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Case Studies

Language: English
Context: nursing sister and volunteer to whom she explaned the care
Title of document: Caring for the Patient in Coma Vigilans
Name of compiler: Stefania Hrivnakova
Actors involved: nursing sister and volunteer
Description of the experience:
Simon had 12 years ago serious car accident and from that time he is in coma vigilance, with hypoplasis of muscles, feeding tube directly in stomach through abdominal wall, urinary catheter and hygiene / bathroom he receives with hoist for disabled people.
Simon is handsome man with nice blue eyes and quiet introvert temperament. He speaks only with his eyes. His body is almost unmoving. In the first years he was able to sit in wheel chair, now for 7 years he is attached to bed. He lives in caritas institutional care and the nursing sisters were able to create home environment for him. They have noticed that when they talk together in his room, he liked it and was calm and slept better, the nurses also have noticed that when they have to took him with bath hoist to distant bathroom, it was humiliating for him Therefore they have asked the leadership to create the environment as if Simon was at home and not in the nursing institution. Two rooms were joined together so that he had bathroom and small kitchen there; his own bathroom next to his room is more suitable. The work as ironing is done in the bathroom so that Simon has the feeling being at home, where the members speak together, do some home works and there is a rhythm of household. Usually 2 sisters are in a shift serving him and one or two other elderly. Simon’s room is a place where the sisters meet, speak together, have coffee and speak about daily duties or have informal discussions. He likes the time to hear the voices of sisters. He has feeling of security and feeling of being home and his face shows satisfaction. One of the sister is taking care of him from the very beginning, she has learned from his non verbal speech and from not regulated voice the needs and likes he has. One of the main objectives of care in caritas center was from the very beginning to prevent decubits and to make passive exercises and care in normal hospital bed. Simon eats with feeding tube and once in a week he has to be defecated. To prevent lungs inflammation the mucus needs to be cleaned with provoking cough. Sisters have learnt from his body language when there is time he needs to cough, the water is infringe into his mouth and he is bend over the bed to help the throat muscles to do the activity.
Sisters always inform him when they leave the room – even for 10 minutes - where they are going and when they are back. Simon likes regularity – in all what is done with him – eating, drinking, his bath and positioning that has to be done every hour day and night. Sisters never touch him before they do not tell him what they are going to do and they not only explain to him, but also they try to find out his consent. When they know that he does not like something (as e.g. mouth deodorant) they accept the feeling and explain why it is needed.. They want him to be informed and secure. During night when he cannot sleep they have discussion with him. It is especially important when after bath he had his massage of hands and legs that sisters tell him what part of leg or hand are massaging, since the patients as Simon did not have any idea where their body ends.
Objectives:
To explain to the volunteer who wants to assist how to treat and communicate with the patient in coma vigilans with full rerspect as if he was awaken.
Means and Strategy:
The explanation and teaching communication with the patient in various acts of nursing and caring, to create for the patient home environment
Conclusions:
It is important to explain to the volunteer not only the individual acts of treatment and caring of the patient, but also whole context and personality of patient, so that there is always human bond with patient and everybody who takes care of him.
Name of Institution: Transfer Slovensko
Role: volunteer

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