Wednesday, September 2, 2009

Case Review

I was referred a patient who lives with his family and his a well respected Maori Elder in the community. He was presenting as what nursing staff described as "innappropriate" "confused" and "vague".
I went to see this gentleman and we got chatting about his roles and values at home. He looks after his grandchildren with his wife and values this alot.
I explained my role and the reason i had received a referral. He admitted that his brain wasnt as fast as it use to be and his thinking was alot slower. I began asking some questions to screen his cognition. When i asked him a question he would not respond with an appropriate response - change the subject and talk about his medical condition.
So was this hearing?, not wanting to answer my question? didnt know the answer? Or more likely cultural????????????
As i went on i wondered if he was feeling quite intimidated by me. I remember thinking back about the Maori Culture and i thought it must of been hard for him to have a "young" "white" "girl" ask him questions and "testing him".
I reflected on this case and talked about it with an OT colleauge. This was probebly the case as he was recognised as a Maori Elder. It all made sense as i ended the session when he said he felt interigated as he didnt know what the questions were about and why i was asking them (even though i had explained)
I did have concerns however about his cogntiion and i didnt want to leave my assessment at that as i had alot of information and no idea what to i contacted the Maori Liason unit and asked if they would support me by visiting him with me. The plan was to assess him preparing a meal however it ended up that the pysch geri team leader arrived to see the patient at the same time so we all sat around and chatted together.
The patient also identified that he would prefer to be assessed in his own environemnt which became the plan with f/u from pysch geri OT.

All in all a good learning experience in respecting the Maori culture and not pushing the boundaries. Also a good use of the Maori Liason unit as they new the patient well though the community and were able to explain what he is usually like.

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