Name:

Age:

Gender:

Contact information for the facility:

Contact information for relative(s):

Contact information for caregiver(s):

I. Medical and Legal Information Gathering    

     1. Location

          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

          a. Learn about the patient's condition

          b. Explain what you want to do

          c. Offer to teach coma communication skills

          d. Offer 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 response...

     8. Inquire about current health and medical conditions: injuries, illness, and special conditions to be careful of:

          a. oxygen, trache, ventilator, intravenous, feeding tube

          b. paralysis, seizures, visual impairment, hearing loss.

          c. 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, or depression?

     12. Personal history: age; relationships; religion; career; lifestyle; language; education; addictions; pre coma health

     13. Early childhood memories and dreams

     14. Mood, attitude, and last experiences before entering coma

     15. How does the staff feel about the person's condition?

     16. Prognosis

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 visits.

     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 feedback.

     11. If possible set up binary 'yes & no' communication.

V. Chart Findings, Especially New Communication Patterns

VI. Consult Colleagues and Teachers, Use Video if Possible

VII. Journal

     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 consult.

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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