“How in the world am I going to chart this?” I wondered as I sat across from Nell, who filled her large wheelchair to overflowing. This was our second attempt at psychotherapy, which I’d discontinued a few months ago because I felt all my efforts had gone nowhere. Nell sat in her room all day, doing nothing and talking to no one, yet she was clear in her thinking and clearly depressed. She resisted all of my suggestions, recommendations, cajoling, begging, humor, and coordination with the team to adjust her medications. Efforts to connect her with her estranged family had produced a tepid response. “She’s been this way all her life,” her son told me when I’d finally called to tell him I’d stopped seeing his mom. “I’ve given up,” he added.
Now here I was, three sessions after the team had referred her for psychological services again, trying to determine a treatment strategy in the face of her extreme hopelessness.
“There’s nothing I can do,” she said, “because I can’t see.”
Her talking clock, talking watch, talking books, radio, and TV sat unused after her initial training in how to operate them.
I consulted with colleagues the next week and they encouraged me to keep going. “You’re the only person she talks to,” they said. “That has value.”
A couple of weeks later I ran into Nell’s aide in the elevator after I’d finished a staff training.
“You know she asks for you all the time, don’t you?” she said.
“She does?” I was shocked.
“You’re Eleanor, right?”
“She calls ‘Eleanor, Eleanor, Eleanor’ all day long. And when she doesn’t want to take a shower, we tell her ‘Eleanor wants you to do it’ and then she goes along with it.”
“I had no idea! Thank you for telling me that.” I was flabbergasted — and relieved that my documentation could reflect some actual purpose and progress.
The next week I sat across from Nell with a lighter spirit.
“There’s nothing I can do,” she said, “now that I’ve lost my eyesight.”
“That must be a huge loss for you,” I replied.
4 thoughts on “Team Communication: A Shout-Out for CNAs”
That’s one thing I liked about inpatient/ LTC settings. When the team players work together, it could be a win-win situation.
I agree, C, and I think we can do a lot more to make interdisciplinary communication easier, more frequent, and more productive.
A fellow resident in this assisted living facility has advancing macular degeneration. She and I have been bridge buddies for five years. She keeps talking about quitting bridge and I keep telling her to hang in. When we play, either as partners or opponents, I call out the cards as they are led or played as trick winner. She plays a good game and when I ask how she is, she tells me. I think sincere conversation is important to her and most others.
Bob, sometimes the best therapy is providing an opportunity for someone not to be a patient, but just to be a regular person hanging out playing bridge.