Monday, February 16, 2009

Difficulty connecting with a patient

Usually when i go and see a patient i find it really easy to connect with them and motivate them, however one patient i saw today was particularly hard to do this with. I didnt really know what to do - she presented with a short attention span, and didnt seem to be able to understand what i was asking her. However this ability seemed to fluctuate. She could give me an answer (during the initial interview) every know and then but other times she was very vague, looked out the window and just sat there as if i wasnt even there.

I tried some strategies to engage her like changing the positioning of my chair, using her name when i asked questions, and trying to take her lead when choosing questions. But unfortunitly i just didnt have any luck. I think maybe i was asking to longer questions and trying closed questions may have been more sucessful however on the spot i didnt think of this. This confused me alot as i wasnt aware that there was any cognitive impairment..

After discussing this case with my suprvisor she recommended that i contacted other OT's who had worked with her (to see if they had any of these problems) and to talk to her daugther to see if she has noticed any changes in her attention/memory and concentration. Unfortunitly i could not get hold of her daughter after several attempts but the OT could not remember the patient vividly enough to give me any detail.

So i decided to talk to other members of the team - i found the physio who had been working with her and she agreed that she was vague sometimes but she thought the problem was motivation...when i think about it i guess that could also be the case.

All this problem solving reminds me of in my training when we learn about cues/hypothesis etc

So heres it all broken down from the reference

(1) Cue acquisition: gathering cues through observation, history, or physical examination;

(2) Hypothesis generation: generating initial hypotheses based on initial cues;

(3) Cue interpretation: formulating patterns of cues through weighing positive and negative evidence; and

(4) Hypothesis evaluation: applying the cues to the hypotheses and evaluating whether the hypotheses hold.

To problem solve this one i will break it down

(1) Cue acquisition: vague appearance when asked a question/not able to follow directions/

2) Hypothesis generation: un interested/un motivated/didnt understand the question/didnt hear me/short attention span

(3) Cue interpretation:

(4) Hypothesis evaluation:

Will go through this case with my supervisor tomorrow

No comments: