Convalescent Nurse's Care Records for Patients with Impaired Consciousness - Part 1: Who Decided There Was 'No Response'?

Have some of you noticed that the title has changed a little? 😊

Guess what!
I'm starting a series! ✨️😊


In this series, I would like to write about the care of patients with impaired consciousness, focusing on it specifically within the rehabilitation nursing practice I perform daily.

And for the title of this first installment, I quoted lyrics from a song by Ayumi Segai, who wrote a self-introduction song for me as a nurse. ✨️
*I have obtained permission from Segai-san. 😊

👇️ Here is the article Segai-san wrote about that song. 😊

Well then!

I look forward to your company. ✨️

Previously, in this article, I wrote about what I usually practice as 'tips for eliciting responses from patients with impaired consciousness.'
👇️I elicit responses from patients with dried shiitake mushroom talk. 😑

This time, I would like to talk about the meaning of the responses shown by patients with impaired consciousness from my own perspective.

When you hear 'impaired consciousness,' don't many people imagine someone just lying in bed all the time?

No, no. 🙂‍↔️🤚

This is a convalescent rehabilitation ward! ✨️
We nurses support every patient in gradually getting out of bed and living their lives. 💪

◆ Don't miss the slightest response

One day, I was assisting a patient with changing clothes after a bath.

Women have, you know.
There is one special piece of equipment for the chest area, right? 🤣

Hiding private zones means being conscious of other people's eyes.
That is a very important awareness for living in society.
So, please, don't be lazy and wear it. 🙂‍↕️
Though many patients are 'unguarded' while hospitalized...

'As a woman, you must store your chest area yourself.' 🤣

Of course, I will assist those who find it difficult to do it alone! 💦?!

...But.
...You know?
When someone else adjusts it, somehow, well...
The fit is just... 😫

Since I usually think about things like that, when I was assisting the patient with changing, I said to them,

🐦️ 'Adjust your position yourself at the end, okay? 😑'

I said that to the patient.
...What on earth am I saying to the patient... 🫩


By the way, this is to a patient with impaired consciousness who usually shows no response even when staff talk to them.

...What on earth am I saying to the patient?...
I said it twice because it's important 🤣

Regardless of the content 😅, there was a clear intention behind speaking to them.

Regardless of whether they could do it or not

what I was about to do / what they needed to do themselves


I wanted the patient to be aware of those things.

And then, the patient... 😳

They adjusted their underwear by themselves...!! ...Amazing ✨️!!

I was trembling with emotion at that moment 🥹✨️

🐦️ "...Mr./Ms. XX adjusted their underwear by themselves 😳✨️?!
Wait a minute?! You haven't responded until now!
So you could hear me all along!!"

"...Pfft 😆"

When I engaged with them, the patient burst out laughing and choked, didn't they~ 😑

Many people choke on their own saliva, you know... 🫩
Sorry for making you laugh (*ﾉω・*)hehe

Looking back on it now, it wasn't just a slight response... they actually responded much more significantly than I thought 🤣

But until then, there was no response even when I spoke to them, and the patient needed assistance with all daily activities...
Who would have thought they'd start adjusting their underwear just from me speaking to them.

It's enough to make your eyes pop out of your head 🫪!!

This 'underwear adjustment incident' became the catalyst for this patient to start regaining their 'sense of self' 🙂‍↕️

◆ What is necessary for movement

Isn't that amazing ✨️??
Huh 🧐?
You don't know what's so amazing??

I suppose so 🙂‍↕️

Let me explain in study mode for a moment 🧐

Humans are built in a way that makes instincts easier to reproduce.

* Eating
* Drinking
* Sleeping
* Excreting
* Feeling cold or hot
* Feeling pain or discomfort

Even if they cannot speak, such responses can appear as facial expressions, eye movements, hand gestures, or body stiffness.

Desires close to instinct are equipped as basic functions for survival.
It can be said that behaviors close to such desires are more likely to appear as responses, even in patients with consciousness disorders.

In contrast, the action of 'adjusting underwear' this time is a more complex and social desire than an instinctual one.
To put it extremely, humans can survive without changing clothes😅

For us, it is a simple action of just 'adjusting underwear,' but when broken down in detail, it is actually composed of this many combined functions👇️

Within this single action of 'adjusting underwear,' there may be the patient's understanding, sensation, movement, and the will connected to daily living activities.

I just couldn't bring myself to believe that the patient's action at that time was 'just a random movement.'

◆Confirming reproducibility

And so.
My rehabilitation nurse spirit was ignited!💪🔥

🐦️
'I'm going to confirm whether that action I saw once was a coincidence or intentional!'

With that enthusiasm, I tried giving the same instructions during bathing and morning/evening changes.

In other words...
It's the 'Great Operation to Adjust Position by Yourself'🤣🤣

In all cases, the patient was able to adjust their underwear by themselves👏✨️
Yay!🎉 We did it!

Since reproducibility was confirmed through my interaction, I then checked if the same action could be performed when other staff members were involved.

🐦️'You know, [Name] can adjust their underwear position by themselves🤭'

😳'What?!! No way!'

🐦️'It's true. Have them do it when you change their clothes!'

😊'It really was true...'

🤣🤣🤣

Through this interaction, it became clear that the act of 'adjusting underwear' was the patient's own intention✨️

If only I can elicit these responses, the patient's daily activities will not expand.
I may be a workhorse 🐎 nurse, but working 24/7, 365 days a year is a bit 🤏
……impossible 😫!
To support the patient's recovery, I need to enlist the help of many people.

◆ 'Intention' submerged in the sea of consciousness

When there is an impairment of consciousness, responses inevitably become sparse.

……However, it does not necessarily mean that our calls are not reaching them at all.

Even if it looks like there is 'no response',
in reality,
they might just be in a state where they 'cannot return' a response.

Following this incident, daily activities that were previously staff-led because there was no response were changed to be supported only after confirming the patient's intention.

The patient, who found verbal responses difficult, began to respond little by little through non-verbal methods, such as turning their face away, nodding, and sometimes showing anger or crying.

There isn't a response every single time. Even so, the number of times that interactions with staff were clearly established increased.

The responses that patients with impaired consciousness show us medical professionals are extremely subtle.

However, within those tiny, voiceless changes, the patient's 'intention' is definitely there.

It's just that...

they cannot easily convey it to anyone other than themselves.
That is the reality standing in the way of patients with impaired consciousness.

In a song written by Ayumi Sekiumi, there is a lyric that says,'I felt like you smiled on the other side of the sea of consciousness'

The unconscious wishes and feelings I hold when interacting with patients with impaired consciousness are tightly packed ✨️ into these lyrics.

What I can do as a rehabilitation nurse is toexplore what intention lies behind the patient's subtle responses, repeatedly verify it, and link it to their daily life to reproduce it.

I believe this is the very first step in supporting a patient's recovery.

◆ Next time...

What I did to connect this 'small intention' to spontaneous action 🤔

What happens when we incorporate the behaviors that shape a person's individuality into nursing care?

I would like to talk about the changes that occurred as a result of gradually cultivating the relationship between the patient and the nurse while deepening our understanding of the patient.

◆ I have also written other articles related to the care of patients with consciousness disorders ✨️

In addition to the article introduced at the beginning, I have written about the care of patients with consciousness disorders.
If you would like, I would be happy if you could also take a look at the nursing care I usually engage in here ✨️