Clinical placements

Tailor your communication to your patient

Caring for a patient with a severe brain injury taught Lauren Stafford the importance of tailoring your communication. 
Lauren Stafford

Caring for a patient with a severe brain injury taught Lauren Stafford the importance of tailoring your communication

While working on an intensive care unit, I helped to care for a man who had sustained a severe right-sided brain injury after falling down the stairs about two weeks earlier.

The patient, who I will call John, had shown little signs of improvement since the event, and the doctors were in talks with his family about how to proceed. They had a do not attempt CPR order in place, and organ donation had been mentioned as it seemed there was little chance that Johns condition would improve.

When John was handed over to us, we were told he had a Glasgow Coma Scale (GCS) of seven out of 15, indicating that his consciousness level was very low. The GCS is scored between three and 15, with three

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Caring for a patient with a severe brain injury taught Lauren Stafford the importance of tailoring your communication

While working on an intensive care unit, I helped to care for a man who had sustained a severe right-sided brain injury after falling down the stairs about two weeks earlier.

The patient, who I will call John, had shown little signs of improvement since the event, and the doctors were in talks with his family about how to proceed. They had a ‘do not attempt CPR’ order in place, and organ donation had been mentioned as it seemed there was little chance that John’s condition would improve.

When John was handed over to us, we were told he had a Glasgow Coma Scale (GCS) of seven out of 15, indicating that his consciousness level was very low. The GCS is scored between three and 15, with three being the worst and 15 the best. It is comprised of three parameters: best eye response, best verbal response and best motor response. 

Part of the assessment asks whether the patient can obey commands. To assess this, John had been asked to stick his tongue out, but he was unable to do so. However, I had noticed that he was able to move his right hand slightly. 

I had learned how to assess GCS on a recent placement on a neurosurgical ward, so as part of my A to E assessment of John, I reassessed his GCS. But instead of asking him to stick out his tongue, I said: ‘John, if you can hear me, give me a thumbs up.’ Very slowly, he managed to clench his fist and stick his thumb up.

Input and response

Obeying commands indicates that the brain has the ability to translate sensory input into a motor response, giving a good overall indicator of how well the brain is functioning. I was amazed by John’s reaction, and felt quite emotional that he could hear me.

This experience was influential in my nursing development. I feel that I demonstrated at least three of the 6Cs by having the courage to question the nurse's previous GCS score, by competently carrying out the GCS assessment task and by communicating with John. His response highlighted how essential communication is in nursing.

I found it difficult to comprehend how hard it must be to lie there and have absolutely no control over your body, yet still be able to hear. Even if it seems that your patient cannot communicate at all, you still have to try. I continually communicated with John, from introducing myself by name to explaining what we were doing and why, such as turning him to prevent pressure damage. 

This experience also taught me that no matter how sick your patient is, you should always remain committed and look for ways to help them. Despite predictions made by doctors about the severity of the bleed on John’s brain, he still had a chance of improving further and possibly recovering. 

Caring for John made me a more compassionate and caring nurse, and my aim is to work in intensive care once I qualify. 


About the author 

 
 
Lauren Stafford is a third-year nursing student at the University of Nottingham 

 

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