Every healthcare professional provides care to patients who are unconscious, unresponsive, or comatose. Each patient is unique; even with the same condition, the case details and course of treatment can be different.
Research has consistently shown that patients who seem to be unresponsive can, in fact, have some awareness of their surroundings and respond to speech. Modern imaging techniques, such as functional MRI (fMRI) have even discovered that patients in a vegetative state can not only hear, but respond to questions through increased brain activity.
Excellent patient care means supporting body, mind, and spirit. Here are some ways to ensure that an unresponsive patient is receiving the best possible care:
1. When you enter the room or approach the patient, speak quietly and announce your presence. Address the patient directly by the name he or she prefers. Let the patient know who you are and why you are there. Don’t startle the patient by suddenly placing the blood pressure cuff or starting a bed bath.
2. Speak to the patient as you perform your duties. You can tell him what day it is, what the weather is like outside, or something interesting you saw on your way to work. Never ignore the fact that there is a real person in the bed who may be aware of his surroundings.
3. Assess the patient’s level of awareness each time you provide care. As a direct caregiver, you may be the first to recognize even a small change, such as a facial expression or a different eye movement. The cognitive level should be checked and documented regularly by a trained team member, such as an RN.
4. Encourage the patient’s family and friends to remain positive when visiting. Patients who have been in the ICU have reported that they could perceive when visitors were sincere and comforting. Likewise, negative or abusive visitors should not be allowed.
5. Remind everyone that patients may still be able to hear, feel, and possibly see. They may not be able to communicate, but still able to sense what is happening. Always talk “to” the patient, never “about” her, as if she were completely awake and responsive.
6. Find out what the patient’s preferences are. Does he like to get up early? Does she like to be hugged? Does he enjoy having the television on during the day? Does she listen to music? The patient’s personality doesn’t change, so try to provide an environment that is soothing and familiar.
During a busy shift, it can be a challenge to meet the needs of every patient. Unresponsive patients should receive equal care, including communication. Remember that hearing is the last sense to go, and speak to the patient in a respectful and caring manner. When you work with these patients, consider what you would want if the patient were your parent or grandparent. Your words may mean more than you will ever know.
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