"I would remind the nurse that just because a patient cannot speak doesn't always mean they can't hear or understand what's happening around them. I would instruct them to follow the same protocol of knocking before entering the room, introducing themselves, and explaining why they are in the room, whether it's to administer medication, check vitals, or assist with some other ADL. I would encourage them to look for other ways to communicate. Perhaps encouraging the patient to nod or blink once or twice, or if they can write, provide them with a pen and paper or dry-erase board to help communicate. If a family member is in the room, it may also be appropriate to look to the family member for assistance or support."

"Just because a patient cannot speak or is in a vegetative state does not mean they cannot think and feel. It's important to remember that when caring for non-communicative patients and treat them with the same respect and care you would with other patients. For example, I always knock when entering the room, introduce myself, and explain why I'm in their room. I will explain each step of what I'm doing; for instance, if I'm checking their vitals, I explain what I'm going to do before I do it and as I move through the clinical process. I look for non-verbal cues for signs of pain or discomfort, fear, or anxiety. Often, patients can still communicate with a smile, a nod, etc., so it's important to be on the lookout for nonverbal cues. I also use close-ended questions that require a yes or no, if they can shake their head. Lastly, if they can write, I will provide a pen and paper to communicate, and I'm very patient throughout the process."

Its important for us to remember that there are different forms of communication, not just verbal. I would discuss with the nurse observing for nonverbal communication from the patient that might indicate a need or pain. I would also discuss whether or not the patient is able to communicate with another method like writing for example. Is the patient able to use a picture chart to point to things they need or are they able to write on a whiteboard? Another important thing for the nurse to remember is can the patient call for help. There are different types of call lights that make it possible for patients with different disabilities to call for help. Finally, if a patient is unable to call for help then they are going to require more frequent checks by staff to assess their needs.