Communication

Situation

A 79yr old gentleman was admitted to the facility following a L MCA infarction 2/12 ago. He displayed R hemiparesis, severe expressive and receptive dysarthria, and unconfirmed homonymous hemianopia. He was a full hoist transfer and was dependent in a tilt manual wheelchair. He was a carpenter throughout his working life, and was subsequently very particular and detailed about his personal appearance and the way things were done for him. His first language was Dutch and with the stoke affecting his speech, was extremely limited in what he could say, and it being understandable.

 

Task

My task was to complete a follow-up assessment of the patient, as his initial assessment on his admittance the day earlier had not been fully completed. The patient was waiting in his room on his bed.

 

Action

I introduced myself and informed the patient of what the session would involve and gained consent. I went through my assessments, including range of motion, manual muscle testing and balance observations.

 

Result

Because the patient was essentially dependent, the session progressed slowly. I adapted the assessment as needed, taking into consideration the R sided hemianopia and hemiparesis, and the dense expressive and receptive dysarthria/phagia. I managed to complete much of the assessment, but the patient became fatigued and the remainder of the assessment was to be finalised next session.

 

Evaluation

It quickly became apparent that the patient had little to no speech available to him at this stage of his rehabilitation, which caused him much distress. I touched base with the nurse looking after the patient prior to seeing him, who informed me he was “picky” about how he looks (but gave no specifics). I wish I had pressed his nurse further about exactly what he is particular about, as the patient became quite anxious during and after our assessment, implying something was wrong with his clothing? I spent valuable time trying to work this out and the patient became further frustrated and anxious.

 

Strategies

I attempted to limit the obvious frustration of the patient by asking yes/no questions as to what was concerning him, and this seemed to help slightly. I definitely should have ascertained exactly from his nurse what he likes in regards to his clothing and bed position. I had an idea but not specifics, this would have benefited the patient and limited the unnecessary angst. Liasing with the OT would also have been an idea to ascertain if any communication strategies had been provided for the patient yet. I did this after the session and this was in the process of being done as the patient had only arrived the afternoon prior. Because the patient is so particular about the very smallest of details, I thought it might be an idea to perhaps take a photo of how he prefers to be positioned in bed and how and where he likes his personal paraphernalia, as he would have to go through this each and every time he encountered a new staff member/nurse until all understood and appreciated how he liked his things. Overall I left the patient feeling very apologetic to his predicament, but more so to the fact I had made his situation somewhat worse this particular morning. I took away from this that each person has their own life experiences, motivations, and limitations and that all of these should be considered and respected.