When Evelyn Robinson arrived on Silverstein 11, she had recently suffered a stroke which left her unable to speak. Communicating even her simplest needs involved a long process of pointing and guessing.
"Whenever Evelyn needed something, I had to go through the entire room, pointing to everything until I found what she was trying to say," said Mary Price, BSN, Robinson’s primary nurse. "For instance, one time she wanted to sit up higher in the bed so her foot didn’t touch the footboard. That hurt. It was very hard for me to figure out."
Price found that every request required the same hit-or-miss approach. "I thought about it from her perspective – she was so tearful, so upset. Plus it took time that I didn’t always have."
There had to be an easier way, Price thought.
“She had a book with pictures but it had only one to two on each page and she was having difficulty turning the pages to find what she needed,” she said. “I thought why not put together a book with multiple pictures on each page? After all she doesn’t have any problems with her vision!”
Price ran the idea past Robinson and got an eager nod. She used her free time to do research and search the web for pictures. “I worked with her on these communication sheets after my shift or came in on my day off for an hour or two. Then I’d go home and work on them based on what she told me.”
Price created a communication tool that was customized to the patient’s needs. One sheet -- the ‘How are you feeling?’ page -- shows faces with different emotions. To help her describe any pain she was having, Price used illustrations of the front and back of a woman’s body, “so it was easy for her to point to where it hurts.” A page of basic needs includes pictures of a bed pan, patient gown, call bell, remote, and phone.
Robinson wasn’t eating well but couldn’t express what the problem was. To help resolve this issue, Price spent one day going over the entire menu with her, finding out what she likes to eat. She also met with Dietary to get a list of appropriate foods. “Now she can point to what she wants, what she doesn’t have. You know it’s something on this page that’s missing.”
Price also encouraged family members to provide a list of names and/or photos that staff could use to help identify who she wanted to call. “I explained to them how a simple list, photo or flashcard could help them communicate with Evelyn a lot faster and minimize the level of frustration experienced by all family and friends,” she said. “I tried to think of everything she could possibly ask for, based on caring for her.”
The picture pages were an immediate success, allowing Robinson to make her needs known and improve her interactions with the staff and her family. When she left the hospital for rehab, she brought her binder of picture pages with her.
Ruth Bell, the unit’s nurse manager, said that other staff members and patients – from their unit and others -- will benefit from the time and effort Price put into the patient project. “Mary was a real leader in this. She recognized that the patient had a problem, took charge and ran with it.”
