Pilnick Alison, O'Brien Rebecca, Beeke Suzanne, Goldberg Sarah, Harwood Rowan
School of Sociology and Social Policy, University of Nottingham, United Kingdom.
School of Health Sciences, University of Nottingham, United Kingdom.
Soc Sci Med. 2021 Aug;282:114156. doi: 10.1016/j.socscimed.2021.114156. Epub 2021 Jun 19.
People living with dementia (PLWD) are almost always admitted to the acute hospital for reasons unrelated to their dementia, finding themselves in the unfamiliar environment of a Health Care of Older Persons acute ward. The effect of this environment creates a challenge not just for a PLWD themselves, but also for the staff who care for them. Concerns have been raised by both policy makers and staff about the quality of communication between hospital staff and PLWD. Using conversation analysis, we examined 41 video recordings of healthcare professional (HCP)/PLWD interactions collected across three acute inpatient wards in a large teaching hospital in the UK. In this paper, we focus our analysis on hard-to-interpret talk (talk where there are problems in hearing, speaking and/or understanding), and the ways in which healthcare professionals respond to this. Repair of hard- to- interpret talk is common in ordinary interaction, but we find that HCPs in this setting use a range of approaches to avoid direct repair. These approaches are: the use of non-committal responses and continuers such as 'yeah' or nods; the use of repetitions or partial repetitions; responding to the emotional tone displayed in the PLWD's utterance; closing the current topic and shifting to the next; and treating the PLWD's talk as related to the task at hand. We suggest that the use of these approaches may be one way in which HCPs manage respecting the personhood of the PLWD, by preserving face and enabling a continuation of an interaction in which the PLWD can take an active part. Our paper provides an empirical demonstration of the high level of interactional skill involved in dementia care work. It also illustrates how these skills can be described and specified, and hence incorporated into the recommendations and tips that are produced for communication with PLWD.
痴呆症患者（PLWD）几乎总是因与痴呆症无关的原因入住急症医院，置身于老年护理急症病房这个陌生的环境中。这种环境带来的影响不仅给痴呆症患者自身带来了挑战，也给照顾他们的工作人员带来了挑战。政策制定者和工作人员都对医院工作人员与痴呆症患者之间的沟通质量表示担忧。通过会话分析，我们研究了在英国一家大型教学医院的三个急性住院病房收集的41段医护人员（HCP）/痴呆症患者互动的视频记录。在本文中，我们将分析重点放在难以理解的谈话（即听力、说话和/或理解方面存在问题的谈话）以及医护人员对此的应对方式上。在日常互动中，修复难以理解的谈话很常见，但我们发现，在这种情况下，医护人员会使用一系列方法来避免直接修复。这些方法包括：使用不明确的回应和延续词，如“是的”或点头；使用重复或部分重复；回应痴呆症患者话语中显示的情感语气；结束当前话题并转向下一个话题；以及将痴呆症患者的谈话视为与手头任务相关。我们认为，使用这些方法可能是医护人员尊重痴呆症患者人格的一种方式，通过保全面子并使互动得以继续，让痴呆症患者能够积极参与其中。我们的论文提供了痴呆症护理工作中所涉及的高水平互动技巧的实证证明。它还说明了这些技巧如何被描述和明确，从而纳入为与痴呆症患者沟通而制定的建议和提示中。
