Monday, 4 June 2007
An 18 yr old boy with down-syndrome was admitted to the respiratory ward at SCGH after spending a week in ICU with a severe chest infection. The pt had an endo-tracheal tube put in and as a result was unable to verbally communicate. This combined with the fact that he was mentally delayed (intellectual capacity of a 6 yr old) made it extremely difficult to treat the pt. After a few treatment sessions I began to develop a non-verbal form of communication with the pt. I found that by speaking clearly and slowly the pt was able to lip read and gained a general understanding of what I was saying. However I did find it very difficult to interpret what it was that the pt was trying to express to me in return as he tended to look down and turn his face away when mouthing the words, making it difficult to see what he was saying. I tried to overcome the problem by continually repeating my questions/instructions and asking the pt to look up at me when responding. However I found that after a few attempts the pt started to get frustrated and would just ignore me making it very difficult to complete the treatment session. After two or three more unsuccessful treatment sessions, I was lucky enough to meet the pts family and through talking to them I learnt a lot more about the pt. They informed me of the pts likes and dislikes and I was able to use this information to help to motivate the pt making our future sessions more effective. From this experience I realised just how important communication with the pt is and how crucial it is to build good rapport with them and that sometimes in order to do this you need to put in a bit more effort and be persistent.
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2 comments:
Hey Kayla,
Something that might help a little with this patient particularly is what is called 'Makaton'. It is a system of communication used to communicate with those with an intellectual disability (not with the hearing impaired). It's basically 'keyword signing' and is very commonly used in down syndrome. You speak english while you sign the keywords to emphasise the main points of what you're saying. A lot of it is 'natural gesture' but there are some really handy signs for basic things like want, like, more etc. They use it with all down syndrome kids nowadays so your patient will probably know at least some of it. If you are still having trouble communicating with this pt I'd be more than happy to photocopy some of it for you or can email some of the resources they gave us to you but otherwise it sounds like you're doing well! xx dani
Great idea to speak to the family kayz, they're so important when working with pt's who are intellectually impaired or unable to communicate. When i was on the same prac there was a 28 year old who was admitted post-aspiration of pool water in a near-drowning. The pt was intellectually disabled and had a lot of difficulty communicating due to brain damage sustained in a MBA 10 years earlier (not sure if his mental age as i didnt actually treat him, just took an interest in the case). What the nurses/doctors/allied health team were using was chart with simple common words (drink/tired/yes/no/want/nurse/mum, etc) in a table format and he was able to point to the words he was trying to express. I'm not sure if it was a pre-existing system his family had been using for years or something someone on the ward thought of, but wither way it made treating him a lot easier. Not sure how well this would work with someone of a 6 year olds mental capacity but for in the future if anyone has a pt who cant communicate, our supervisors would love it if we suggested something like this. And speaking to and involving the family like you did is a great idea too! Well done, xox
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