Discharge Reflection

I've been asked about my criteria for discharging patients a few times and think its about time i wrote some reflections. An area i'm developing knowledge in is cognitive communication impairments. I'm starting to realise that:

1) Finding out pre- morbid communication behaviours from the patient and a significant other.

2) Addressing the impact of the patients cognitive communication impairments on their ability to participate in activities on the ward.

3) Involving the patient in goal setting identifying key areas they wish to work on with examples

and

4) Using therapy groups with peers to facilitate the feedback process


are key to developing a successful, meaningful therapy program.

Reflective log: Discharge 08.05.13

1. Think of a recent therapy session or event.

I had a discharge discussion with a patient. This patient had had a LMCA infarct in his non-dominant hemisphere (left handed) causing a mild flaccid dysarthria with right facial weakness and some mild cognitive communication impairments. I completed the LA- Trobe questionnaire with the patient and his partner. The patient and his partner identified: going over and over the same ground in conversation, and carrying on talking about things for too long in his conversations as key communication attributes that had been exaggerated by the patient’s stroke. The patient reported that pre-morbidly he had a tendency to be verbose when he was anxious and to repeat information. The patient also worked as a lecturer and as a performing musician. The OT and physiotherapist reported that the patient was unable to multitask and that when he talked too much and repeated information he was less productive in therapy.

2. Describe the session/experience

I spoke with the patient about speech and language therapy. The patient formed communication guidelines in his own words concerning how he would like therapists to give him feedback when his communication was disrupting sessions. I then spoke to the patient and we agreed that he would come to a communication and newspaper group and would complete some facial weakness/ sensation exercises independently (for a very mild right facial weakness) but would be discharged from SLT.

3. What did this session make you feel?

I felt that by involving the patient in his discharge I was able to address his concerns and give him the information he needed about his condition.

5. What has this session has taught you?

- To consider which is the best setting to work on cognitive communication difficulties and perhaps discharge patients if I feel SLT input is not appropriate in this setting.

 – If they do not impact on therapy perhaps cognitive communication impairments are best worked on in a rehab rather than acute setting or in the community.

- To ensure that the patient is able to access therapy and that their communication is not negatively impacting on other therapies (e.g. OT/PT).

- To get extensive pre-morbid communication information on patients with suspected cognitive communication impairments.