Lessons Revisited, Part 1

Over the last two weeks, I have observed many professional caregivers providing the much needed care that my father required after his surgery.  I have also participated in his care while he was hospitalized and then discharged to home.

The first lesson I want to share with others is that when professional caregivers are talking to individuals and family members they need to always practice the simple task of presenting information in a clear, concise and easy-to-understand method. They need to reinforce their explanations and ask those involved to repeat the information to verify not only that the words were heard but also understood.  There are other factors that should also be taken into account; do any of those involved have a hearing deficit or visual limitation-- many with even the most minor of hearing impairments have learned to lip read in order to better comprehend the conversations around them-- that could interfere with their understanding?  Inform the staff and allow them to post the information-- usually as an over-the-bed sign-- near the individual.  Language barriers may also exist between individuals and caregivers; asking for a medical interpreter for assistance may be needed.  Pain medications and anesthesia have lingering effects especially for older individuals and can cloud perceptions; the same information may need to repeated several times over several days to be fully understood.  No caregiver should ever assume that a nod of acknowledgement is an indication of comprehension.

Dad had his surgery on Friday and his surgeon reassured us that he had told Dad that they had to create another ostomy because there had been a hole in his bowel after they removed his bladder.  I have no doubt that other healthcare providers had repeated the same information to him over the next day or two. 

On Sunday afternoon, I was sitting quietly at his bedside as Dad alternated between napping and watching a baseball game.  After several hours, he looked over at me and said softly; “Did you know that I had a hole in my bowel?  They fixed it already.”  It was at that very moment I realized he had not yet comprehended what had occurred.  I explained to him that they had repaired the hole but in order to do so they had to make an another outside ostomy to divert the stool and allow the bowel to heal.  “I have two openings now?” he replied as he tried to raise his head to look at his abdomen.  I nodded yes.  The crushed look on Dad’s face was extremely difficult to watch.  I went on to explain that if everything healed as planned they would be able to reverse it in several months and close the second hole on his abdomen.  Dad just closed his eyes and shook his head slowly.