Communicating With Unconscious Patients: An Overview

Area of Science:

• Neurology
• Critical Care Medicine
• Nursing

Background:

• Hearing is often considered the last sense to depart in unconscious patients.
• Historically, limited evidence led to reluctance in communicating with unresponsive patients.
• Research from the 1990s onwards has shed light on patient awareness during unconsciousness.

Purpose of the Study:

• To review evidence on awareness in unconscious patients since the 1990s.
• To identify when awareness occurs and methods for its detection.
• To explore the benefits of communication and healthcare professionals' plans for interacting with unconscious patients.

Main Methods:

• Conducted a literature search of over 150 articles and books on unconscious patient experiences.
• Utilized databases such as PubMed, CINAHL, and the British Nursing Index.
• Analyzed post-course responses from 105 registered nurses and other healthcare professionals.

Main Results:

• Standard scales like the Glasgow Coma Scale may miss awareness in non-responsive patients.
• An estimated 25-40% of patients with disorders of consciousness can perceive auditory stimuli.
• Patient isolation and loneliness can cause significant physical and psychological harm.

Conclusions:

• Significant evidence indicates that some patients in vegetative states can hear and understand.
• Electrophysiological methods and patient interviews confirm awareness in seemingly unconscious individuals.
• Awareness is experienced during the onset of unconsciousness and during movement, even when not outwardly apparent.