Lifelong Learning Programme

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Close the door!

Zurana Noskovičová
Language: English
Country: Slovakia
Typology: health care professionals
Text:
Mr. Rudo is about a year after a brain stroke. He is able to sit himself up on the bed and drop his feet down on the ground. He uses his left hand and keeps things on the night stand. He can get up alone with a help of a four point support stick, and sideways walk about 10 steps from the bed to the dining table. He drags the paralyzed leg behind him. He can sit on a chair by himself and eat alone. He has a colostomy. Rudo is independent using the urine bottles which are within his reach on a chair by his bed. He understands what people tell him but is not able to answer. He uses only “ta ta ta”. When he wants to explain something more difficult or ask for something he says only “one two three four”. Communication is thus very limited. Sometimes he gets angry or resigns when the nurse cannot guess his wishes. Rudo is 76 years old, he is a widower. His children with their families live in other villages and visit him regularly. They provide him with shoppings, keep his household clean, provide him with medications and according to the need also provide a care for him. That is the reason why to nurses come3 times a day to his house. They help him to prepare the food, help him with personal hygiene, empting the urine bottles and with rebinding the colostomy. Rudo used to work as a farmer and a house in which he lives used to be an old farmer house. He used to be a hunter so his house is full of stuffed animals. It is his favorite topic. Rudo subscribed newspapers and he likes to read them. There is a remove control next to his bed, he likes watching TV. Nurses give him also bottles with water near to his bed; he can pour water on his own. Rudo eats always the same for his breakfast - tea, fruit yogurt, banana and cake. It is important for him to have everything prepared as usual. Everything in his room has its own place. When there is something unusual, moved or somehow changed Rudo is not satisfied. Then he tries to explain to the nurse what needs to be changed. For example when the TV channel is changed Rudo starts to count, one, two, three...that is how he express that something needs to be changed. Then he usually wants to play puzzles. Switch the TV? Ta ta. Open the window? Ta ta ta ta. Ah, so you are hot, turn down the heating? Ta ta ta. If the nurse does not puzzle out what he wants, the tension is growing. The nurse explains to Rudo that they will try to communicate the other way. She sits in front of him and says good morning. She lets him read from her lips and encourages him to repeat what he hears. Rudo tries to repeat syllable by syllable. Sometimes he succeeds and the nurse compliments him. Sometimes he does not and then the nurse repeats the word as many times as he needs for successful repetition. That is how the way of communication gradually changes. When Rudo uses ta ta ta the nurse explains to him she does not understand and offers him words and when they agree about what he wanted to express they repeat the word together until he can say it. Every morning, lunch and dinner along with eating or hygiene they try to look for meaningful words from his daily life and he learns to use them again. Sometimes they practice by naming the objects in a room or activities they are doing. Rudo sometimes can repeat a word without problems and that makes him happy. They are starting to have small talks together. The nurse helps Rudo to dress up. The nurse tells him to take on the socks, Rudo says yes. Rudo tells her tatatata, the nurse asks him whether he wants to drink, Rudo says no. The nurse asks if he wants a tissue, Rudo says yes. The nurse then tells him to repeat and let him repeat. Rudo repeats: gi ti. The nurse repeats give me a tissue. Rudo tries give me a tissue. After weeks of practice they try to really speak. Rudo is happy when he manages to say simple sentences and when he does not he laughs at nurse’s expressions. One morning the nurse comes to the kitchen where is colder than in Rudo’s room and he shouts at her: tatata, the nurse come back and asks him what he wants. Rudo: door. The nurse: door what ? Rudo: close. The nurse closes the door and then she can hear Rudo’s laugh. She brings him a breakfast and says: Good apetite. Rudo repeats: good apetite. After couple of weeks Rudo can use abou 10 words by which he can express what he wants. For example he says: a bag when he needs to change colostomic bag and the practice continues. The nurse starts to ask him about the stories of hunted animals. It is his favorite topic so he tries to speak. OBJECTIVES: Help Rudo learn a few simple sentences so he can express his needs and demands. Reduce the feeling of communication helplessness and isolation. MEANS AND STRATEGY: Nurse CONCLUSIONS: Rudo flawlessly greets the nurse back when she comes. He repeats sentences offered by her and he can reply yes and no in the right way. He enjoys again trying to communicate


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