I am currently on a placement where a lot of patients have ETT's and are very sedated or they have tachy's. One particular patient i have been treating quite regularly has a trachy. I had never come across intubated patients in any other prac before this one and so this was a very new experience to me. My patient with a trachy was becoming better every day and his sedation levels were being weaned so we could hopefully begin to increase his mobility. I hadn't thought about it too much before, simply i suppose because i haven't come across it, but once he was alert he had a great deal of difficulty communicating with me (as well as other staff) because he couldn't express himself in words.
It was a new situation i came across. I have experienced patients who speak very little English, as English is their second language however i seemed to always manage treatment sessions alright as these people were all fairly independent compared to my patient with the trachy.
I assumed that gestures etc. would always be suffice with patients that have a reduced ability to express themselves and if they were still struggling perhaps an interpreter would be a good idea. But with this patient there's nothing altered about his language. He speaks English normally and can communicate fine but due to the trachy it has affected his ability to tell staff if he's in pain or if he is short of breath etc.
Over time i have limited my talking with this patient to simple questions which he can either nod or shake his head to. This works well most of this time and some things that he commonly wants i can now interpret as i am starting to get to know the patient better.
In future i will endeavour to be more succinct with my questioning of patients as not only is it important for patients who have a compromised ability to express themselves via language but it also makes more sense when dealing with aged people, younger kids and pretty much everyone. Sometimes it's easy to fall into the trap that everyone is understanding what you are saying and are able to express themselves back in the same manner. It's good to experience this situation to realise not all people have the ability to say what they want when they want.
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Good post, Erin, ive also had a prac that involved many intubated and ventilated pts many of which were long term and also had trache's. Your reasoning sounds spot on, cos i tried to adapt similar strategies with mostly good effects. I also found talking to the nursing staff that work around the clock or family members that are often with the pt if there are any facial expressions or gestures that indicate certain things. Once the speech therapist gets involved with decuffing of the trache a speaking valve can be put on and the pt's often have a lot to get off their chest!
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