Title: Demonstrate basic principles of communicating with a cognitively impaired client.
Course: Medication Aide (14051-36) > Section: Preparing for Safe Administration of Medications

Demonstration should include

- the three components of communication (i.e., message, sender, receiver)
- positive communication
- good listening skills
- communication barriers (e.g., failure to listen)
- caregiver barriers
- the definition of cognitive impairment
- the causes of cognitive impairment (e.g., delirium, depression, dementia)
- the behaviors associated with Alzheimer’s disease and other types of dementia
- the definition of aphasia
- communication techniques to minimize behavior problems
- communication techniques with a cognitively impaired client:
  - Follow the plan of action regarding communication techniques that are effective for each client. This may be called the individualized service plan (ISP) or, in some facilities, the “Action Plan.”
  - Remember that what works for one client may not work for another; be flexible.
- communication techniques with an aphasic client:
  - Stand where the client can see you.
  - Look at the client the entire time.
  - Do not shout. Clients who cannot speak are not necessarily hearing-impaired and shouting may cause aggressive behavior. Speak clearly and enunciate carefully.
  - Do not rush the client.
  - Use writing pads, chalk boards or a communication board.
- behavior management techniques:
  - Identify the behavior and the cause using the ABC’s of behavior management:
    - Antecedent—What happens before the behavior?
    - Behavior—What is the behavior? Identify accurately.
    - Consequence—What happens as a result of the behavior?
  - tools for managing behavior:
    - Direct and redirect the behavior.
      - When the client is not achieving goals, direct them using such actions as cueing or mirroring.
      - When the client is doing something inappropriate or dangerous to self or others, redirect them to another action.

    - Ignore the behavior, when appropriate.
    - Increase personal tolerance for the behavior, especially with the dementia client.
- actions for managing the angry client
  - agitation
    - Listen closely and try to determine what triggered the behavior.
    - Watch the client’s body language for signs of escalating anger, such as

      - loss of eye contact
      - repetitive movement, wringing of the hands, clenched fists
      - increase in motor activity, such as frequent changes in position or pacing
      - change in tone of voice, repetitive sounds, crying, complaining.

    - Remain calm; think before speaking.
    - Leave the client alone if appropriate and allow them to calm down.
  - physical aggression
    - Avoid actions and issues that cause the client to become combative.
    - Call for assistance if the client loses control.
    - Back off when it is appropriate and allow the client time to settle down.
    - Keep yourself and others at a safe distance; protect yourself and the patient.
    - Stay calm; don’t threaten; never hit back.
  - When anger passes, talk with the client to try to understand and to provide comfort.

Process/Skill Questions:

- What communication strategies can an MA use during interaction with others?
- What specific methods can improve the cognition of a cognitively impaired client?
- What cognitive prompts are available in an ALF (e.g., clocks, calendars, daily activity, and menu schedules)?
- How would an MA respond to a 90-year-old client who is asking where her mother is?
- What are four alternative activities an MA could suggest for a confused client who is becoming agitated?