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Care Planning: Making Decisions That Involve Everyday Participation And Communication.

2146 words - 9 pages

The biomedical approach to assessments and care planning seem to be the accepted form of communicating physical needs from a hospital environment. Certainly, all the people we have admitted to the home in the past ten years arrived with a plan of care that was medically led, if it is even supplied at all. Therefore, it is possible to argue , that a plan of care focused on the influential abilities of a person with dementia would be more than helpful in comparison to the medical diagnose. Consideration of the decision making process would identify aspects of well-being and enhance consistency of care. The hospital discharging Marjorie described her communication receptive skills as mild receptive aphasia. They confirmed she was able to follow two/three stage verbal commands. The assessment stated Marjorie was demonstrating evidence of slow auditory processing and retrieval. Marjorie’s verbal expression, showed jargon fluent aphasia and word finding difficulties, often breaking in mid sentence. However, there was no evidence recorded that considered her actual understanding of what she actually saying. The documented evidence indicated Marjorie had demonstrated frustration during her stay in hospital and this was witnessed during the first meeting at the home. Marjorie refused to engage eye contact and appeared withdrawn, when encouraged to participate in her assessment she shouted angrily at care staff. Outbursts of frustration and anger can occur if a message is met with misunderstanding or if it is ignored (Cohen-Mansfield, 2008). People who have communication needs, such as those with dementia, require skill and empathy to exchange information both verbally and non-verbally. In practise people with dementia may not clearly transmit words. Expressive aphasia is limiting by inhibiting the ability to convey feelings through words and language. We considered the biomedical assessment demonstrated a divide of inclusion, as Kitwood (1993) describes those without dementia and those with dementia as ‘us’ and ‘them’. Nursing staff had completed a physical assessment but they had not included Marjorie in this process. Kitwood further recognises how the exclusion of power can affect the personhood of people, we consider Marjorie felt challenged for this reason and her abilities were not included in her plan of care.
In order to improve practise we considered it important to understand the framework surrounding communication and identify which, if any, practises would facilitate communication with Marjorie. Firstly, the Shannon and Weaver (1949) transmission model named as morse-code by its application, versus Kitwood’s (1993) interaction model of communication. Communication is a two way exchange of information, it involves transmission and reception, Marjorie was experiencing difficulties expressing her identity she was struggling to be recognised as an individual but she was communicating her wishes using other cues. We understood...

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