)– build
more complex scenarios in 3rd & 4th year
NO EVIDENCE IT CHANGES BEHAVIOUR
More Research- but who funds?
’
‘

18. Conclusion
• Feasible ?scalable
• Foundation level
• Further Evidence
•‘’
Please do it; you don’t try to change
my world, they are in my world
it’s comforting to me, to know that
there is something there like this

19. Quiz: which response
Caroline Evans is an 86 year old retired school principle. She lives with her husband Reg, they
have no children.
1) It's 1 am in the morning and you hear Caroline shouting at another lady in her
bay. When you get to Caroline she is shaking and repeatedly saying "it's not fair
on the children".
How would you respond?
a) Mrs Evans, it's 1 am in the morning, please stop shouting and go back to sleep.
b) You're upsetting the other patients, please calm down and we can talk about
what's worrying you in the morning.
c) Caroline, I spoke to Reg, he said the children are fine and for you to go back to
sleep.
d) Caroline, I can see you're upset. What's worrying you about the children?
2. Caroline walks back to her bedside and sits in her chair. She is restless and is
playing with her cannula which was inserted for IV fluid administration.
How would you respond?
a) Caroline I have some papers that need to be marked, I wondered if you could
help me?
b) You have to look after that (the cannula) for me Caroline. That is your job for
tonight.
c) I'm going to bandage up your arm, so you can go to sleep. Reg will be in in the
morning to see you.
d)Caroline, please stop pulling at the needle in your arm, you will hurt yourself.