By: Julie Henderson
Communication isn’t always easy. However, obtaining good information from patients or residents on the condition of their health, personal preferences concerning their diet, care in general, social circumstances and lifestyle, in addition to a good medical and family history, is crucial to good health. During my recent rotation at Future Care Irvington in Baltimore, MD, I was given many opportunities to engage with residents and I recognized that gathering this information could be challenging for various reasons. This facility cares for people approximately twenty years old and up. Not all residents stay long term, as some go through rehabilitation and are sent home. Either way, I was given opportunities to gather history and dietary information from many residents to better care for each one. To do this, I needed to consider ways to gain the information from individuals who were unable to easily communicate.
First, there are many different types of communication roadblocks when giving information to or receiving information from a resident.
- Residents may have vision or hearing problems that affect their ways of transferring information. For hearing considerations, which are heightened while wearing a mask, I asked each resident if they could hear me at my regular tone before continuing to talk with them.
- Psychological status, education level, language barriers and readiness to make changes are important factors to consider, too. Some of the residents I worked with had strong accents, but I was able to decipher them by actively listening and repeating what I had heard.
- A few of the residents that I encountered had communication struggles due to strokes that caused slurred speech and sometimes muscle weakness in parts of their bodies. I assessed a resident who informed me that he needed assistance with cutting up his food and opening condiment packages because his left side was not functional. I had to listen carefully as his speech was slurred. His deficits could have affected his needed nutrient intake if we hadn’t known to provide assistance.
- Encephalopathy, dementia and Alzheimer’s disease, all of which affect memory and hinder reasoning, were common disabilities I witnessed. Therefore, the information I gained from these individuals needed to be supplemented with information already in their records, by direct observation and by checking with those caring for the resident.
I gained experience working with residents who had challenges with speaking. Some had tracheostomies, others spoke very softly and some were without their dentures. I learned to face those I was talking with, listen carefully, and look for gestures and head nods. I wanted to give every resident the opportunity to share with me what they could.
Researching the resident through their medical records first was helpful. I was able to gain background information about each person and get insight on medications that could have interfered with food and nutritional status before I went to see them. I had a resident tell me he wanted bananas and tomatoes occasionally, but because I saw his medical diagnosis in his records, I was able to explain why he doesn’t get those items in his diet. Until I became more comfortable in my role, I used a list of questions from the nutrition assessment computer format to gather and record information about the residents I met. The team uses that information to guide each resident’s care. I asked questions about chewing and swallowing difficulties, if they had their natural teeth or not, nausea, vomiting, bowel movements, allergies, food and beverage preferences, and about their height and usual body weight.
While considering strategies for communication with residents, I thought of many options to gain the needed information for their individualized nutritional care. When entering any resident room, I learned to give the courtesy of knocking and introducing myself. Afterall, this was their home away from home. I made every attempt to talk to them in person and listen intently. If family members or friends were available in person, I included them in our discussion. They often were helpful with filling in missing or additional details. For example, I entered a resident’s room to find his wife was present. While asking questions to the resident, she informed me that he wore dentures and that he would not have them during his stay at the facility for fear of them getting lost. This was valuable information. I made sure we would provide appropriately textured foods for the patient. Right from initial intake, I learned to consider the residents’ cultural backgrounds, as they may not eat or drink certain things due to their beliefs and religious practices. In addition to the residents and their family and friends, another useful source of information was other staff members. Staff could tell what they heard or witnessed about certain habits, likes, or dislikes of the residents.
When working with residents who were receiving enteral or parenteral feeding, the assessments were geared towards gastrointestinal concerns, labs, and well-being. I had to shift gears when speaking with them for information, since they were not eating by mouth. The formula they received was primarily determined by estimated nutritional needs, and then was adjusted, if necessary, due to health concerns and symptoms from the formula itself or the rate of feeding. Observations of visual physical appearance and measurements were done rather than nutrition focused physical exams due to the fragile nature of the residents in long term care facilities. I reviewed lab results, bowel movement output records, and any pertinent medical records to look for changes in resident status and provided suggestions for a review. I was asked to give my suggestion for a person who had psychological issues and was opening her tube feeding and letting it drain out onto the floor. She was already on nocturnal feeding to assist, but now it wasn’t helping. I recommended giving her bolus feedings to provide her nutritional needs while under supervision.
To conclude, I have been told many times in the internship to “get comfortable with being uncomfortable.” As an intern, going into a room to visit a resident was intimidating at first, especially without looking over the medical records. Also, I initially felt uncomfortable when residents were unhappy, but listening to them was valuable and they had the right to be heard. By the time I finished my rotation, I found comfort in caring for the residents and finding opportunities to get the information needed to help them. I began building relationships and rapport with residents and staff, which was the highlight of my time at Future Care Irvington. I believe with different experiences throughout the University of Maryland internship, I will continue to learn tricks that work to gain the information that I need to best care for those I serve.