Week 4: Consent & Communication at Extendicare

This week at Extendicare, my partner and I were tasked with testing resident's blood glucose levels (BGL) so the nurse could determine if they required insulin prior to breakfast. It turns out this task had little to do with the process of using a glucometer but provided a great opportunity to practice (and subsequently learn about) communication and consent.

Communication

From the first resident we attempted to test a BGL for, we had communication difficulties. Many of the residents we were assigned to obtain a BGL for appeared to have hearing difficulties. To communicate, we attempted to speak louder, use shorter sentences, rephrase, and use visual signals with the glucometer. With these strategies we were able to communicate with most residents, but I wanted to research additional communication strategies to be prepared for future clinical placements. Communication tips from the Canadian Hearing Society (2013) include to choose a well-lit area, maintain eye contact, do not cover your mouth, write things down, reduce ambient noise, use animated body language to support your words, and ask the individual for the best way to improve communication. As the majority of the residents were on contact precautions, we had to wear masks. This unfortunately meant that residents were not able to lip read to enhance communication. Two communication strategies from the list that I did not consider were the lighting levels in the room (it was early morning so quite dark) and writing down our request (I had my notebook in my pocket that I could have utilized). I also did not think to ask any of the residents how we could have improved communication. To improve from this experience, I have written in my clinical notebook the list of communication tips so that I can refer to it in future placements if I have difficulty communicating.

Consent

As discussed in Medico Legal last semester, there are four types of consent - informed, expressed, implied, and involuntary. As testing BGL is an invasive procedure, it was important that we obtained consent. We had one resident who despite our best efforts at communication, was not able to provide us with either informed consent (understanding of the nature, expected benefits, material risks, material side effects, alternative courses of action, and likely consequences of not having the procedure; Ungar, 2018) or expressed consent (nodding or holding out a hand; Ungar, 2018). My partner and I decided that as we could not obtain consent from the patient, a communication barrier did not grant us consent, and we did not measure the resident's BGL. We informed the nurse that we were unable to obtain the BGL and hoped that they would be better able to communicate with the resident to obtain consent.

Reference List

Canadian Hearing Society. (2013). Communication tips. Retrieved from https://www.chs.ca/communication-tips-0

Ungar, M. (2018). Consent [PowerPoint slides]. Retrieved from Moodle.