PSYCHOSOCIAL EFFECTS OF EFFECTIVE COMMUNICATION ON THE ELDERLY

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PSYCHOSOCIAL EFFECTS OF EFFECTIVE COMMUNICATION ON THE ELDERLY

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Effective communication with older people is an important aspect of nursing practice. Ineffective communication can lead to older people feeling inadequate, disempowered and helpless. Nurses have a duty to ensure that older people think they are being listened to and that their concerns are being validated in a non-judgemental way. Central to effective communication is the ability of nurses to be self-aware, and monitor their thoughts and feelings about, for example, negative stereotypes associated with the ageing process.

Effective communication can sometimes be difficult to achieve due to the effects of ageing, but nurses can overcome some barriers through thoughtful interventions. It is important to treat older people as individuals, and to monitor and adapt communication accordingly. By doing so, nurses can ensure older people feel empowered, respected and able to maintain their independence.

Communication can take many forms. At their most basic, verbal communication is the interaction between people using noises or words, while non-verbal communication is the use of hand gestures, body language and eye contact (Croston 2018). Basic communication skills are needed for social interaction and help communication on an instinctive and primitive level. However, there is a difference between social interaction and therapeutic communication, which is commonly required in more formal situations.

Therapeutic communication can be described as a person-centred interaction that involves a nurse using eye contact, open body language, active listening and physical contact. Empathy, silence and respect for the other person are also important aspects of therapeutic communication, along with nurse well-being (Stockmann et al 2018). Hammar et al (2017) suggest that building relationships involves three separate subcategories of communication. These are:

• Seeing the individual.

• Being respectful.

• Showing empathy and compassion.

These subcategories are complex. Being respectful, for example, requires an ability to tailor communication to the individual, while at the same time respecting the individual’s dignity and showing compassion. Using therapeutic communication to tailor messages to the individual can support the delivery of health-related knowledge, thereby promoting health and well-being (Williams 2013).

Effective communication is central to the development of a therapeutic relationship, although the tendency of professionals to link older age with poor cognition, weakness and resistance to change (Schroyen et al 2018) can have an adverse effect on the process. For an older person, the ability to communicate effectively with another person is central to self-esteem, identity and quality of life (Tolson and Brown-Wilson 2012); for the professional, effective communication is essential to understand and assess the older person, and promote their health (Hafskjold et al 2016). However, communication with older people can sometimes be ineffective and based on a transactional model, such as the performance of medical tasks, rather than a person-centred model. Older people have reported being treated with a lack of respect by, and receiving insufficient information and negative attitudes from, nursing staff, all of which can adversely affect the communication exchange (Hanson 2014, Harrison et al 2016). Communication must be effective to enhance the quality of care provision and to identify potential serious issues, such as abuse.

Listening to older people is central to the promotion of person-centred care and dignity (Dickson et al 2017). Listening effectively requires self-awareness, and an ability to focus on the older person and what they are saying. Trevithick (2012) describes the skills and characteristics associated with listening to the older person, including eye contact, an open body posture and the ability to notice cues or key phrases. Moss (2012) identifies three skills nurses can use to show they are listening attentively to what an older person is saying (Table 1). It is important that these are used sensitively, not mechanically.

Nurses’ awareness of their strengths and limitations during interactions with others is central to effective communication. For example, being able to discuss nutrition with an older person may be straightforward but exploring their faith or sexuality can prove more challenging. Exploring areas for development through reflective activities enables nurses to be more involved in the therapeutic relationship and can enhance self-confidence and growth (Ellington et al 2017).

Self-awareness is a central part of emotionally intelligent practice, a concept that is important to the development of interpersonal skills and relationships with others (McQueen 2004). In their seminal work Salovey and Mayer (1990) state: ‘Emotional intelligence can be defined as the capacity to process emotional information accurately and efficiently, including that information relevant to the recognition, construction, and regulation of emotion in oneself and others.’ For example, working with older people often places nurses in emotionally difficult situations, such as dealing with distress, safeguarding issues or care at the end of life.

To act appropriately in these situations, it is important that nurses can recognise others’ and their own emotions. A nurse caring for an older person at the end of life may be reminded of the loss of a member of their own family, for example, but remembering such feelings of sadness can support an empathic response. However, there may be occasions when nurses’ feelings of grief influence them in a negative way so that their emotions take over, making them incapable of caring for others.

Nurses need to be able to recognise emotions and manage them in a calm and professional manner. Over time, reflective practice can support them in this developmental area. Thompson (2006) suggests some guidance for dealing with emotionally difficult situations using the acronym SARAH

It is important that nurses communicate effectively with older people to ensure their needs are met, although negative stereotyping of older people can hinder this process. WHO (2019a) describes ageism as the ‘stereotyping, prejudice, and discrimination against people on the basis of their age’. According to a report by Age Concern (2008), one in three people surveyed considered older people to be ‘incompetent’ and ‘incapable’. While most healthy older people do not lose the ability to communicate effectively, ageism remains a problem, with millennials holding the most negative attitudes towards ageing (Royal Society for Public Health (RSPH) and Calouste Gulbenkian Foundation 2018). Ageism is harmful because it can lead older people to feel marginalised and excluded from society, which has detrimental effects on their health and well-being.

1.2 STATEMENT OF THE PROBLEM

If nurses stereotype older people and make age-based assumptions about their ability to communicate, they can lead older people to apply such stereotypes to themselves (RSPH and Calouste Gulbenkian Foundation 2018), thereby lowering their expectations and perhaps failing to maximise their potential. Nurses who speak slowly, use patronising language and simplify sentences – a practise described as ‘elderspeak’ – can lower older people’s self-esteem and make them feel powerless (Ryan and Butler 1996). Some nurses speak to older people too loudly, even though only one third of people over 65 have hearing deficits (WHO 2019a, 2019b).

A more helpful approach to interaction is described in the Communication Enhancement Model, which focuses on communication in health promotion (Ryan et al 1995). The model promotes an advocacy and partnership approach to decision-making and takes into consideration the preferences of the older person when deciding on care. It supports facilitating interactions that match the level and needs of the older person, rather than assuming that all older people behave the same way, thereby promoting an egalitarian approach to care. Nurses using this model can develop the ability to:

• Continually assess the older person.

• Recognise cues on an individual basis.

• Modify their communication to accommodate individual needs.

It is important to remember that older people are not a homogeneous group, but have a wide range of life experiences that influence their perception of illness and their ability to communicate with healthcare professionals. Waterworth et al (2018) found that older people, especially those with multiple health conditions, may attribute symptoms to ageing, which can deter them from contacting health professionals. Nurses should be mindful of personal and cultural differences, and understand older people’s individual preferences for care, while considering biological and social changes that can influence communication during consultations.

1.3 Objectives of the study

1. To understand the impact of effective communication on the elderly

2. To understand the relationship between effective communication and psycho-social development of the elderly

1.4 Research Questions

1. What is the impact of effective communication on the elderly

2. What is the relationship between effective communication and psycho-social development of the elderly

1.5 Research Hypothesis

H0: There is no relationship between effective communication and psycho-social development of the elderly

H1: There is a relationship between effective communication and psycho-social development of the elderly

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