New patient education is provided to every patient prior to starting hyperbaric therapy, and being able to communicate with a patient is an absolute must in order to provide a safe treatment. Occasionally an interpreter may be required for patients who speak a primary language other than English, and other patients may be extremely hard of hearing or deaf.
Once the treatment begins, during the descent phase, the pressure differential is significantly increased on the patient’s ears, making it increasingly difficult for the patient to hear the CHT speaking to them. This is the time when good patient communication requirements come into play ensuring the patient is able to both clear their ears and communicate it to the CHT. The CHT always maintains eye contact with the patient during descent. All new patients are instructed to use hand signals in the event they are having trouble clearing their ears during this time.
For 14 years now, I have treated a large number of hyperbaric patients, some of whom have been challenging to communicate with, either because of a language barrier, hearing difficulties, or some medical deficit such as aphasia from a prior CVA. Patient body language is extremely important to observe during a hyperbaric treatment. One recent example was with a patient who did not speak English. The patient became a bit restless during treatment and pulled his blankets off. Although it was quite obvious the patient was over heating, I have also seen patients do this when they are experiencing confinement anxiety. I used a hand gesture to the patient simulating it was hot by wiping my forehead. The patient then nodded and gave me a thumbs up! I then increased the ventilation rate and cooled the patient down.
Now it’s not always this simple. There was another incident where a patient urgently needed something during the treatment but did not speak English, making it very difficult for the patient to communicate with me! I couldn’t tell if the patient was ill or something else was wrong. The patient didn’t seem to be in a lot of distress but needed something urgently. I ended the treatment and gave the patient the hand signal that he was coming up. The patient nodded in acknowledgment. During the ascent, I motioned to the patient by rubbing my abdomen in an effort to illustrate having an upset stomach. The patient nodded with a big smile. I said to myself that’s what he’s needing, and as soon as the patient was at surface, I slid the gurney out and put the rail down. The patient jumped up and ran to the restroom.
The hyperbaric patient is completely dependent on the CHT while in the chamber, from temperature control through ventilation rates to TV channels and volume. Paying close attention to a patient’s body language will provide many clues as to the needs of each patient. Sometimes patients don’t or can’t communicate their every need. It’s up to us to stay alert and keep the patient both comfortable and safe.