Field Notes from a Convalescent Care Nurse: Closing My Eyes Helped Me See the Tricks to Assisting with Changing Clothes

Up until now, even though these are nursing-related articles, I've been writing about things like duct tape crafts and dried shiitake mushrooms, which are a bit unusual 🤣

This time, I'd like to return to something a bit more practical.
I'm going to talk about what we observe and how we interact when we are by the side of a patient who 'cannot change clothes well'.

This happened when I previously held a training session on higher brain dysfunction.
Most people...

'Higher brain dysfunction'

'That sounds kind of difficult... 😑'

They would brace themselves, and I felt like my message wasn't getting across...
What should I do?
I was worried about that at the time.

◆ Can't change clothes even without paralysis?

Why?
Even though the body moves??

That's right 🙂‍↕️
Even if the body moves,if brain function is impaired, people struggle even with something like changing clothesHigher brain dysfunction is a 'functional impairment' of the 'higher (high, complex level)' 'brain'.

Because it is a disorder occurring inside the head, you cannot judge whether there is a disorder just by looking, unlike cases where there is 'paralysis' or a 'fracture'.


Even though the patient themselves is having a very hard time, it is a troublesome disorder that is difficult to convey to those around themit is a tricky disorder.

◆ Where do they stumble when 'changing clothes'?

For example.
I handed them clothes saying, 'Please change into these!' but...

You haven't changed yet, have you? 😳

Huh? And, isn't it inside out? 😳

Doesn't that happen?
Let's unravel what is happening to the patient at this time.

* Cannot prepare to change clothes.
* Does not know the order of changing clothes.
* Knows it is clothing when looking at it, but does not know how to handle it.
* Does not understand the structure of the clothes, such as front/back, top/bottom, or inside/out.
* Cannot concentrate because they are distracted by surrounding sounds or things in their field of vision.
* Keeps doing one thing endlessly and cannot move on to the next action.

For these reasons, patients may find it difficult to change clothes by themselves.

◆ I had them experience what the patient goes through 👕

Many nurses know as a matter of knowledge what it means to be unable to change clothes.
But in the clinical setting, patients are struggling.😑

I wonder why that is...🤔

After thinking about it, I came up with the idea of having them simulate what it means to be unable to change clothes.💡

The experience is done in pairs.
*One person acts as the patient.
*The other acts as the caregiver.

The rules are:
*The patient role closes their eyes and puts on the clothes handed to them by the caregiver.

*The caregiver hands the clothes to the patient in a disorganized state, having turned them inside out or flipped one sleeve beforehand.

*While the patient is putting on the clothes, the caregiver can give as many instructions as they like, but they cannot lend a hand.

*The time limit is 3 minutes.⏲️ It's the perfect amount of time, just like Ultraman's activity limit.

That's all.🙂‍↕️

What I wanted them to experience in this training was:
The patient's feelings
The difficulty of watching someone who is struggling and unable to do something.

◆During the experiential training.

Since the patient role has their eyes closed, they cannot see the full shape of the clothes.
We tried it with two types of clothing, a T-shirt and a jinbei, but:

“Huh? What is this?😵‍💫”
“...This is definitely inside out...🫩”
“The strings, where are the strings??😩”

Some people carefully checked the tags to find the front, back, inside, and outside.
Some people couldn't figure it out and cried out to the caregiver, “What is going on??”
Some people couldn't finish even after the signal that the time limit had passed.

There were all kinds of people.🙂‍↕️
On the other hand, as for the caregiver role:

Some people silently watched the patient's actions.
Some people gave instructions one by one, saying, “Not there, over here!”
Some people anticipated the patient's movements and gave instructions.
Some people couldn't help but lend a hand.

Here too, various reactions were observed.

After the experience, I asked for their thoughts.🎤

*Patient role
😫
“I didn't think changing clothes would be this difficult just because I couldn't see the shape of the garment.”
😵‍💫
“Even though I'm thinking hard, when people say this and that from the side, it just makes me more confused.”

*Caregiver role
😅
“It's faster to help, so I end up reaching out.”
😓
“It's hard to convey things with just words.”
😣
“I can't wait for the patient's pace.”

Hmm.🙂‍↕️
Good reactions.✨️

Even veteran nurses were understandably bewildered when handed clothes in a tangled state.
We used the simulation of closing their eyes, but actual patients,

even if they can see,
and even if they know it's clothing,
find it difficult to change clothes.

◆ Concrete Intervention Methods

These are the materials actually used in the training.
What I want you to pay attention to is:

* The TV is left on.
* You can hear the conversation between the roommate and the rehab staff.
* A staff member who came to distribute tea calls out.
* The caregiver is giving many instructions.
* The patient is holding in their need to use the restroom.
* The patient is distracted by a toothbrush that was forgotten to be put away.

Even if you are told 'Please change your clothes ☺️' in such a state, you can't concentrate at all, right?

So, how do we actually interact?

Create an environment where they can concentrate.
That is all there is to it.

* Turn off the TV.
* Close the curtains to block the view.
* Of course, be mindful of their sense of shame.
* If it is a busy time, such as when roommates are talking, intervene again when the room is quiet.
* Take care of things they are concerned about, such as using the restroom, in advance.

Only after preparing to this extent can the patient finally focus on changing their clothes.

And, even after they start changing,
the caregiver's approach can make changing clothes either easy or difficult.


🆖Examples of care to avoid
* Talking about things unrelated to changing clothes.
* Giving instructions one after another.
* Handing over all the clothes at once.
* Handing over clothes without the patient understanding their structure.
* Handing over clothes without considering the order of dressing.

It's such a waste....
Even if you go to the trouble of preparing the environment, it's all ruined...😩
I'll cry! I really will!!


🆗Examples of care I want you to practice
* Confirm that their attention is directed toward changing clothes.
👉 Just saying 'Let's change clothes' is often not enough to get the message across.
Look at the patient's face and check their reaction to see if your words are being properly understood. Non-verbal reactions, such as whether they make eye contact or nod, are very important.

* Watch over them quietly while they are moving.
👉 Even if you create a quiet environment, if the caregiver keeps talking, the patient won't be able to concentrate.

* Speak up only if they get stuck in their movements.
👉 Even if they are struggling, if they can think and solve it themselves, it is important to have a 'waiting attitude' rather than jumping ahead and giving them the answer.

* Hand over clothes one by one so the shape is clear.
👉If you spread the clothes out once to show their shape, it becomes easier for them to visualize what they are wearing. Since it can be difficult to think about the steps for changing, hand them only one item at a time.

And what is surprisingly important is that the caregiver should not stand directly in front.
* Of course, if there is a risk of falling, prioritize safety.

When looked down upon from the front, patients tend to feel psychologically tense.
I make it a point to sit next to the patient who is sitting on the edge of the bed to watch over them or support their body.

◆ Feedback from Participants

'I was moved by the lecture from the patient's perspective.'
'The experience of putting on clothes with my eyes closed was interesting.'

I received comments like these in the post-training survey.
Some participants returned to the ward and became teachers themselves, encouraging other staff to try the experience.
Some people even practiced both good and bad interventions when interacting with patients to confirm the difference.

As an instructor, I was very grateful that they took what I taught in the training back to the field to practice and spread it✨️

The importance of providing care and speaking with a heart that cares for the patient.

Being a caregiver who can think about what the patient is thinking and what they want.

Being a caregiver who can think about why a movement is difficult when facing what a patient cannot do.

Regardless of whether they can or cannot do it, I want to respect what the patient wants to do, stay positive, and be able to think through things together.

I would like to conclude this article with a wonderful comment from a participant😊
Thank you so much for reading this far😆