Patient Communication: Picking Up Where Medicine Leaves Off

We've all seen patients who were far beyond the reach of medical treatment suddenly defy the odds and recover. We've also seen patients who were well on the road to recovery, take a turn for the worse for seemingly no reason at all. No matter what the technology or how terrific we are at our jobs, sometimes medicine just isn't enough.

Case in point, a few years ago, I saw a woman in her sixties after she had had a moderate CVA. No matter what her doctors did for her, she still wouldn't regain consciousness - defying explanation. Her daughter was thousands of miles away at the time and when the doctor reached her, he told her that her mother mighty not live long enough for her to get to her side. After several minutes, the daughter finally convinced the head nurse to put a phone up to her mother's ear, so she could talk to her. The nurse put the phone by the patient's ear and could hear her daughter talking to her, telling her that she was on her way and that everything was going to be fine. The moment her patient heard her daughter's voice, the nurse watched in amazement as her vitals stabilized, her eye lids began to flutter and her eyes opened, looking straight up at the nurse! Two weeks later, she was out of the hospital and on her way to rehab.

That's the miracle of communications.

Whether a family member, a friend or just a familiar face, our patients need to have the people they love surrounding them, when they're ill, in pain, or afraid. As caregivers, it's part of our job to realize that patients might be too ill or physically unable to initiate the contact they so desperately need, on their own.

I wish that were the end of the story. A few years later, the same woman was injured after a bad fall and taken to a different hospital. Despite being in stable and then good condition, a few days later a lack of the most basic medical care caused the woman to spiral into critical condition. When the hospital called her daughter to notify her of her mother's hospitalization days later, she learned that her mother was now unconscious and may not survive. While trying to get a flight back, she begged the nursing staff to put a phone next to her mother's ear, so she could talk to her, possibly for the last time. But at this hospital, the nurses and doctor refused. In fact her doctor said that she was suddenly opening her eyes and looking around. But despite her daughter's pleas to let her talk to her mom while she could still hear her, he tells her that he has no way to get a phone to an ICU patient. "We'll try and figure something out in the morning," he says. Unfortunately the patient didn't have that much time and she died hours later, never again hearing her daughter's voice.

The next time you're caring for a patient with compromised communication ability, take a moment to see their surroundings from his perspective.

· If your patient can speak, is the telephone close enough to them?

· Do they need help dialing, or able to see well enough to read a number out of their address book?

· If your patient is unable to hold a telephone would they benefit from a speakerphone?

· If your patient can't speak, have a patient representative or volunteer ask them to write the name of someone that they would like to have called for them and hold the phone up to their ear to facilitate communication.

· For patients who cannot speak, patient Internet access can be a real lifesaver, because they can type an email message or have one typed for them.

· Is your patient unable to see or unable to hear? Then take a moment to call a department or caregiver who can bridge those problems to enhance communication.

· Since many hospitals still don't have a means of patient communication in the ICU, you may have to get a bit more creative for patients in care units.

Many hospitals now have low emission wireless phones that can be used in critical care units. Wireless web pads also work well, or what about a regular phone, kept at the nurses' station that can be plugged into an outlet in the patient rooms when needed. Communication isn't just a patient's right - for many it can be their only link to the outside world, or a life-renewing source of strength and love.

Combine that with terrific medical care and watch the miracles flow.

For tools you and your staff can use to facilitate patient communication download a free copy of the Seven Steps to Successful Notification System, in PDF format, at the Next of Kin Education Project web site. Along with the Information Kit, you'll find patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

Laura Greenwald, CEO/The Next of Kin Education Project nokepinfokit@juno.com

The Seven Steps Information Kit can be downloaded free of charge at http://clik.to/7stepsThe Reminder Products can be purchased at our NOKEP store http://www.cafeshops.com/7steps