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Providing care for an unconscious patient: a child who does not respond

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How do you communicate with a non-responsive patient? A student nurse discusses various methods to interact with patients on ventilators

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Danielle Hunt

I have recently completed a placement on a paediatric intensive care unit where a majority of the patients were muscle relaxed and sedated. This means that the patients for one reason or another were placed on a ventilator, a mechanical and invasive form of ventilation where we deliver air to patients to help them breathe. Furthermore, this is an extremely traumatic and stressful time for families to witness. It is fundamental that as a student I effectively communicate during this period to comfort both child and family.

However, this was a new environment for me, as I had no previous experience dealing with a child who did not respond back to me. Even a young baby will respond with facial expressions or small movements. I was very apprehensive and unsure about how to comfort the child. Whilst I knew I had to adhere to the Nursing and Midwifery Code of Conduct (section 7: communicate clearly), it would also be unethical to provide care such as suctioning without informing the patient. Imagine if your family or child was treated in such a way? 

Usually, a child would be able to tell you if he or she was in pain or wanted someone to talk to. But it is always difficult to get a response from children on ventilators. Therefore, you have to use your initiative. This was challenging but extremely rewarding. 

I decided to do some research on the best ways to approach the patients. Was there evidence out there to support practice? Would the patients best respond to non-verbal communication, such as touch and silence or verbal communication? It is important to note there is limited evidence on the perceptions and attitudes of a patient on a ventilator, but there is vast research on therapeutic communication and emotive language. 

I read about it and implemented it in practice. My nerves soon settled when I saw the comfort it brought to the parents and it also encouraged them to communicate with their child. This brought me immense pride and satisfaction as I was able to facilitate a bond with a parent, who was more anxious than myself to communicate with her child surrounded by wires and tubes.

The use of soft toys to provide comfort and create the sensation that someone was around had a remarkable effect on the child. In one circumstance, I was able to slow down a child’s heart rate with tachycardia. This shows a clear rationale for using this form of communication with children on ventilators. 

It is important to include parents in your efforts, as they know their children best and will be able to understand if they are distressed or what their likes and dislikes are. For example, one child loved music and this was a very effective form of communicating with him. We would stop the music when we were about to perform a procedure and briefly explain it to him. This would inform and comfort him and ensure we are treating him with the utmost respect and as an individual.

After reading the research, I was able to provide evidence-based practice for providing care to a child on a ventilator. I was also able to encourage parents and educate staff on new findings, such as the use of soft toys or clothes that smell of home. This provides comfort and leads to effective communication, thus allowing us to deliver high-quality care.

Remember, you are not alone when feeling nervous talking to a patient on a ventilator or who is unconscious. It is important we communicate effectively and treat the child as an individual. Imagine how the parents or family might feel to see their child on a ventilator. Learn from them, and encourage them to communicate with their loved one. Therapeutic communication is the most effective form of communication, a lesson I will take with me through my nursing career. 

Danielle Hunt is currently in her third year studying child nursing at Birmingham City University 

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