CASE #1 Mrs. Gregg is a 55-year-old widow who has had an active career as a lawyer. She is an avid reader. She is an independent woman who has had to adapt to many changes in her life. She enjoys crafts and sings in the choir at her church. She has an adult son and daughter, and two grandchildren who visit her frequently. She lives in her own home, a small bungalow in the city. You are assigned to give care and support to Mrs. Gregg, who had a stroke two weeks ago. She is paralyzed on the left side and has difficulty speaking. She is able to hear well and can understand when you speak to her. The long-term goals for her care include:

• regaining mobility

• regaining speech

• being as independent as possible

• preventing complications such as contractures and pressure sores You are required to assist her to participate fully in all activities of daily living, and assist to meet her physical, safety, and psychosocial needs.

1. What information would you want to find out about Mrs. Gregg and her home before beginning her care? (2 marks

2. List the types of information that you would expect to obtain from the care plan. (2 marks)

3. In the following problem, explain briefly the feeling expressed by the client and the actions for the Personal Support Worker to take (2 marks each).

Situation 1

Mrs. Gregg continually uses her knife to eat with and is generally unable to choose the correct utensil and unable to cut her meat. She has difficulty getting food to her mouth. She resists help. One day she threw her plate across the room.

Client’s Feelings

PSW Actions (physical and emotional help)

Situation 2

Mrs. Gregg has expressed a desire to read, but she is unable to understand the text in her old books. She asks you to help her practice words. She says that she has trouble passing the time and that she expects to return to work in several weeks.

1 Client’s Feelings

2 PSW Actions (physical and emotional help)

Situation 3

One day when you approach Mrs. Gregg, she is crying and says she doesn’t want to get up. She says, “None of this should have happened to me. What did I do to deserve this?”

Client’s Feelings

PSW Actions (physical and emotional help)

Situation 4

Mrs. Gregg insists on getting up by herself and moving independently from her chair to the bathroom. She uses a walker. Occasionally she falls. She is a private person and does not want you to attend her in the bathroom.

Client’s Feelings

PSW Actions (physical and emotional help)

4. Using all of the above information, describe how the following factors might affect Mrs. Gregg’s relearning of speech and mobility. Use case study information to help answer questions. (3 marks)

1. Age ________

b. Individual characteristics: personality

1. Environment

5. Describe five (5) ways in which the PSW can promote Mrs. Gregg’s self-esteem and motivation during her daily routines. (5 marks)

1. ___
2. ___
3. ___
4. ___
5. _____

6. Define Restorative Care and what role it would play in helping with Mrs. Greg’s rehabilitation. How could the PSW assist with this process? (2 marks)

ANSWER

Information about Mrs. Gregg and Her Home

Before beginning her care, it is crucial to gather information about Mrs. Gregg and her living environment. This information may include:

Mrs. Gregg’s medical history, including the details of her stroke and any pre-existing conditions.
Her medication regimen and any specific requirements.
Details about her stroke, such as the type, affected areas, and severity.
Information about her daily routine, hobbies, and interests.
Any allergies or sensitivities she may have.
Her level of mobility and the extent of her paralysis.
Her communication abilities, including any difficulties with speech.
Information about her family and support system.
The layout and accessibility of her home, including any modifications required for her mobility.
Any safety concerns in her home.
Her dietary preferences and restrictions.
Information about her emotional and psychological well-being.

Types of Information from the Care Plan

From the care plan, one would expect to obtain the following types of information:

Specific care goals and objectives for Mrs. Gregg’s rehabilitation.
Details about her prescribed therapies and treatments.
Scheduled activities and exercises aimed at improving her mobility and speech.
Information about any medical equipment or aids required for her care.
Guidelines for her dietary needs and any restrictions.
Protocols for medication administration and management.
Procedures for monitoring and addressing potential complications.
Instructions for maintaining her skin integrity to prevent pressure sores.
Guidelines for emotional and psychosocial support.

Situational Responses

Situation 1:
Client’s Feelings: Frustration, independence loss.
PSW Actions: Gently encourage the use of appropriate utensils, offer to cut her meat, provide emotional support, and explore alternative strategies for mealtime independence.

Situation
Client’s Feelings: Boredom, anticipation of returning to work.
PSW Actions: Engage in word practice, read books aloud, encourage cognitive stimulation, and offer encouragement regarding her return to work.

Situation 3
Client’s Feelings: Sadness, loss of control.
PSW Actions: Provide a listening ear, offer comfort, validate her feelings, and explore ways to boost her mood and motivation.

Situation 4
Client’s Feelings: Desire for privacy, independence.
PSW Actions: Respect her privacy wishes while ensuring safety, assist when requested, and collaborate on strategies to prevent falls.

Factors Affecting Mrs. Gregg’s Rehabilitation

Mrs. Gregg’s age may affect her relearning of speech and mobility as older adults may experience slower recovery and may have co-existing health conditions that complicate rehabilitation efforts.

Individual Characteristics (Personality)

Age: Mrs. Gregg’s personality traits, such as independence and determination, may positively influence her rehabilitation as they can drive her motivation and active participation in therapy.

Environment: Her home environment plays a significant role. If her home is modified for accessibility and safety, it can facilitate her rehabilitation. However, any environmental barriers or hazards could hinder her progress.

Promoting Self-Esteem and Motivation

Provide positive reinforcement and praise for each achievement, no matter how small.
Encourage active participation in daily routines and rehabilitation exercises.
Listen actively to her concerns and feelings, offering emotional support.
Involve her in setting achievable goals and tracking progress.
Foster a sense of independence by allowing her to make choices within her capabilities.

Restorative Care and the PSW’s Role

Restorative care focuses on maintaining or improving an individual’s level of function and independence. In Mrs. Gregg’s rehabilitation, restorative care would involve implementing exercises, therapies, and activities aimed at regaining her mobility and speech. The PSW can assist by:

Encouraging and facilitating her participation in prescribed exercises and therapies.
Providing emotional support and motivation during rehabilitation sessions.
Assisting with activities of daily living, such as bathing and dressing, to promote independence.
Collaborating with the rehabilitation team to ensure a coordinated approach to her care.
Monitoring and reporting any changes in her condition or progress to the healthcare team.

In summary, gathering comprehensive information, addressing emotional needs, and promoting self-esteem and motivation are essential components of caring for Mrs. Gregg. The concept of restorative care plays a crucial role in her rehabilitation, with the PSW serving as a vital support and facilitator in her journey towards recovery and independence.