Clinical: Lecture 5 Part 2
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Your pt talks and talks and talks about her general health. Time is limited so you repeatedly and tactfully redirect her conversation toward a focused discussion of her scapular fracture. Finally she snaps, "Why do you keep interrupting me?"
1) Respond reflectively to her comment
2) Explain how you would use your rapport building skills to handle this situation. Would restatement work effectively? What about summary?
- Is this situation still giving you problems now? How is this affecting your scapular fracture?
- I would make sure the pt understands I find her concerns important but that our goal is to rehab the scapular fracture.
- You could summarize her statements to show you are listening and then try to move smoothly into the topic needed to be discussed.
A female pt's chart contains the following entries:
Vital signs: 16 breaths per min; BP 130/86mmHg; pulse 80bpm, temperature elevated over night
urinalysis: cloudy yellow/green; foul smelling
1. what can you learn from these entries?
2. should these results affect OT plan of care?
cooler room, etc
Look at your interview. Can you figure out how your interview questions fit into the HOAC II framework?
the intent of the question, the clarity of wording, and the TYPE of question (open or closed; focused or non-focused) make a difference b/w gathering random info or conducting a focused interview
Main points: Review elements of clinical decision making process (CDM)
building a complete pic of the pt
Clinical Decision Making (CDM) Process
- 1. communication --build the rapport
- 2. Review the pt record
- 3. pt interview
- 4. pt physical exam
HOAC II: Hypothesis driven algorithm for clinicians
- 1. collect initial data
- 2. generate problems list
- 3. formulate exam strategy
- 4. conduct exam and refine problem list
- 5. est. goals, plan a time to re-examine the pt
- 6. plan and implement intervention
Before moving on to the intervention, you must have:
- gathered interview info and exam info that supports your choice of dx, including at least one measurement tool that looks at something other than impairment info
- developed a working differential dx
- used evidence, or clinical experience to determine likely prognosis (How much recovery expected? How long will it take?)
- combine and prioitize NPIP/PIP list. Set fxn-based goals w/ pt so each relates to some limitation or problem identified in this prioritized list
- documentation details what we do (the why should be evident by reading info in interview, exam and goals) to extent that another therapist could perform treatment w/o speaking to you
- establish frequency
- detailed explanation about what occurs in therapy or at home
- describe expected participation level of pt/family
- decide who will provide care
- justify skilled nature of care given
- no matter how well designed/executed, intervention is meaningless unless it achieves the outcomes set at the beginning
- impairment outcomes: start to answer "so what" but fall short
- functional outcomes: fully answer 'so what'
- NOTE: You must set desired outcomes at the start
Reassessment of existing/anticipated problems:
- is intervention appropriate?
- were any PIP/NPIP's overlooked?
- was case management a success? how does therapist know?
- should therapy continue or is pt done? How does therapist decide?
What must happen if you decide to bring a pt back to therapy?
there has to be a change in the intervention
What would you like to do?
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