Transcript Talk to Me Treat me as an individual, not as a diagnosis

Talk to Me
Treat me as an individual, not as a diagnosis
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Developmental disability (DD):
A deficit or impediment in the way a person grows and changes over time that
deprives him or her of accomplishing specific things. It stems from many
factors that prevent typical development, which involves physical and/or
cognitive development. It is often assumed that the person has lower
intellectual functioning, which is not always the case. People with Down’s
syndrome, autism spectrum disorder, and cerebral palsy are often classified as
having a DD.
Intellectual disability (ID):
Limitations in mental functioning, communication, self care skills, and social
skills. These limitations cause people with ID to develop more slowly, and to
have difficulty learning.
Both DD and ID can be caused by many factors, such as genetics, difficulties during
pregnancy, difficulties at birth, health problems. It is important to know that not
everyone with a physical impairment may have intellectual difficulties, and not
everyone with intellectual disabilities may have physical impairments. Each
person is an individual, and is capable of learning, though maybe at different rates.
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Down’s syndrome:
Caused by an extra chromosome 21. Characteristics may include variable cognitive abilities,
speech and language difficulties, larger tongue, high arched palate, visual problems, cardiac
problems.
Autism spectrum disorder:
A huge variety of manifestations, all involving pervasive difficulties in reciprocal social
interaction, and in communication (may not talk, may use pictures or signs, may echo words of
others). Also, these individuals may display repetitive and unusual behaviour and may have a
hard time coping with change.
Cerebral palsy:
A group of motor disorders, can be caused before, during, or after birth. It is a non-progressive
but a permanent decreased control of movement, coordination and/or balance. There is an
abnormality in muscle tone (stiff, spastic, dystonic and/or inconsistent muscle control). These
individuals can have normal intelligence, but damages to the brain increases the risk of
slowness to learn. Articulation of words can be difficult, making it hard to understand them.
Fetal Alcohol Syndrome:
Characteristics include growth retardation, developmental delay and abnormalities in
neurology, mental health and facial characteristics (e.g. small eyes, long thin upper lip,
flattened midface).
Dual diagnoses:
This could include any number of diagnoses at the same time. A person with Down’s
syndrome may also have autism like behaviours. A person with cerebral palsy may have
depression.
Click to Begin Case Studies
Rob is a 27 year old male, who was diagnosed with Down Syndrome. Rob injured his
ankle during a soccer game. He has already been assessed and the physiotherapist is
currently advising self-care management (e.g. ice regime) and prescribing exercises for
him to perform at home. While explaining these exercises to Rob, Rob nodded
constantly and responded with “um hm,” “okay,” and “yes.” After the therapist has
finished giving instructions, she asked Rob to repeat what she said. Rob was silent. The
therapist then asked Rob, “How and when would you apply the ice?” He responded,
“Every hour. “ Because Rob did not completely answer the question, the therapist then
asked, “How long?” He replied, “Fifteen minutes.” She then asked him, “What do you do
to the ice?” He replied, “Put it in the bag and put it on my ankle.” She sent home written
instructions in small print and medical jargon.
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What communication strategies were effective?
What communication strategies were not effective?
What barriers were present in this case study?
What could have been done differently?
Answer
Introduction
Case Study 1
Case Study 2
Case Study 3
Conclusion
It is important to treat each patient as a unique individual, regardless of the
diagnosis. Although Rob has Down Syndrome, it does not always mean he is
illiterate, unable to speak and understand, cannot learn and follow instructions, or
need a caregiver to be at an appointment with him. Despite having the same
diagnosis, the levels of function in individuals with Down Syndrome vary greatly.
Examples of effective communication strategies:
1) The therapist identified that there may be barriers to learning and addressed
this by asking Rob to repeat the instructions. Rob responded well and
demonstrated his understanding when prompted.
2) She could have kept her questions simpler in this case and addressed one issue
at a time because Rob was only able to answer one part of the question. E.g.
She could have asked, “When do you apply the ice?” After Rob has answered,
she could then ask for how long.
3) Repetition and recall are effective ways to facilitate learning.
4) Her intentions were well and sent Rob home with written instructions. And
made sure the print was bigger and simpler in language.
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Betty is a 40 year old female. She was born with cerebral palsy, which causes muscles
spasms in her face and throat. She is able to communicate but her words may become
garbled at times. With her caregiver, Sally, Betty is seeing a new family doctor for the
pain in her back. The doctor introduced himself to Betty and Sally and commenced the
assessment by asking Betty about the purpose of the visit. As Betty tried to explain her
back pain, the doctor nodded and said “okay” when in reality he did not understand
most of the words Betty said but did not clarify because he was afraid of hurting Betty’s
feelings. The doctor was also rushed for the next appointment. When there was a pause
in Betty’s reply, the doctor immediately talked again, thinking Betty was finished. The
doctor performed her physical assessment without fully knowing what Betty’s
complaint was. Sally noticed how the doctor was not assessing Betty’s back and pointed
it out. As a result, the doctor just talked directly to Sally instead of Betty for the rest of
the visit.
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4.
What communication strategies were effective?
What communication strategies were not effective?
What barriers were present in this case study?
What could have been done differently?
Answer
Introduction
Case Study 1
Case Study 2
Case Study 3
Conclusion
Communication Strategies: Don’t assume: When talking to
someone with cerebral palsy, be aware that cerebral palsy
Does not mean the individual is developmentally delayed.
The individual may struggle with musculoskeletal problems, which can be manifested
as poor speech due to difficulty in moving muscles around the mouth and throat.
Examples of effective communication strategies:
1) Pretending to understand what the patient is saying is a form of disrespect and
devalues communication. The doctor in this case study could have asked Betty to
slow down in her speech and repeat what she said.
2) If the doctor allocated more time for seeing Betty, he could have had more time to
converse with Betty to understand her health history.
3) The doctor also should have asked Betty for permission to talk directly to Sally
about her health.
4) Furthermore, he could also have asked Betty and Sally for more effective ways to
talk to Betty, such as slowing down his speech, asking Betty to repeat, providing
enough time for Betty to reply, talking to Betty at her eye level, asking the question
in a different way if he could not get an answer.
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Marvin is a 37 year old male, nonverbal and is presented in the ER, extremely
agitated. The triage nurse was initially unaware of what was wrong with him and
attributed his lack of response to his mood and attitude. She asked many questions
about Marvin’s reason for visit but Marvin could not reply. After a while, Marvin
pulled out a card that identifies him and his inability to speak. The nurse asked
Marvin to wait while she retrieved a diagram of the human body. She asked Marvin
to point to where he felt pain and provided him with a pen to write, in case he
could write. She maintained the same tone of voice and did not talk louder.
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4.
What communication strategies were effective?
What communication strategies were not effective?
What barriers were present in this case study?
What could have been done differently?
Answer
Introduction
Case Study 1
Case Study 2
Case Study 3
Conclusion
Although Marvin is ‘nonverbal,’ Marvin can produce
sounds. The nurse did well when she used other
resources to communicate with Marvin. She also did not
assume that Marvin could not hear and speak louder.
Examples of effective communication strategies:
1) She could have simplified her questions to yes and no questions, to which
Marvin could have shaken or nodded his head.
2) Other things that the nurse could have done are asking Marvin if he could
speak and determining whether Marvin had a family member she would
verbally communicate with as well.
3) If Marvin arrived at the ER with someone who can speak, it is important for the
nurse to maintain eye contact with Marvin, speak to Marvin and allow Marvin
to communicate in whichever way Marvin is comfortable with.
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These are only some of the most common
presentations, and should not be over
generalized. Remember, each person is an
individual, and will present as such. No two
people are alike. Discover how each individual
communicates best.
Take the time to learn about the person, not the
syndrome.
Introduction
Case Study 1
Case Study 2
Case Study 3
Acknowledgements
Conclusion
Many thanks to H’art School of Smiles for the directors, volunteers and students,
who welcomed us and showed us how to communicate, to dance, to paint, to sing
and to appreciate those around us.
Press Esc to End Module
Developed by nursing students of Queen’s University:
Cindy Leung, Nilofer Momin and Rachel Cerre