Wednesday, March 2, 2016

Making Requests: A 3 Step Process

When You Need A Helping Hand:
Communicating Your Wants and Needs

Whether it's neurological impairment or cognitive decline, language deficits can make it difficult, if not impossible, to ask for help. When you can't get the help you need, the consequences range from being uncomfortable to being unsafe, and everything in between. As a result, making requests or expressing wants and needs is of utmost importance for patients and caregivers, but it's not as simple as it might sound. 

To retrain this skill, I recommend practice that is based on a 3 step process: get your caregiver's attention, say what's wrong, and then ask for help. Here's a little more detail about each of the components for making an effective request...

1.  Get Their Attention

Using a loud, strong voice, it's easy to get help once you have your caregiver's attention. Practice achieving good volume during therapy sessions, using the visual feedback of a sound level meter. In most quiet home environments, a vocal intensity of 75-85 dB will be sufficient for gaining the attention of others...even if they're in another room.

As much as possible, call caregivers by name.  If a caregiver's name isn't able to recalled quickly or accurately, incorporate photos and written cues as needed, or rehearse names using Spaced Retrieval Technique

In a healthcare facility, gaining the attention of caregivers may be as simple as pressing a call button. Therapeutic training with use of the call button may be in order.

2.  Say what's wrong 

In simple terms, tell what's on you mind by identifying your problem.  Be clear! While a gesture is great for clarifying or supplementing a message, its meaning can be incorrectly interpreted. 

For instance, it may not be apparent to someone else that you're thirsty if you just tap your cup on the table. The cup may be removed without the chance for a refill unless you speak up by saying, "I'm thirsty."

Squinting your eyes doesn't necessarily mean the blinds need to be adjusted to prevent the sun from shining in your face. A caregiver may see a contorted facial expression as an indication of pain. To really get your point across, say, "The sun is in my eyes."

3.  Make a request

Caregivers aren't mind readers, so now that you've got their attention and they understand the problem, make a specific request. 

Would you bring me some apple juice?

Can you close the blinds?

Now, let's put it into practice!  I created a list of scenarios to help patients with aphasia and dementia practice their requesting skills.  I've had good success using this approach and these questions.  

As usual, not every question applies to every person, so pick and choose your favorites. If there's a question that should be on the list but isn't, please leave a comment at the end of the post and I will be sure to add it. 

PS:  Double click the pop-out button (upper right corner) to print or download the document. 

Using a hierarchical approach based on your patient's language skills, start low and work your way up. This it how it might sound during practice. :

What would you say if you were in pain?

Good:  My head hurts.
Better:  Laura, my head hurts.
Best:  Laura!  My head hurts. Can you please bring me some Tylenol?

What would you say if you didn't like the clothes that were picked for you?

Good:   I don't like this sweater.
Better: Angie, I don't like this sweater. 
Best:  Angie, I don't like this sweater. Can you find another one?

The next time you need a functional speech, language or  problem solving activity, give this list of questions a try...your patients and their caregivers will be glad you did!

Refusing to ask for help when you need it, is refusing someone the chance to be helpful.
Ric Okasec