Coma is always shocking. Although
the best medical procedures attend to
the immediate needs of the body of coma
clients, family and friends are at a loss
in knowing how to support their loved
ones further. Unfortunately, the majority
of care is based on the belief that the
person in coma is not really present.
Even when it is believed that the person
is present, it is often assumed that they
can only be shocked out of their state
through various “arousal” techniques.
While these methods are potentially useful,
they seem unnecessarily violent and may
lack follow through for continuing communication
beyond initial reactions. Go to arousal
approaches.
Back to top.
At ComaCARE
our approach is deeply respectful of the
individual and their inner journey. In
our understanding, coma is an extreme
altered state of consciousness in which
the person is not relating to ordinary
reality.
However,
people in coma are experiencing potentially
meaningful experiences and can often be
reached through special communication methods.
It is an advance that coma
clients are often now talked to and
it is acknowledged that stimulation is important.
What is not readily recognized is that communication
is a two way process and coma clients are
also trying to be heard. Their “voice”
can be “heard“ through minimal signals;
sounds, movements, postures, breathing patterns,
skin flush, etc. Go to
training for carers
Back to top.
ComaCARE work
does not focus on getting the person to waken,
although this sometimes happens. The goal
is to communicate with the person and to provide
a loving sense of companionship. Comatose
people often fear isolation more than physical
pain and death.
Coma clients are listened to so that a conversation
can take place. The ComaCARE giver
serves as an awareness helper and the client has greater
opportunity to complete their processes of unresolved
relationships, abuse issues, dreams for the future,
even their dying process. Go to
Living Wills.
It is important to note that as ComaCARE
we follow the path of nature whether the person decides
to “awaken” from a coma or to die. Each of these choices
should be treated with humility and respect. Therefore,
when someone trains in coma work it is important they
have spent time to understand their own attitude and
feelings towards death or they will project their
process onto the client. Similarly, it is critical
that expressions such as facial grimaces are not automatically
believed to be an expression of pain, but that there
is appreciation that the client may be having a completely
different experience than our interpretation.
Back to top.
For
the family
If a client is in coma the whole family is affected,
financially, socially, emotionally. It is stated that
for every coma client it is likely that at least six
people will need emotional counseling and ComaCARE
training.
Feelings of helplessness, anger, bitterness and fear
are often evoked in the family members and friends
of a coma client. When the person is in a coma there
may be disagreements over their bed. These should
be taken out of the room.
If the coma client chooses to emerge they may re-enter
a world where someone has taken up their responsibilities
or they may have a deepened spiritual understanding
that they find difficult to integrate in their daily
life. It is essential that any work with a coma client
involves family and friends, including post coma counseling.
Back to top.
Nurses and care givers suffer from high levels
of burnout when caring for coma clients because they
do not experience any response. Communicating with
the coma client brings new meaning and satisfaction
to their work.
There have been numerous tales of people awakening
from coma and sharing how they felt to be treated
as “already dead” by care givers. This is often due
to the fact that nurses and care givers are not trained
in communication techniques and hence are unaware
of the attempts of the coma client to communicate.
It is undoubtedly stressful to nurse a coma patient
and some of the techniques suggested by coma workers
mean breaking away from existing group culture; maybe
looking or sounding a bit silly. This is why care
givers should be trained in groups to give each other
support. In most cases coma clients have high communication
output levels and respond to high levels of positive
input including more than one person working with
them at a time. Senior medical staff needs to support
or sanction the communication efforts of caregivers.
Back to top.
- A ComaCARE intervention
may begin with family interviews to understand the
client and the family before the coma.
- The coma worker always introduces themselves and
states that they hope the client doesn't mind if they
spend some time with them.
- The ComaCARE worker spends
time breathing in unison with the coma client and
meticulously observing and gently testing to see if
there are any response mechanisms and minimal cues
which can set up a binary yes/no answer system.
- The time lapse between the intervention and getting
a response is fully appreciated in this approach,
when clients are on morphine and other pain medication.
- The Coma worker/s
-
Notices signals - through posture,
position, movements, breathing, colouring.
-
Responds to each signal.
-
Gently touches the body part
that is moving.
-
Matches their responses to the
signals.
-
Notices the person’s responses,
interacts with them and encourages interaction.
-
Adds sound and develops additional
communication.
- When a binary system is set up, care givers
and staff members are trained to use it to open
up communication about pain, pain relief, relationships,
inner work, completing life tasks and spiritual
questions.
- Awareness help is then offered to the coma client
through this yes/no answer system. Go to
training
for carers
Back to top.
Return to THE COMA CARE INITIATIVE
|
