Big thanks to Amy Mindell Ph.D. and Dr. Pierre Morin
Review and record the following material, as possible and applicable
Contact information for the facility:
Contact information for relative(s):
Contact information for caregiver(s):
I. Medical and Legal Information Gathering
a. At home
or a medical facility?
b. Is family
content with location and treatment options?
2. Living will. What does it outline? Who
has durable power power of attorney for health care?
3. Talk with relatives and caregivers
about the patient's condition
what you want to do
c. Offer to
teach coma communication skills
information about handouts and books
4. How long has the person been in coma?
5. Read charts for background and record
current details and medications
6. Details of how the person became comatose and
causes: metabolic changes, dementia, traumatic brain injury, stroke,
brain mets, anoxia, psychogenic factors...
7. Test results: CT, MRI, PET, EEG,
Glasgow Coma Scale, Ranchos Los Amigos, Caloric test, Doll's Eye's
8. Inquire about current health and
medical conditions: injuries, illness, and special conditions to be
trache, ventilator, intravenous, feeding tube
paralysis, seizures, visual impairment, hearing loss.
fractures, contusions, contractures, infections, ulcerations,
thrombophlebitis, constipation, diarrhea. .
9. Rehab: physical, speech, or
occupational therapy; sensory stimulation; massage, acupuncture,
Reiki, Therapeutic Touch, Trager, Shiatsu, other forms of body work,
music therapy; counseling; spiritual care. . .
II. Personal Information Gathering
10. Are family/friends coping and
receiving emotional support, counselling, spiritual care, group or
family therapy. . . if wanted?
11. Has the client been in coma
previously, knocked unconscious fainted, under anesthetic, spaciness,
12. Personal history: age; relationships;
religion; career; lifestyle; language; education; addictions; pre coma
13. Early childhood memories and dreams
14. Mood, attitude, and last experiences
before entering coma
15. How does the staff feel about the
III. Preparation for Interaction
1. Gain permission from medical staff to
work. Check on the best times to work: the most up awake time for your
patient; most convenient time for staff; and best timing around family
2. Try to take along a co worker for
increased awareness and efficacy.
3. Notice thoughts and feelings as you
travel to see your client. Remember these as a baseline to compare to
new reactions after entering your client's presence. You may also get
hunches, or fantasies that may prove useful later for communicating.
4. If possible arrange to have a family
member, family friend, or staff introduce you.
5. If you are a family member or friend,
how are you holding up? What is your mood? Confusion, uncertainty,
fear, and depression are common and understandable. GET HELP.
IV. Interacting with Your Client or Loved One [Coma Work and
Palliative Care + Coma: A Healing Journey]
6. Knock on the door, even when open. Say
hello and ask permission to enter and visit awhile.
7. Notice the atmosphere (heavy, light,
sleepy. . .) and any new sensations, thoughts, or fantasies as you
enter and settle.
8. Observe and listen closely: posture;
limb and digit movements; breathing location and patterns; facial
expressions and movements; cues in and around their eyes; speech or
other sounds from the larynx, lungs, air passages, ventilator, sounds
in the environment.
9. Pace the breath.
10. Intervene with blank access and follow
11. If possible set up binary 'yes & no'
V. Chart Findings, Especially New Communication Patterns
VI. Consult Colleagues and Teachers, Use Video if Possible
1. Your clients signals and reactions.
2. Your interactions together.
3. Your impressions, intuitions and
feelings after each visit. Journaling will help you learn
about your clients and track their changes over time and help you
NOTE: Your journal entries and experiences may be useful for the
body of anecdotal research we are collecting for furthering the
development of those working with people in coma. THANK YOU.
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