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Sunday, February 6, 2011

Mental Status

I knocked at the door. 

“Come in!”  Ms. Caldwell exclaimed, mustering all of her strength to greet me. 

“May I visit with you?”  

Ms. Caldwell had been admitted to the nursing home a couple of days ago.  After being hospitalized for a hip fracture, the surgeon had explained she needed rehabilitation therapy before returning home. 

“Yes. Have a seat.”  Her voice sounded as weak as it did the day she first arrived.  She was lying in bed.  Her slender arms moved slowly, trying to adjust the pillows under her head. 

“Can I help you?”  I drew close to her bed, attempting to reach the pillows.

“No, I’ve got it.”  Her words tumbled with effort from her mouth, but I understood. I  found myself almost staring at her when I spotted her bright eyes.  I had not noticed she had beautiful blue eyes, bright in contrast to her light brown curly hair.  

Ms. Caldwell’s eyes were curiously focused on the clipboard I was resting on my left arm, poised to write my social services assessment paperwork on. 

As a social worker, I conduct a psychosocial assessment on each one of my new residents.  Part of the assessment has to do with what we call ‘the resident's mental status’. We want to know about the resident’s current state of mind, for instance, if he/she knows who he/she is (orientation as to person), where he/she is (orientation as to place), and if he/she knows the date (orientation as to time).  

Also, we ask questions to explore their memory—both short and long-term. This evaluation is required in each skilled nursing facility.  And it is a component of a more extensive—comprehensive assessment, which will be crucial for the inter-disciplinary team to determine the level of care, and the type of interventions a resident may need. 

I explained to Ms. Caldwell the reason for my visit and about the questions I was going to ask. 

“Okay.”  She answered, her voice in disbelief. 

On my first conversation with Ms. Caldwell upon arrival to the facility, I noticed she paused quite often, and at times appeared that she had to think hard before articulating an answering.  My first observation may have not be an accurate reflection of her mental status.  It’s quite common to see elderly patients confused after surgery, and then a week later, be back to their normal acuity of mind.  However, sometimes residents may have an underlying cognitive deficit and the confusion may be just part of their baseline mental status. 

At this point, I was not sure about Ms. Caldwell. 
I asked her the first question. Ms. Caldwell glared at me.  Sometimes residents may dislike this type of visits, the visit where they are asked 'tricky questions' and their embarrassment and frustration at not knowing the answer or how to respond is exposed.  As gentle as I always try to be, the residents know they are being tested for their cognitive status. 

I pondered what Ms. Caldwell’s reaction would be. 

I felt a bit of excitement when she answered appropriately.  I continued asking questions, and she continued giving me accurate answers.  A pleasant feeling filled me when we were finished with the last question. 

“Very good!” I said, flashing a grin. 

She glared at me again. Then her lips curled up, drawing an endearing grin.  And her words came out with unexpected strength, and delightful irony.

“I hit my hip, not my head.”


Mariette VandenMunckhof-Vedder said...

Dearest Doris,

Oh my, what a delight; that lady was NOT shooting from the hip either.
Thanks for visiting me and for leaving me a comment + mail. You mean a lot to me.

Your stories are always very special and I was wondering how many 'skilled' nursing homes we have. Hope that most patients being admitted get to see a bright, caring and considerate angel like you...

Wishing you a great week ahead and lots of strength in dealing with what is coming your way; unexpectedly at times.



Unknown said...

You hit it right there, Ms Caldwell! Hope you have a speedy recovery and be on your feet again.

Anonymous said...

Very cute Doris. I'm so glad that you share these wonderful stories. And that you see far beneath the surface of these interactions. I always look forward to your posts.

DUTA said...

Smart answer, Ms Caldwell!
Well done and well-written, Doris!

Speaking of the head which obviously controls everything in the body, I've read somewhere that massaging the scalp regularly could proove very beneficial to all kinds of health problems.

none said...

I love the way you capture these people you meet with such precision. :-)
And I like her answer, hehe.

Amrita said...

You are so professional and well cordinated and mindful of everyone 's need and condition. You have a personal touch while interacting with the residents that make s it so special. I am learning so much from you Doris.

Tony Sexton, Site Administrator said...

Very good….

There is so much we can learn from our Residents from everyday conversation and observation, and we do thankfully.

I fear at times that we sabotage our own good intentions when we show up for our assessments with clip board and forms in hand. Sure there are many required assessments, yet how do we negatively affect our resident’s psychosocial well-being if it seems to them they are being “ganged-up” on with all of our paper-work?

Clip board and form may indeed be what works with one resident, yet for another we can accomplish our same goals in the midst of a game of checkers or just an ordinary conversation.

Perhaps that is an area that far too often is neglected in Skilled care, “ordinary” conversation.

Enjoy your articles, keep up the great work!!

Tony Sexton

Have Myelin? said...

Oh I just love that story! =)

cyclopseven said...

This assessment obviously gives you a good insight into their mental status.

“I hit my hip, not my head.”...I like this statement very much. Thanks for sharing this with us, it gives me a peep into the assessment aspect.God bless all.

Kittie Howard said...

Gosh, what a beautiful story...and a beautiful lady.

Nicole said...

How cute. you write such cute anecdotes!

Rita said...

What a wonderful response for your patient! I love it! I can just see my mom saying the same thing! I love your stories. They make my day!

Ann said...

I love Ms. Caldwell. She made me laugh for a good few seconds and grin for even longer. Did you laugh?

Mary Aalgaard said...

Her wit was still sharp! Great story.

Unknown said...

You have a natural talent for anecdotal writing -- this was a real pleasure to read! Thanks for stopping by my blog and following. I look forward to reading more from you.

Have a wonderful day!

Anonymous said...

Always the unexpected with this wonderful, "special" people! Another great story. I look forward to each story you post!!
Ann Best, Author

Jules said...

LOL, have you been reading my, "Throw them a curve" posts?! This was special, I play the same game with my grandmother. :)

Stop my blog post today and pick yourself up some blog love :D
Jules @ Trying To Get Over The Rainbow

Toyin O. said...

Another engrossing story, thanks for sharing:)

Relyn Lawson said...

I love this story. I sure hope I'm that kind of sassy old lady.

Anonymous said...

Hahahaha! Great story!!!

Bica said...

I love your story. This sounds just like something my paternal grandmother would have said - always a sharp wit!

Bica said...

I love your story. This sounds just like something my paternal grandmother would have said - always a sharp wit!

Karin said...

Sounds just like the folks at our place! We just love sharing a good sense of humor!

dr.antony said...

That was an interesting story .There is a writer in you!

Ms Caldwell might have been smart.The comment appears cool first.She obviously has not lost her sense of humor.

But I would tell her, at least on another occasion ," Mama,it is not necessary that you bang your head".
Because we see confusion in patients,who are simply admitted to hospital for some other unrelated problems.