Strategies for effective communication using personal protective equipment in nursing homes: a qualitative study

Abstract Care of persons with living with dementia is complicated by using personal protective equipment (PPE). Masks and other facial coverings although protective, prohibit visualization of lip-reading and nonverbal cues and obscure identity. The purpose of this qualitative study was to determine best practices for effective communication while using PPE from the provider (n=10), resident (n=5), and family perspective (n=4). The 19 participants were recruited from four states. Qualitative content analysis identified two major themes: (1) challenges experienced during nursing home pandemic care, and (2) the communication strategies to overcome PPE challenges. Although our interviews were not focused on experiences outside of using PPE, all participants voiced trauma surrounding the lockdown for residents and separation from their families. All participants expressed pessimism surrounding the PPE, but this was also met with feelings of normalization surrounding its use. The communication strategies discussed focused on emphasizing (1) verbal and nonverbal communication skills, and (2) person-centered communication. The general communication strategies recommended were consistent with expert opinions such as using written messages and gestures, using loud speech, using clear speech, identifying self, and varying approaches based on person and context. Person-centered approaches centered on the staff and resident "knowing each other." Specifically, knowing the resident is essential to understanding their personal barriers and facilitators to successful communication and knowing each other in a personal and trusting manner helps overcome barriers caused by PPE. This study provides practical suggestions for best practices in communication and reinforces the need for person-centered communication focused on psycho-emotional care.