non-verbal communication

Posted by Elizabeth Holliday on August 12, 2008 at 10:29pm
Hi Irene, I'm privileged to be working with a centenarian, age 104, who is from a Latin American culture. I speak a little Spanish, which is one of the reasons I was assigned to her. She has had a stroke, and so in addition to having difficulty understanding her language, she is also speaking in a new, made up language that even her family has trouble understanding. So when I meet her, there are many things that prevent us from easily communicating. So I'm really focused on reading her non verbal cues. Overall I feel that she is pretty open to the gentle touch. Often she draws one leg up, causing me to slow down and evaluate other signs of openness. But today, she showed several signs of closing that I had not seen before in her. She drew both legs up, and held her hands firmly, in a folded position, over her abdomen. Her breathing was short and shallow and indicated anxiety, and took a long time to lengthen and deepen. She did not open up to the touch as usual. I modified in a way that felt respectful and appropriate. The other different thing today was that while we were doing massage, there was a lot of lively discussion, in her native language, between the caregivers and the hospice nurse who was visiting. I suspect that this may have been a big part of the reason for her not relaxing into the massage. At one point she did go into a deep relaxation and fell asleep. I watched as the legs leaned over from their drawn up position. Later, as I was grounding her legs, she stretched the legs out to accomodate the touch, which was a sign of openness, but they remained taut and glued together, adding to all of the signs of being closed to touch. Definite resistance. At the end, I was finished with the massage, but the care team were still having their meeting, so I just held her hand. It was at that time that I finally felt her engaged in the touch, and opening into the connection of the touch, intertwining her fingers into mine without my anticipating or initiating that. This was very affirming for me, and I am grateful, yet everything that led up to that moment was confusing. She's a very impressive woman. Even at 104 she anticipates where I'm going and moves as if to help me. She has impressive strength and fortitude, and I have great respect for her. The caregivers smiled in an approving and appreciative way, not seeing the negative indicators that I was observing. I am a little confused about how to proceed with her. I kind of worked through the negative indicators and I don't know how I feel about that. She says things to me that I don't understand, and when I ask the caregiver to translate, she humors the patient and says, yes Mamacita, sort of giving up on understanding it. I think I have to accept that I won't be able to understand her words, and that she may not understand mine. But what about these indicators? What would you do? Thank you for your input. Peace, Elizabeth

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Replies

  • Elizabeth Holliday August 27, 2008 at 10:52am
    Thank you, Irene, for your reply. This was very helpful!

    Peace and blessings,
    Elizabeth
  • Irene Smith August 22, 2008 at 8:35pm
    Too much stimulation in the room. Very confusing for anyone and especially someone 104 and dying..

    The second thing that comes up for me is that touch is very intimate . There was a social situation happening and to relax into such an intimate modality of care was also a great demand under those circumstances. For me, when you took her hand you were integrating touch into the situation that was already happening instead of trying to direct her elsewhere.Hand holding is universally accepted as a form of support . It integrates easily into social settings.

    When I go into a room where there are other people I always ask if I should come back at another time. If im asked to stay then I want to find how i can integrate into the room rather than redirect someone's focus. Communicating with the family and health care provider would have been a good first step. Knowing what was happening could have given you information as to how to more easily integrate touching.

    Blessings Irene smith Author of Providing Massage in Hospice Care
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