Nonverbal patients

[Kris Scanlon]

One of the situations that many of us in hospice often find challenging are visiting nonverbal patients. By "nonverbal," I mean patients who are awake, but not able to verbally communicate. I would like to know how others respond to similar situations, and what they do when visiting nonverbal patients? Thank you

[Deb Brady & Erica Marks]

The Memory Bridge Project might be a great start. We had a volunteer fall in love with this program and she not only brought the project to VT but also brought the founder. He did several community presentations to different audiences and it was a wonderful experience for all. The site you can find info on is www.memorybridge.org. We purchased the video and had a viewing and discussion as an inservice for our volunteers. Best of luck.

[Kris Scanlon]

Wow, Irene! This definitely gives some wonderful specifics on doing some very simple things that can help bridge connection and communication. Thank you!

[Irene Smith]

Kris, Tanie and Francis

As touch support, I am often called in when other care givers are not sure what to do .Just like all of you when the dying person is non verbal or has inappropriate responses due to
dementia, confusion or reactions to medications,
I State what I am going to do.
I Speak slowly and clearly,and take a breath which leaves a space for integration of what I have said.I stay alert to any body responses from the dying person that would indicate comfort or lack of comfort with the request to touch.

When using a dying person’s body language as positive or negative indicators for touching I must sit and witness the body language without touch first .I tell the client what I am doing and why.

Once I have a pattern of the body’s animation I use the following indicators to determine if the touch is a comfortable medium. Reading body language requires me to be calm, quiet within myself and centered.

Positive Indicators may be gestures of opening or releasing such as;
* passing gas * urinating
*tearing *sighing
*mouth opening * drooling
* forehead relaxing * hands opening
* breath slowing down or deepening.
Negative indicators may be gestures of holding or closing such as ;
*clinching teeth , * fists or drawn mouth
* drawing legs up *tightening forehead
* rapid breathing * rapid heart beat
* pulling at the covers * turning away from the touch

.If there is no readable response or the response looks positiveI follow through with the touch.
I stay alert to any changes in the dying person’s body language.
I then Touch gently , and slowly exactly where I said Iwould touch

I Tell the dying person if I change to other areas of the body.

I Continue to speak what I am going to do next. This prevents
anxiety and allows for a deeper sense of relaxation.

As you, I believe that slowing down and speaking what we are doing is a major support for the non verbal client. Sometimes I will just sit and allow a supportive silence. I think alot of times people try to fill the space. I believe allowing space is also a precious gift to share with another human being.

Blessings Irene Smith Author of "Touch Awareness in Caregiving"

[Tanie Heitz]

Kris,
Like Frances, I always speak to the patient as though they can hear what I am saying and pay attention to their body language. Not only their facial expressions but the entire body. (Being a CNA and having to give baths and do a lot of personal care allows me to do this). Now, depending on their unique circumstances, if they are able to, I will use a letter board for them to try to communicate their wishes or ask yes or no questions and have them give me a thumbs up or thumbs down for yes and no responses. I took care of a lady that had an unusual disease that prohibited most body movements and facial expressions but the stiffness of her limbs gave me an indication whether she was having a good day or a bad day so I would tell her jokes or talk about one of the movies she had on a shelf (and she had numerous), etc. All the while seeing if she was relaxing. For those that don't do personal care, sometimes just simply holding their hand will tell you a lot. Agreeing with Cheryl, singing helps a bunch. I have noticed over the years that the people I sing to seem to really enjoy it. I hope this helps a little.

[Kris Scanlon]

Tanie, this helps MORE than a little, it helps a LOT! Hopefully it might provide insight for others too. Thank you

[Cheryl R. Walls]

When I would have to make nursing visits on our non-verbal patients, I would do my nursing assessment, then I would sing to them, I would talk to them, read my Bible to them, make sure the TV station was on a channel I thought THEY would appreciate, not a channel the staff wanted to watch while performing their care, I painted fingernails, applied lotion to hands, would straighten their sheets, comb their hair, or even just moisten their lips or apply balm. You can only imagine how you would feel if you were "trapped" in your body with no way of verbalizing how you feel or what you want. That's how I approached the patients and that's how I teach my volunteers to approach their patients.

[Kris Scanlon]

Excellent, Cheryl - thank you!

[Frances Shani Parker]

Kris, I view non-verbal patients as interesting challenges. I like coming up with ways to bridge the gaps in our communication. I never assume patients can't hear me, unless they have been officially diagnosed as hearing impaired. I talk to them the way I would talk to hearing patients. I tell them what's going on at the nursing home and other news. Even when their eyes are closed, but I know they are awake, I tell them who else is in the room and say something positive about them to those present, so patients can feel included in the conversation.

I check their assignment forms and talk to their caregivers, if they are available, to find out what their background and interests are. These are more topics for me to mention to them and sources for ideas. If they are able to leave the room, I take them on walks or wheelchair rides. I read to them, play music that I think will suit their taste, touch them to reinforce my presence; I feed them, sing, play the radio, and watch television with them, regularly making comments and always analyzing their body language to see if I'm making a connection.

When I do a good job of this, I usually see signs that we are making progress. There may be smiles, alertness, something in their eyes that tells me our communication gap is getting smaller, that we are forging relationships that enhance our lives. That's when the beauty of hospice volunteering sweeps me up like a great piece of music.

[Kris Scanlon]

This is absolutely fantastic! Thank you so much for sharing!