Deanne J. O'Rourke RN, MN, Doctoral Candidate
1| Michelle M. Lobchuk RN, PhD, Associate Professor
1| Genevieve N. Thompson RN, PhD, Associate Professor
1| Christina Lengyel RD, PhD, Associate Professor
21Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
2Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Correspondence
Deanne J. O'Rourke, Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.
Email: [email protected]
Abstract
Aim: A discussion of the use of video feedback as an effective and feasible method
to promote person-centred communication approaches within dementia care and long-term care.
Background: Effective strategies to integrate person-centred approaches into health
care settings have attracted global attention and research in the past two decades.
Video feedback has emerged as technique to enhance reflective learning and person-centred practice change in some care settings; however, it has not been tested in the context of person-centred dementia communication in long-term care.
Design: Discussion paper.
Data Sources: Articles dating from 1995 to 2018 retrieved via searches of the
SCOPUS, CINAHL, MEDLINE and Cochrane Systematic Review databases.
Implications for Nursing: Inclusion of video feedback in a person-centred dementia
communication intervention for nurses and other health care providers may effectively fill a gap evident in the literature. This intervention can offer feedback of enhanced quality and enduring impact on behaviour change relative to traditional training.
Conclusion: A critical review of empirical and theoretical evidence supports video
feedback as a potential means to enhance person-centred communication within the context of dementia and long-term care. The promising benefits of video feedback present a novel research opportunity to pilot its use to enhance person-centred com-munication between nurses/health care providers and persons with dementia in long-term care.
K E Y W O R D S
communication, dementia, feedback, long-term care, nursing education, nursing practice, patient-centred care, video recording
S U M M A R Y S T A T E M E N T
What is already known about this topic?
• Promoting a shift away from task-oriented interactions to foster a relational focus can transform person-centred care approaches for residents in long-term care and dementia care settings.
• Evidence suggests that video feedback is an effective approach to enhance health care providers' person-centred communication approaches with persons served.
• Video feedback has not yet been applied nor tested in the context of improving nurses' or health care providers' person-centred dementia communication skills within long-term care.
Received: 19 April 2019 Revised: 27 July 2019 Accepted: 6 January 2020 DOI: 10.1111/ijn.12820
Int J Nurs Pract. 2020;e12820. wileyonlinelibrary.com/journal/ijn © 2020 John Wiley & Sons Australia, Ltd 1 of 10 https://doi.org/10.1111/ijn.12820
What this paper adds?
• A critical review of empirical and theoretical evidence to support video feedback as a means to enhance the elements of person-centred communication within the context of dementia and long-term care.
• Video feedback is a novel approach that may effectively fill a gap evident in current person-centred dementia communication inter-ventions and strategies for long-term care nurses and health care providers.
The implications of this paper:
• A research opportunity exists to pilot the use and feasibility of video feedback to enhance person-centred communication between nurses/health care providers and individuals with demen-tia in long-term care.
• Video feedback may enhance reflective learning and sustained person-centred communication behaviour in comparison to tradi-tional forms of training.
1 | I N T R O D U C T I O N
Globally, a desired philosophical shift towards a health care approach that is person centred and relationally situated (Brooker, 2004, 2007;
Harding, Wait, & Scrutton, 2015; Kitwood, 1997) has challenged nurse educators, practitioners, and researchers to find effective strategies to translate these concepts into dementia care practice. As high-quality dementia care and enhanced quality of life for the person with demen-tia is facilitated through effective person–provider interactions and relationships, attention has been directed towards enhancing health care providers' person-centred communication (PCCommunication) skills (Downs & Collins, 2015). The purpose of this discussion paper is to demonstrate that the use of video feedback (VF) offers a novel approach to improving nurses' and other health care providers' PCCommunication skills within the context of dementia and long-term
care (LTC). For the purposes of this discussion, VF involves a health care provider watching a video of their interaction with a person served, followed by a face-to-face opportunity to discuss their perfor-mance with a facilitator and receive feedback.
Person-centred care (PCCare) is considered the international gold-standard approach for health care and service delivery within dementia care (Downs & Collins, 2015; Harding et al., 2015). The foundational work of Kitwood (1997) on PCCare, personhood, and relationships established a theoretical basis for how person-centred dementia care is defined. To further refine and clarify the aspects of Kitwood's philsophy, Brooker (2007) subsequently developed the VIPS framework (ie, Value the person, Individualize care, Perspective of the person with dementia, and Supportive social environment), out-lined in Table 1. PCCommunication is felt to be a necessary opera-tional component of quality person-centred dementia care (Brooker, 2007; Downs & Collins, 2015; Kitwood, 1997). The importance of PCCommunication has been supported by evidence that indicates LTC residents react more positively (Savundranayagam, Sibalija, &
Scotchmer, 2016), experience enhanced mood and affect (McGilton, Sidani, Boscart, Guruge, & Brown, 2012), and report higher levels of well-being (Custers, Kuin, Risken-Walraven, & Westerhof, 2011) when health care providers demonstrated effective relational behaviours during interactions.
As such, efforts have been made to clarify the elements of PCCommunication within older adult and dementia care contexts.
Ryan, Meredith, MacLean, and Orange (1995), through their theoreti-cal work on the Communication Enhancement Model, posited that via an enhanced awareness of ageing and use of individualized assess-ment skills, health care providers appropriately modify their communi-cation approaches using sociolinguistic accommodation strategies (Table 2) to match older adults' communicative abilities. Subsequently, Ryan, Byrne, Spykerman, and Orange (2005) found that certain rela-tional elements of person-centredness pertaining to communication, as defined by the person-centred philosophy of Kitwood (1997) (Table 3), were evident in health care providers' positive interactions with residents in LTC. Savundranayagam and Moore-Nielsen (2015) provided additional depth to this theoretical discourse by
T A B L E 1 VIPS framework describing the elements of person-centred care
Element Definition
Value (V) Value people with dementia and those who care for them:
Promote citizenship rights and entitlements regardless of age or cognitive impairment and eliminate discriminatory practice.
Individual (I) Treat people as unique individuals and provide an individualized approach:
Appreciate that all people have a unique history and personality, physical and mental health, and social and economic resources, and that these will affect their response to dementia.
Perspective (P) Look at the world from the perspective of the person with dementia:
Recognize that each person's experience has its own psychological validity, that people with dementia act from this perspective, and that empathy with this perspective has its own therapeutic potential.
Social Environment (S) Provide a supportive social environment:
Recognize that all human life is grounded in relationships and that people with dementia need an enriched social environment that compensates for their impairment and fosters opportunities for growth.
Note. Brooker (2007).
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demonstrating that effective PCCommunication in dementia care con-sists of both evidence-based relational and linguistic strategies (Table 4).
The acquisition of PCCommunication knowledge and skills by health care providers is required to transform a customary task-based care approach to a relational person-centred exchange. However, PCCommunication education and training programmes alone are often insufficient to realize change in health care provider behaviour (Berkout, Boumans, Mur, & Nijhuis, 2009; Eggenberger, Heimerl, &
Bennett, 2013). Effective person-centred interventions must also influence an individual's core values and deeply embedded care beliefs (Finlay, Antaki, & Walton, 2008). Viau-Guay et al. (2013) examined
the transfer of person-centred principles into LTC practice and found that workplace philosophies often conflicted with health care pro-viders' personal beliefs and values. Thus, it is suggested that transfor-mation strategies include an educational and a values-based approach where health care providers have an opportunity to reflect and act upon their current beliefs and values about care provision (Viau-Guay et al., 2013).
VF is a promising technique that has shown potential to improve reflection upon and learning of PCCommunication skills across a variety of health care settings and providers (Finlay et al., 2008;
Fukkink, Trienekens, & Kramer, 2011). Although it may have broader applications as a training tool, it is not evident from the literature T A B L E 2 Sociolinguistic strategies of accommodation
Strategy Definition Examples
Approximation Adjusting one's language and
communication patterns to be similar or dissimilar from another
Dialect/accent Rate of speech Intonation Interpretability Attuning to the other's ability to understand
the conversation
Modify complexity Increase clarity Topic familiarity Interpersonal control Adapting communication based on
perceived power, control, role, and status
Opting in or out of exerting power/control over the conversation
Discourse management Adjustment of communication based on perceived or stated needs of the other
Topic selection/sharing Maintaining face Emotional expression Responding to the other's recognized or
reported emotional and relational needs
Reassurance Tension reduction Expressions of caring Note. Ryan et al. (1995).
T A B L E 3 Kitwood's positive person work (affirming interactions)
Interactions Definition
Recognitiona A person is recognized by preferred name and acknowledged as a person with unique thoughts, feelings, and preferences.
Negotiationa A person is consulted about their choices and preferences in care and daily life. When possible, a person is supported to be an active participant in the decision-making process.
Collaborationa Two or more people work together to complete an activity or meet a goal, for example, care is not“done to” a person in a passive sense but“with” the person.
Play The provision of an activity for the purposes of enjoyment and self-expression.
Timilation A form of interaction that stimulates the senses, for example, aromatherapy or massage.
Celebration Life moments are celebrated when they arise, not just at important landmarks such as birthdays and holidays.
Relaxation A low level of intensity and recognition in which a person may wish to relax in solitude or in the company of others.
Validationa Accepting the reality of another even if it is a result of hallucinations or misperceptions.
Holding Providing a safe psychological space to enable a person to truly express themselves.
Facilitationa Aligning closely with collaboration, a person is enabled or supported to do what otherwise they would be unable to do.
Creation Encouraging a person to be creative and spontaneous, as this can be therapeutic.
Giving In the spirit of an I-Thou relationship, one accepts whatever expressions of kindness a person with dementia gives.
Note. Kitwood (1997); Ryan et al. (2005); Savundranayagam and Moore-Nielsen (2015).
aAffirming interactions pertinent to person-centred communication (PCCommunication).
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base that this approach has been tested or utilized to promote per-son-centred dementia communication within a long-term care set-ting. Using theoretical and empirical insights, this discussion paper presents rationale and support for the use of VF to promote PCCommunication within the context of dementia and LTC.