After a couple of months trying to perfect my initial interviews, I think I’ve got it. Every department may have a different form to fill in and go into various amounts of depth, but the information gathering is roughly the same. You are trying to look at the patients pre-admission baseline in an attempt to discharge them at the level they were functioning at, pre problem/pre admission and decide how much rehab they need to get back to that level of function.
It’s one of the first tasks that you’ll get as an OT student. At first, as a nervous OT student, I went through the initial interview proforma like a checklist, sometimes hardly looking up from the form, rigidly sticking to the questions. I wanted to make this interaction like a semi-structured interview so I could engage with the client more. In my previous job as a careers adviser I used to interview young people aged 13-19. There was certain information I wanted to get but the important thing was to engage with them, so the information was richer, better, that they opened up to you and trusted you. If you’ve got teenagers, you’ll know getting them to talk is no mean feat.
But how can I keep the information that I need to ask the patient/client in my head? As a learner, your head is buzzing with all new information and it’s easy to forget what you’re meant to be asking the patient and just blurt out “where’s your toilet? Is it upstairs or downstairs?”
Well I’ve found a way of doing it, and dear reader, as a thank-you for reading my OT waffle, it’s here for you to try it and please let me know what you think. It may not work for everyone and I have honed this with the older adult physical health population. I’ve worked it like a story/narrative (borrowing an idea from Kawa river but not the concept). It’s easy to remember what you should be asking (hopefully) and it lets me get an idea of function and people’s habits as well as helping the client picture their routine so the information is richer. This means your eyes are off the paper and onto the client and it’s easier to develop rapport with the person.
Before you start:
• Introduce yourself, your role, what OT is in your context and get consent.
• Ask them what they prefer to be called
• If they are an older adult, I like to establish if there is an ear that they prefer me to talk in if their hearing is impaired.
• I also make a point of washing or cleaning my hands in front of them
• Establish their type of residence: if they live in a house, bungalow, or a flat. If there are stairs, how many rails and if their toilet of bathroom is upstairs or downstairs.
• Establish if they have carers, how many and how many times per day they call and at what times.
• If they walk with a walking aid.
• Who do they live with
• Do they have lifeline or other falls alarm system
I call this my Home and Habits interview (the name should jog your memory what you should be asking about).
“I want to find out a usual day in your life before you came into hospital/had the fall etc. Imagine you wake up in your bed at home. Are you able to get in and out the bed by yourself? Do you have any equipment round the bed to help pull you up?
OK, so you walk (with your zimmer/delta/walking stick etc) to your bathroom. You’re now going to get a wash. Do you usually have a bath, shower or a strip wash?
Do you have any equipment that helps you get a wash?( You can elaborate here depending how they normally get clean e.g. shower chair, grab rails, perching stool, walk in shower, bath board etc)
Right, so you’ve had your wash. Are you able to get dressed yourself?
So you walk to the toilet, are you able to get on and off the toilet by yourself? Do you have any equipment or grab rails that help you? Do you have a commode in the house? Where is it?
You go downstairs to the kitchen. Are you able to prepare your meals yourself? Do you eat your meals in the kitchen or somewhere else? (you are looking to find out if they need a kitchen trolley here if they eat their meals in the living room).
Do you make hot drinks for yourself?
Staying in the kitchen, who does your laundry? Who does your cleaning? Who does your big shop?
You walk to the living room, Do you sit in an armchair or on the sofa? Are you able to get in and out the armchair/sofa by yourself? Do you have any equipment to help you? (You’re looking for chair raisers or a riser/recliner here).
Let’s now go out of the house. How many exits do you have? Which ones do you use? Do you have any steps or grab rails to that door? Do you use a different walking aid outside? You may find that they tell you that they don’t go outside very often.
Lastly, do you have any other equipment that makes life easier for you?. Any other grab rails that we’ve not spoken about?”
If someone does have carers hopefully at the different points at the interview they may say: “the carer does that” so you can establish what the carers do to assist.
I hope this helps you get to grips with collecting a subjective history from the patient. Feel free to add/subtract anything to your imaginary walk around the house that you need to collect (e.g.do they take medication by themselves, pets,owner/occupier or rented property).
Please bear in mind that I’m newly qualified and this works in my situation. I haven’t got the benefit of experience, so be kind! But I’ve found that this works for me, while I gain much, much, more experience.
UPDATE: 21/12/14. Found this really helpful resource from OT discussions blog.