Joondalup Cardio (second entry)

Situation: The following entry refers to a 68 year old male patient who had been admitted with a chest infection two days earlier.
Task: I had to complete an initial subjective and objective assessment.
Action: Initially I gathered as much background information from the patients medical records and from results of investigations, such as chest x-rays and arterial blood gases. From the medical records I learnt the patient was dysphasic and suffered from severe dementia. Consequently I telephoned the patient’s wife to complete the subjective assessment with her. I then spent 20 minutes objectively assessing the patient.
Result: My assessment enabled me to compile a problem list for the patient and subsequently, structure an appropriate treatment plan.
Evaluation: I believe my greatest strength in this situation was in my preparation. The initial time I took to read through the patient notes allowed me to identify the patient’s dysphasia and dementia and act accordingly by contacting his wife. Completing the subjective assessment with the patient’s wife also allowed me to pass the relevant information onto the rest of the multidisciplinary team so they could start discharge planning appropriately. Upon reflection one weakness which I have identified was my lack of verbal communication with the patient when I actually came to completing my objective assessment. I was so preoccupied with his dysphasia and dementia that I neglected to speak to the patient during the assessment and on reflection I am aware this would have been frustrating for the patient and was a missed opportunity to build rapport.
Strategies: I believe planning and gathering as much background information prior to beginning an assessment is extremely helpful and is a strategy I will continue to use in the future. This strategy allows me to identify any complicating factors for physiotherapy such as communication barriers or in another case I was able to identify a patient who was palliative and thus physiotherapy was not indicated. This was the first time I had contacted a patient’s next-of-kin via telephone and although I was quite nervous it was extremely beneficial in gathering a concise social history and an idea of the patient’s previous functional level. I have since used this strategy to confirm another patient’s normal functional level with the nursing home they were admitted from. In the future I need to remember that although a patient has dementia or expressive dysphasia it does not mean that will not understand and benefit from verbal communication.