Start right now.  Keep your voice soothing, calm and reassuring.  Take a deep breath and smile, it will come through your voice.  Tell them they're safe and being cared for by good people.  Tell them you'll be there for them.  Tell them you're going to keep talking to them so they know you're there.  Tell them to get their rest and heal for now.  Keep it positive and light.  Click here for Signs of Response.

 

Remember, recovery is a gradual process, a transition.  They're not going to sit up, open their eyes and ask what's for dinner as shown in the movies.  We're learning more every day about the mind/body connection but there's still so much to find out.  The medical staff will do all they can and sometimes that just means keeping them stable.  Watch for tiny responses to stimulation and be very patient.   

 

Remind the patient you'll be there for them, no matter what happens.  You'll be there to help them wake up.  Reassure them every time you come into the room.  Their sense of time is off right now.  Minutes may seem like days and vise versa.

 

Let them know who will be helping if there will be others involved with their care.  Remember to keep the room peaceful and calm with only 1 or 2 people on a regular basis.  Extra visitors should only stay a short while.  Watch for signs of recognition or agitation.  You might not get the response you expect, but any response is good right now.

 

Remind visitors to be calm and positive.  Give them an idea what to expect when they walk in so they're not completely caught off guard.  Watch for positive reactions to visitors, they might be key people to involve in care.  Remember, too many visitors can be overwhelming or tiring. 

 

Gently encourage the patient to respond, no matter what their physical or mental condition.  It will feel strange talking to someone who's unconscious, so tell the person. "I might sound a little funny, but I'm still getting used to this.  So bear with me, okay?"

 

Unless the cause of unconsciousness is something horrible (like an assault), gently explain what happened.  Remember to keep it very simple.  The details can come later. Try to talk about it as a way to understand what's happening now.  Let them know you're there to share the challenge with them.  Try not to speculate about what the future will bring, instead encourage facing each day with a positive attitude.  The key is to let them know they're not in this alone.

 

Keep all conversations positive.  If something needs to be discussed that is negative or difficult, take it out of the room.  This is a time of "what ifs" and "if onlys", but those things don't need to be said in front of the patient.  Be sure to read our wonderful articles on this and other topics.  Coming soon

 

When you come into the room, knock and say who you are, even if you only left for a short time. "It's Mom returning from getting a snack."  When leaving, no matter for how long, say "I'll see you at eight o'clock in the morning" or "I'll be back, I'm just getting lunch." "Good-bye" sounds like you're not coming back.

 

Tell the person what day it is and what time of day.  Say "Good morning (afternoon/evening)" to help orient them to passing of time.

 

Sleep/wake cycles of coma patients are usually not normal so do things with them day or night unless restricted by the medical staff or a roommate.

 

Talk to them about good news of the day or the weather, read the comics or favorite section of the paper to them.  Tell them about all the good things that happened today.

 

Bring their favorite music.  Sing songs, read a book, tell them jokes.  Play recordings by family members.  Watch television or listen to the radio with them.

 

Tell them of good wishes from friends and family.  Read get well cards or emails you receive.  Remember to keep it positive and light.

 

While you're doing these activities, watch for signs of recognition or a response of any kind and note it in your journal.  And remind them you're going to be there talking to them every day, waiting for them to give you a sign.  Tell them you hope it will be soon and you'll be watching.

 

Remind the person of his strengths.  Talk about past challenges and how he conquered them, even if all you can think of is a three legged race they won.  Keep reminding him that he doesn't have to go through this alone.  You'll be there to help every step of the way.

 

When possible, let the person listen to a loved one or friend on the telephone. Keep the conversation short, no more than 30 seconds or so. Then finish the call by thanking the loved one or friend for calling.  Remember to tell the patient what's happening and ask if they would like to talk to ________.   Watch for a response of any kind.  Even tears are considered a good response.

 

If the person receives cards, read them out loud. Display them where they can be seen by staff, visitors and patient if they opened their eyes.  If cards haven't arrived yet, urge people to send them.  People don't always think of sending a card to an unconscious person.  Ask for cards.

 

If the patient is religious, pray with him. Tell the person about prayers being said for him. Encourage clergy to visit or read a note from them.  Make any religious expression one of affirming hope and love. 

 

Leave the radio or television on to favorite programs if you will be gone for an hour or two.  Avoid overly emotional music or programs. Check listings in a local newspaper or TV Guide to choose the best station.  Ask family and friends if they know of favorite programs or stations, if you're not sure.

 

Remember, they (and you) may prefer quiet for a while, too.  Just sit and hold their hand.

 

If you know the person prefers to be called by a nickname or has some other needs that may not be known easily by all staff, put up a neatly lettered sign with the request. Covering it with a "zip-lock" plastic bag will keep it clean. Click here for a list of things to consider

 

When medical staff members talk about the patient in front of him, gently let them know that you would prefer that everyone assume the patient can hear and that the staff please include him in the conversation.  If the conversation is negative, ask to continue outside the room.

 

Ask the medical staff to be included in your attempt to communicate with the patient.  Let them know what you're trying to do and ask that they assume that the patient can hear everything that's being said and done around them.  Don't expect them to do anything beyond their duties.  They have their hands full already.  Just make them aware and maybe they'll talk positively to the patient when they come in during their rounds.

 

Remember, there are many levels of consciousness.  Some people who appear unconscious are "locked in" a physical paralysis but are actually aware of their surroundings.   If you think the person may be "locked in", ask the person to move his eyes upward.  The ability to move the eyes upward can sometimes survive damage causing the Locked In syndrome.  See Locked In Syndrome

Tell them what you're going to do and then hold their hand or stroke their cheek.  Be sure they know who you are and what you're doing.  They've had a lot of people they don't know touching them and for the most part, it hasn't been pleasant.

 

Watch for signs of recognition like tears or a change in facial expression.  And don't be offended or hurt if they withdraw from you.  It really is a good sign right now.  Remember, it's all going to take time.  Any response is good and should be noted in your journal.

 

Try to keep their personality in mind when you touch them.  Some people love to be caressed and hugged while others are good with a hand shake or pat on the back.  We all need to be touched, but we also need to be comfortable.  So as much as you may want to give them a big hug, holding their hand and speaking softly may get through to them much better.

 

Touch them often as a way to show them you're still there.  Tell them touching them is your way of letting them know you're close by, since they might not be able to hear you very well or see you.

 

Tell them what you'll be watching for, like fingers or toes moving and show them.  Remember to tell them what you're going to do.  Massage their hands to warm them a little and gently move their fingers and say "See, like this, you can do it."  Do the same with their toes, but only if you think they'd be okay with it.  Some people are funny about having their feet touched or they may be ticklish.

 

No matter what the patient does, gently praise them. Remember to let them know it's okay to rest and regain their strength.  Tell them you know they're resting so they can try to move.  Tell them you'll be there when they're ready and you hope it's soon.

 

Use lotions to massage the hands and feet, if you can.  Be careful of allergies however.  Their skin can get very dry and circulation can become a problem when lying flat for extended periods of time.  A light massage can help stimulate the sense of touch.

 

Gently wash their face with a damp cloth or brush their hair, if you can.  A cool cloth on their forehead can help with fever.  Ask the medical staff what they suggest.  Watch for any response like relaxing or grimacing to tell you if you should continue.  And remember, any response is good.

 

If they have a favorite stuffed animal, figurine, picture or special item that you can put on their bedside table, bring it, tell them you have it and place it in their hands.  Watch for a response and don't be surprised if they take it from you.  Remember not to bring anything of value or that can't be replaced easily.  Set the item on the table where they would be able to see it.

 

Make it a little easier for them to move their fingers.  Put your hand in a fist and place it under their hand to make it easier for them to move their fingers.  Having their fingers hang loosely over yours will also give you a better chance to catch any movement.  Tell them what you're going to do and why and that you're watching for them to move the fingers on their right (left) hand.  Try sitting next to them, have your fist in place, then asking them about things with Yes or No answers.  Remember, be patient.  It can take a while to get a response.

 

If you happen to bump the bed or brush against their body by accident, tell them what happened.

 

Document any responses or reactions. Include a sigh, tear, sneeze, cough, blush, yawn, twitch, sound, ears turning red, the slightest finger or toe movements, eye movements even during apparent sleep, and so on.  Include monitor changes, too, like a rise or fall in heart rate or oxygen level.

 

Click here for the study form.  Use it to document responses.

If the person moves or has a reaction in any way, try to document what was happening prior to the response. Guess what stimulus may have lead to the reaction. If possible, repeat a stimulus that appears to produce it and watch carefully for a response.

 

Remember, it is very difficult for them to respond in any way right now.  It can take a while to achieve any movement, so watch carefully and be patient.  And don't expect the same response each time.

 

No matter what the patient does, gently praise them. Remember to let them know it's okay to rest and regain their strength.  Tell them you know they're resting so they can try to move.  Tell them you'll be there when they're ready and you hope it's soon. 

 

If you happen to touch them or drop something accidently and there is a response to it, make a note in your journal.  If you get a response and can repeat it without hurting them, of course, do it and see what happens.  Tell them what happened and the response they had and ask if they can repeat the response without the stimulus.  Move their head or arm, for example.  Watch carefully and be patient.

 

The journal and documentation may seem tedious or unimportant at first, but after a while you'll start to see a pattern.  For example, his heart rate might rise every time his wife comes into the room or he moves his arm a little when the nurse reaches to take his pulse.  If he's in the coma for a few days or a few weeks, the journal will be important for you and, if you decide to share the information with us, it will also be important to future coma patients through our research.