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When even an own shower cabin becomes a maze

Karin Branikova
Language: English
Country: Slovakia
Typology: health care professionals
Text:
Albert is again back home with his wife after a sudden brain stroke followed by a physiotherapy treatment. Albert at the age of 74 enjoyed with his wife the deserved retirement. They could afford to travel because as a former railway man he was still legible for discounted tickets for him and his family as well. He has a married daughter which lives in the same village. He liked very much to play with his granddaughter who he took for long walks in the nearby woods. Albert was active and independent. He was used to decide in the family matters. He used to read a lot, met with his friends, he was social. He was interested in political happening, he enjoyed working in his garden and around the house. Last year Albert survived a sudden brain stroke. After the acute phase had past he took complex physiotherapy treatment in a physiotherapy institute with an aim of refreshing his lost functions. Afterwards he returned home. Nowadays he lives with his wife in a family house. Albert needs constant presence of another person because he is not able to manage his ordinary day. He is not able to judge possible risks, neither provide self service actions. He does not speak, only occasionally he repeats words and sometimes he understands what is said or what the instructions are. The communication is tough. He has a permanent urinary catheter because he is not able to urinate spontaneously or find a toilet by himself. His motoric skills remained preserved in the whole body. The client walks around the house and garden but he can not avoid a risk of falling (for example, down the stairs or into the garden pool, on a road where cars drive). He needs a full care on daily basis of his personal hygiene, clothing, drinking regime and food. He does not at all understand the changed situation. He does not understand why his wife or the nurse guide him. He is not able to understand the meaning of things. Verbal explanations basically do not get to him. He does not start any meaningful activity spontaneously. If he is left alone, he only sits and looks or walks within the space. For Albert it is difficult to adapt to a new situation. He shows his frustration by anger. He clenches his fists, makes faces and grimaces. He refuses to cooperate. Albert has an altered ability to understand what is spoken. He does not know how to read nor write. Albert can enjoy when he sometimes understands the spoken language, for example when he answers a greeting. He can not answer the question of what his name is but he can sign his name and it is visible that he is happy. When he is not able to react to any other task, it is visible that he is trying to understand and that he worries. At the end he signs his name. Therefore, it is obvious that he lacks a sense of accomplishment from his spent effort. However, he is nervous and impatient. Since the stroke Albert is irritated in the company of other people and if he has to stay there longer he becomes angry. On the other hand, he likes to walk in the garden of his daughter. It is big and wihout any pitfalls. In free space he can walk for a long time. It feels peacefully and he feels contended here. The need to communicate in ordinary life situations burdens him. The nurse has responsibility for taking caring of the morning whole body hygiene and dressing up as well as the regular everyday control of the permanent catheter and its bags. With simple instructions and non verbal communication she motivates Albert to undress himself, safely pass the step into the shower cabin, cooperate when setting up the satisfacory water temperetaure for him and participate within his preserved abilities on the task of daily hygiene. The nurse takes over activities which Albert can not perform by himself or he can not decipher the instructions. Albert has difficulties getting used to the presence of a strange person in the intimate situations. His wife decided to leave the room at those times so Albert gets accustomed to the fact that some care will be taken by other people besides her. The nurse sensitively reacts to Albert’s non verbal dissatisfaction. Repeatedly she encourages him to seek together the way of understanding each other, she repeats questions and uses non verbal support. She shows him how to make individual gestures. The method is very similar to when you are trying to communicate in a foreign country with a person with whom you do not speak a common language. In the moments when they understand each other Albert’s frustration from dependency and his loose of control can be avoided. If the nurse is able to understand and meet Albert’s need he is satisfied and pleased that he managed to communicate. She equally motivates Albert to dress up after the hygiene. Daily routine repetition of the self service activities under the supervision and training of new creative ways of communication with another person return to Albert at least a part of the self-determination and self-esteem feelings. When he is able to express a need or refuse an activity which he does not want, when he meets with understanding, he looks satisfied. The process of hygiene, dressing up and self service activities helps to create new communication patterns which support Albert’s self-expression and help him regain independence. They at least partially return him to the times when he knew how to feel well with other people. OBJECTIVES: The client accepts nurse’s support during the daily hygiene and does not react to it angrily. He perceives it as a help. Relief for his wife as the main person in his whole day care. Creating new communication and coping strategies. MEANS AND STRATEGY: Motivational and clarifying talk with the use of non verbal communication as a support during the whole time of general personal hygiene. Creating the feeling of security and acceptance of client’s needs. Facilitating client’s self-expression in a new way. CONCLUSIONS: The client needs to regain back the feelings of security and control in new conditions when he cannot verbally express his needs and cannot orientate himself adequately in the situation.


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