This past Saturday I visited my mother who was on day 40 of an unexpected and tumultuous acute care hospital stay. When I last saw her, she was less than 24 hours post stroke, and In the nine days since my return she had regained near normal function of her right arm and leg. While rapid recovery of motor function gives reason to be happy, her persistent expressive aphasia ( aphasia is difficulty with speaking or understanding language) has created frustration for her and for us as she attempts to communicate with family and hospital personnel. And, despite a **Joint Commission standard that states that a patient’s communication needs must be met, in the 9 days post stroke, no speech therapy intervention had been offered which might have helped to establish my mother’s communication abilities and decisional capacity. (The latter being especially relevant as we had scheduled a meeting to clarify my mother’s preferences regarding continued care. )
On Saturday, I introduced my mother to a simple communication board containing words and pictures. Adding to that, I had written down some personal information, including family member’s names. Quickly I was able to validate my family’s observation that her understanding of language was quite good, and despite the limitations of the available vocabulary, my mother quickly accessed the communication board , which was now secured to her hospital bed . Although communication with my mother is now a combination of pictionary, charades and twenty questions, communicate we have. We have clarified Advance Directives, answered my mother’s questions about the long hospital stay, and provided her an immediate way to request basic needs.
Two days ago, my mother was transferred to a rehabilitation facility. A new setting, unfamiliar people, and my mother’s limited ability to speak, has created a renewed anxiety in me. I have already had to clarify her first name which was listed in error on some records, facilitated her ability to respond to a “memory test”, a facility requirement, and a nearly impossible task for someone with aphasia, and we have waited, together, for a response to her call light. As I prepare to leave for a return home, I wonder and worry if her unpredictable and limited speech will serve her when I am not at the bedside to interpret.
The inability to effectively communicate occurs for many hospitalized patients, including those on ventilators, those with tracheostomy, and those with progressive loss of speech from neurogenic conditions such as ALS. If you are a family member of such a patient, and the patient has not yet been evaluated by a speech language pathologist, demand it from their physician. Of course, my recognition of the power and importance of communication has been the driving passion for what I have done professionally for the last 30 years, yet, there is still no preparation, it seems for the reality of seeing a family member’s vulnerability due to loss of speech.
** The Joint Commission is the accrediting agency for hospitals and other health care settings and annually establishes policies to guide standards of care including patient safety, and includes a requirement for meeting a patient’s communication needs. Please visit their website to learn more:http://www.jointcommission.org/
On Saturday, I introduced my mother to a simple communication board containing words and pictures. Adding to that, I had written down some personal information, including family member’s names. Quickly I was able to validate my family’s observation that her understanding of language was quite good, and despite the limitations of the available vocabulary, my mother quickly accessed the communication board , which was now secured to her hospital bed . Although communication with my mother is now a combination of pictionary, charades and twenty questions, communicate we have. We have clarified Advance Directives, answered my mother’s questions about the long hospital stay, and provided her an immediate way to request basic needs.
Two days ago, my mother was transferred to a rehabilitation facility. A new setting, unfamiliar people, and my mother’s limited ability to speak, has created a renewed anxiety in me. I have already had to clarify her first name which was listed in error on some records, facilitated her ability to respond to a “memory test”, a facility requirement, and a nearly impossible task for someone with aphasia, and we have waited, together, for a response to her call light. As I prepare to leave for a return home, I wonder and worry if her unpredictable and limited speech will serve her when I am not at the bedside to interpret.
The inability to effectively communicate occurs for many hospitalized patients, including those on ventilators, those with tracheostomy, and those with progressive loss of speech from neurogenic conditions such as ALS. If you are a family member of such a patient, and the patient has not yet been evaluated by a speech language pathologist, demand it from their physician. Of course, my recognition of the power and importance of communication has been the driving passion for what I have done professionally for the last 30 years, yet, there is still no preparation, it seems for the reality of seeing a family member’s vulnerability due to loss of speech.
** The Joint Commission is the accrediting agency for hospitals and other health care settings and annually establishes policies to guide standards of care including patient safety, and includes a requirement for meeting a patient’s communication needs. Please visit their website to learn more:http://www.jointcommission.org/
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