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Case Studies in Long-term Care

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Case studies have been quite beneficial for both new graduates and ...seasoned practitioners like me.

Conducting a clinical case study forces you to target the primary needs of the resident. You minimize your risk of missing anything, and that's a good thing. In light of PPS, RUGS and all the SNF care planning, we usually have little time to investigate the full clinical rehabilitative picture of a resident. Many of our treatments today are similar to fast food: patients are in and out in less than 20 minutes.

The other day a caregiver was observing a therapy session with her mother, who is recovering from hip surgery. She said, "It looks like you are herding cattle in here today, and my mother is on the production line."

I walked over to converse with her and learned that her primary concern was whether or not we were addressing what she felt were her mother's primary needs. I believe that sometimes we need to just slow down a bit and observe our surroundings.

A true case study takes into account the physical, mental and emotional status of the resident.

I hear you saying, Clarissa, we are doing that already with the resident care plan process. Yes, you may be. However, the intimate details of clinical care approaches and special clinical feedback for each often gets overlooked. My viewpoint is that case studies force clinicians to develop clinical accountability and a primary method of problem solving. It benefits residents more if case studies are conducted while they are on your caseload and not after discharge, but this is not required.

Here are some suggestions and prerequisites of how you may start this process in your department.

1. Decide which case study method you will use to begin the process. You may begin with a team process or individual professions. Clinicians involved in the process must be open-minded and willing to accept constructive feedback from others.

2. Choose a challenging resident each month. Present your case study over lunch, which by the way, you might provide.

Highlight any specific physical and mental abnormalities and supporting treatment techniques and goals. Share your approach to your treatment process. Be ready with pen and paper to receive ideas and feedback for this case.

Your presentation should not last more than 15 minutes because you will need to reserve time for discussion by your peers. Emphasis should be on the primary needs of the patient (top three areas) and on your approach in order to achieve your goals.

This will be a good time to ask for help and suggestions by your team members. It may also be wise to invite your immediate supervisor to this session. It should take no longer than 30 minutes when presented in an orderly format.

Presenting case studies in your professional environment can be quite stimulating for you and rewarding for the resident. It also says to you and others, "I care about my clinical growth, and I am open to receive constructive feedback."

Subsequently, there is one word of caution: feedback given in a negative manner can cause interpersonal conflict. All input should be given in a loving and kind manner. Suggestions given harshly and demeaningly can sabotage the entire process. This is not the time to throw darts at your peers!

Mature and caring clinicans can usually handle this with no problem. Their feedback is only a suggestion and not a mandate.

Fostering an environment of learning and growth benefits all parties involved, and that hopefully yields better quality of care for our residents.

Clarissa Fells Smith, PhD, OTR/L, has a doctorate in health services administration with a specialty in gerontology/geriatrics. She has worked as a manager and clinical education specialist and is currently an independent contractor, trainer, consultant and workshop leader in geriatric rehabilitation. Readers may contact her at clarissafsmith@aol.com.

Sample Case Report Outline

 Today's date: May 15, 2002

 Date of OT evaluation: May 3, 2003

 Presentation of case study: May

 Name: Bessie Doe Smith

 Date of admission: May 1, 2002

 Age: 78

 Primary diagnosis: CVA (R) hemiplegia

 Secondary diagnoses: diabetes mellitus, poor vision

 Prior living arrangements: independent at home, non-driver

 Long-term care plan: to return home to independent living

 Rehab services needed: physical, occupational, and speech therapy

 Supporting relatives: her daughter and son-in law

 Person completing case study: (you)

Elements within the case study will include:

 Why you chose Bessie Doe Smith for the case study

 How long Ms. Smith was in treatment

 Ms. Smith's motivation in the rehabilitation process and any supportive family or friends

 Your findings in the evaluation process


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