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this Learning Module, you will learn the six steps of giving effective demonstrations to increase your residents' or tenants' ADL independence. As you are aware, some
residents need additional assistance in grasping a concept beyond mere verbal
instruction, which was discussed in the last learning module. This is where demonstration,
or showing a resident the ADL procedure becomes a valuable tool.
order to do this, you have to break an ADL down into its separate steps, or parts.
For example, let's say that you have a resident or tenant, Mildred, in the early
stages of Alzheimer's who has recently had a hip replacement.
The transfer from
her bed to her wheelchair involves several parts:
1. Scoot to the edge
of the bed
2. Sit on the edge of the bed and place her feet on the floor
3. Push herself off the bed to stand
4. Support her weight while standing
5. Reach and grasp one arm rest of the wheel chair, positioned by her bed.
6. Pivot or turn
7. Grasp the other arm rest
8. Ease herself into the
Step 1 - Observe Your Resident
one in demonstration of a transfer is to observe your resident. Then, decide if
he or she would benefit from a demonstration. Here's an example of how you make
the decision whether to demonstrate or not.
say that, in the past, Mildred has been able to do all parts of the transfer independently.
But, this morning, you observe that her eyes are not open as wide as they usually
are. Instead of looking at you when you speak, she looks at the floor. You ask
if she feels okay. Mildred states that she was worrying about her daughter's visit,
and did not sleep well.
one extreme option you have upon noticing her disorientation is that you could
make the decision that she is completely unable to transfer. You call for an assistant
and physically lift her into her chair. However, this obviously goes against your
ALF's philosophy of independence, choice, and perhaps even dignity, since she
is merely seeming temporarily lacking mental clarity. Her behavior does not, at
this point, seem to warrant such an extreme measure.
course, if there were a fire in the building, yes. But when you
give too much assistance to a resident, you are giving them the
message that they are incapable of performing the task themselves.
Also, by placing Mildred in her chair, you may be taking away
any ADL confidence that she had built up over the months after
her hip replacement.
Question #1: When you give a resident too much assistance you
give them the message that they are what? To
select and enter your answer go to .
The "Happy Medium"
total dependence and total independence, you have to make a decision
of how to find a happy medium. This morning, based upon your observation
of Mildred's unusually foggy state of mind, you decide to suggest
to her, "Why don't you sit in bed for a little while longer
until you wake up a little more, Mildred. I'll be back in about
15 minutes." Mildred agrees. So you assist the resident in
the next room to brush her hair. When you return, Mildred looks
slightly more alert, and states that she doesn't want to miss
breakfast and wants to be in her wheelchair.
Question #2: If you feel that your resident needs a little
extra time to get focused in the morning, you should do what? See above
to start with verbal instructions in the form of some question
because she still looks a little dazed. You ask, "Mildred
can you scoot to the edge of your bed and place your feet on the
floor?" You observe that she is slower than usual, and a
little clumsy, getting her feet slightly tangled in the sheet.
So you assist by pulling the sheet and covers out of her way.
To reinforce her independence you say, "Good job Mildred,
I know you don't feel the best this morning and that took some
effort on your part." Since Mildred has had a stroke affecting
her left side, you place her wheelchair on her right, unaffected
instead of standing, as in the past, she now sits on the edge of her bed staring
off into space with a dazed, unfocused look in her eyes. She does not seem to
know what to do next. You really feel that if you instruct her to get into the
wheelchair, she might be at risk of a fall. Once again, you could physically assist
her, or call for someone to help you. But keep in mind, since her admission two
months ago, she has performed this transfer with no physical assistance.
summary, step one in demonstration is, after you observe your
resident's alertness level, decide between physical assistance,
demonstration, or a combination. Your decision to demonstrate,
or show a resident rather than physically assist, brings us to
the core challenge any caregiver faces daily regarding ADLs Your
challenge is as follows. Do you uphold the philosophy of your
ALF to encourage Mildred's independence? Or, do you play it safe
and give physical assistance, which takes away independence?
it goes without saying, you can demonstrate, and then give physical
assistance as Mildred does the transfer, but often times we merely
give the physical assistance and never give a thought to the option
of giving a demonstration first. You make the judgment call. So
as an alternative to physical assistance, you say to Milldred,
"Let me show you what to do. I know you've done this before"
Question #3: The core challenge in any ALF is independence
versus what? .
Step 2 - Positioning
let's get back to Mildred. Step number two in demonstration is
Positioning. With Mildred, to position your demonstration of the
transfer, move her wheelchair towards the end of the bed about
one or two feet away. Then, you sit next to Mildred on her bed
after asking her permission.
the positioning of your demonstration, all too often when we demonstrate,
we may show the resident a task with an obstructed or blocked
line of vision or view. To avoid this common error or problem,
note Mildred's eyes. Then look at the area that you want her to
observe. See if anything is in the way to prevent her observation.
Interestingly enough, besides the edge of the bed and arm of a
wheel chair, the most common obstruction for this demonstration
of a transfer is your own body. Often times we show a resident
something and our back or arm or hand is blocking their line of
vision. So, position your demonstration, then check for any obstruction
in their line of sight.
Question #4: In positioning your demonstration, the most common
item blocking your resident's view of your demonstration usually
is what? See above
Step 3 - Single-Word Instructions
Step Number 3 in your demonstration is single word instructions.
You learned about giving single word instructions in Staff Training
Module two. The key to be remembered from that module is to use
simple one or two word instructions as you demonstrate. In other
words, after you explain or introduce what you are going to do,
by saying something like, "Mildred, I'm going to show you
how to get into your wheelchair," limit what you say to one
or two word instructions. A lot of chatter and a long complicated
sentence will be distracting and confusing.
Question #5: Single word instruction during your demonstration
is important because it does not what? .
Step 4 - Check for Understanding
number four is checking for understanding of your demonstration.
While you are demonstrating, maintain as much eye contact with
Mildred as possible. First of all, check if you have her attention.
Secondly, check for some sign of understanding like a head nod
or perhaps a knowing smile. If she appears to still be in a fog,
you might check the pacing of your demonstration.
Repeat it by
saying something like, "I know there are a lot of steps involved
in this. Let me show you again in slow motion." After the
second demonstration, recheck Mildred's understanding by asking,
"Did you want to see that again before you try?" So
step number four is, as you do your demonstration look at your
resident's eyes, facial expression, and gestures to check for
attention, understanding, and repeat at a slower pace if needed.
Question #6: During your demonstration, check for your resident's
what? See above
Question #7: Repeat the demonstration how? .
Step 5 - Active Participation
number five is active participation and an added alertness check.
Relocate the wheelchair closer to Mildred. Reassess Mildred's
alertness. If you feel by observing her posture, eye openness,
eye contact, and facial expression that she is alert enough to
transfer without physical assistance, you ask, "Okay Mildred,
are you ready to try now?" As she starts the transfer, observe
for signs of weakness and faintness. Have her sit back down on
the bed, if you feel that she is not capable of independently
Question #8: Before your resident attempts the ADL, especially
if their is a risk of a fall, check alertness by looking at your
resident's what? See above
Step 6 - Safety
number six is safety. Of course, when regarding safety, keep yourself
in close proximity or close to your resident should she or he
need physical assistance.
Mildred's transfer, stand close enough to slide your arm under
her armpit, and grasp her forearm should she start to fall. Consult
your supervisor for other falls procedures. Also, as an added
confidence builder, as Mildred performs the transfer, give verbal
instruction as a reminder of the steps in the transfer. Use the
same single word instructions you just used in your demonstration.
When the transfer is complete, use the skills you learned in module
one, and reinforce her independence by saying, "Mildred,
good job of getting into your chair!" Your compliment uses
Question #9: As your resident performs the ADL, check that
what are followed? See above
Now let's review
the six steps in a demonstration that we have just gone through
so that you can apply them to any ADL demonstration.
Step 1: Observe the resident's alertness based upon eye
openness, eye contact, facial expression, body movement, and speech.
Then, decide if your resident could benefit from a demonstration.
Step 2: First, position the equipment or supplies to provide
the easiest access for the resident. For example, with Mildred,
you placed the wheelchair next to the bed on her unaffected side.
If she were brushing her hair, you would place the brush to her
right side. Second, make sure that your demonstration is clearly
in the line of vision of your resident and nothing is blocking
his or her view.
Step 3: Demonstrate using simple words or phrases; then
repeat your demonstration more slowly if needed.
Step 4: Look at the resident's face and eyes to see if
you have their attention and they understand.
Step 5: Request the resident to perform the ADL.
Step 6: Stay in close proximity, should physical assistance
be needed. Also, provide sincere, positive reinforcement or compliment
during and at the end of the ADL performance.
Question #10: After the resident performs, or attempts to perform
the ADL, give the resident a what?
Question #11: How many times should you repeat your demonstration?
As many times as are what? .
summary regarding Demonstration, the Six Essential Steps are as follows:
1. Observe and decide if a demonstration is appropriate.
2. Position your
demonstration for easy viewing.
3. Use single word instructions.
for attention and understanding.
5. During resident's activity participation,
use single word instructions and compliment efforts.
6. Take appropriate safety measures.
In staff training module four, you will learn how to use key types
of verbal prompts to increase ADL independence.
Peer-Reviewed Journal Article References:
Fleiner, T., Trost, A., Depiereux, R., Zijlstra, W., & Häussermann, P. (2015). Geriatric psychiatry in motion—Bringing physical exercise to geriatric psychiatry: A multi- and interdisciplinary program to promote physical activity among elderly psychiatric patients. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 28(4), 173–181.
Gruenenfelder-Steiger, A. E., Katana, M., Martin, A. A., Aschwanden, D., Koska, J. L., Kündig, Y., Pfister-Lipp, E., & Allemand, M. (2017). Physical activity and depressive mood in the daily life of older adults. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 30(3), 119–129.
Rapp, M. A. (2015). Exercise in geriatric psychiatry: Challenges and opportunities. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 28(4), 147–148.