Monday, February 22, 2010

Case review: Motivating using occupations

Patient details:
Male, 31. Lives alone.
Family local, Mother and Father supportive
Out of area patient

Reason for admission: Elective R) TKJR - covered by ACC

Medical Hx:
Seizure when young resulting in R) sided weakness
Genetic magnesium deficit disorder
Accident when young as a result of a seizure - resulting in a fall, and damage to subcondylar area of tibia
Pain in R) knee increasing and reducing mobility

OT assessment/process
Reviewed notes which identifed that pt had been not cooperative with nursing staff and PT staff
Identified that patients Mum had been contacting ward excessively to review how he was going
Discussed patient with PT re: mobility status, and level of engagement with PT

Met with patient, introduced self/role and asked for consent to talk with him initially.
Response to OT was to shut eyes and turn head away, no verbal response. Asked if it was ok to contact family, no further response from patient

OT left the situation and discussed interaction with ACNM, identified need to contact family for hx, and commence intial assessment.
P/Call with patients mother, who seemed to be very distressed, perhaps next time I could have thought about who would be the best person to contact due to the circumstance e.g. anxious mother. But planned to meet with family and patient on ward that pm.

Discussion with PT re: meeting family. PT keen to attend.

Met with patient and family that pm, PT reinforcing how important it is to do knee exercises and Dad trying to support PT, however patient very receptive still. Discussion with Family, pt and OT re: home environment and pre-admission occ performance, and plans for discharge.

Outcomes of assessment by OT:
Patient experiencing behavioual outbursts limiting ability to engage in PT/OT assessment/treatment and discharge planning.
Planned to review function and behaviour mane, and refer to SW re: ?supports needed for d/c

Reviewed patient with team in the morning. Discussion re: sending him home re: not participating with PT, and abusing nursing staff

OT and SW arranged to meet with patient to review needs for discharge, and ? supports.
Patient communicated by answering closed questions directed by OT regarding how managing here, how will manage at home, what supports he thinks he may need. Patient receptive to answering questions.

The breakthrough....
By applying occupation he was alot more willing to participate. It was simple but it worked.
I used an occupational task such as getting dressed and asked him to show/demonstrate how he can manage putting on this underpants and trousers - and he did it no probs.

Although he didnt want to participate in any transfer practice i was able to apply what i had seen with him moving on the bed, and what i had talked with from the nursing staff and what i new his enviornment was like to determine that he should manage physically at home.

But i was concerned about his behaviour and what he may do at home, as he had a hx of sleeping alot. Others raised questions about his cognition, and i wondered how i could even begin to assess that. From what i new about the patient, when he was answering my questions he was very appropriate, and he was prev living alone.

Im a bit stuck on where i can go from here? Other than asking the family if they have any concerns about his ability to live independently etc.

I came out of the interaction with him feeling really good about my interaction with him, i was able to get alot of information out of him by thinking about how to approach the situation, thinking about the wording of each question and linking it to why i needed to see e.g. d/c

I discussed this with the SW, who wasnt so convinced that it went well, however the rest of the team that had known the patient were convinced that it was a good outcome for this paticular patient.

So plans from here
a) contact family re: d/c plans and support they require ? if they can offer or if they want assistance
b) ability to live independenly long term? screening cognition
c) discuss in supervision re: behaviour/cognition and how best to assess this patient


1 comment:

Anonymous said...

如果,人類也像鼠輩一般,花很多時間來吃飯和睡覺,一定會改善健康。 ....................................................