INTEGRATIVE CARE 10/16a Teaching Workshop

Question 1

Goals during documentation

Answer 1

• The goals should be updated regularly depending on the length of the episode of care.
• The goals also should be updated whenever there is a change in the patient’s or client’s progress or medical status.
• *Note: State laws and certain third-party payers may have specific expectations on how often goals are updated.

Question 2

Why do we write goals?

Answer 2

1. motivate patients with short term and long term goals
2. To define and communicate the purpose of your plan of care (collaborative)
3. To facilitate the management of your patient’s progression
   - -> Understand if your interventions are progressing to the end goal
4. To determine the efficacy of your intervention
5. To satisfy requirements for reimbursement and meet standards of accrediting bodies

Question 3

Clinical documentation of goals

Answer 3

1. Long Term Goals – (the end of the episode of care, multiple weeks)
   - Return to prior level of function or new functional level
   - Over a month
2. Short Term Goals – (several sessions, 1-2 weeks)
   - Acute musculoskeletal injuries have short time periods
3. Session Goals – (that day)
   - Focus for current session and what you want to achieve in that space

Question 4

SMART Goals

Answer 4

Mr. Jones will walk 500’ independently with a SPC within 4 weeks.

Specific: 500’, device, time frame
Measurable: distance, level of assistance
Achievable: check long term and short term goals
Relevant
Time bound: defined in 4 weeks

Question 5

-What sets you up for objectivity in goal setting?

Answer 5

Measurable goals, ensure that it isn’t an average, look at outcome measures, based on data that’s collected during initial examination

Question 6

-What makes a measurement biased?

Answer 6

Towards age, to ensure that insurance/reimbursement policy doesn’t get cut
-Don’t make our plan based on what we think insurance is going to cover

Question 7

what is the significance of functional relevance

Answer 7

Functional/Relevance

• Ensure that there is relevance to some functional aspect of life
• Need to tie objective to some form of function that the individual needs to do/adds value to them

Question 8

Patient centered, functional goals promote

Answer 8

• actively facilitate the participation of the patient/client, family, significant others, and caregivers in the plan of care
• individually meaningful activities that a person cannot perform as a result of an injury, illness, or congenital or acquired condition, but wants to be able to accomplish as a result of physical therapy

Question 9

why focus on patient centered and functional goals?

Answer 9

1. meaningful to patients
2. health care policy
3. reimbursement practices
4. standards of accrediting bodies increasingly require the goals of physical therapy and other professional services to be patient-centered and functional.

Question 10

patient practitioner collaborative model

Answer 10

1. Behavioral diagnosis

2. Initial rapport building

Question 11

Desired outcomes of patient’s and families

Answer 11

1. If you were to focus your energies on one thing for yourself, what would it be?
   
   2. What activities do you need help to perform that you would rather do yourself?
   3. What are your concerns about returning to work, home, school, or leisure activities?
   4. How can I help you to be more independent?
   5. Imagine it’s 6 months down the road. What would you like to be different about your current situation? What would you like to be the same?

Question 12

how do you alter the following goal statements so that they are SMART goals

1. Improve shoulder AROM
2. Improve standing tolerance
3. Improve walking distance

Answer 12

1. In 2 weeks improve shoulder AROM by 20o to allow patient to brush hair on their own and cast overhead fishing rod
2. In 4 weeks, report at least a 2 point improvement in the numeric pain rating scale during standing while fishing
3. In 4 weeks, demonstrate the ability to ambulate 500’ with a SPC safely and independently to facilitate the ability to walk to the mailbox (make sure you put distance and functional goal)

Question 13

define patient or client centered

Answer 13

tailored or customed to the unique needs of an individual

Question 14

define objective

Answer 14

unbiased and based in fact

Question 15

define measureable

Answer 15

quantifiable

Question 16

define functional

Answer 16

relating to a particular use or purpose

Question 17

define time-dependent

Answer 17

held accountable to a determined interval

Question 18

what are the components of well written goals?

Answer 18

1. Identification of the individual who is receiving therapy and will carry out the program. generally the patient or the client, but may also be the caregiver or family members
2. description of the movement or activity
3. connection of the movement or activity to a specific function
4. specific conditions in which the movement or activity will be performed
5. factors for measuring performance
6. time frame for achieving the goal

Question 19

steps needed when teaching a patient

Answer 19

1. determine what you need to teach
2. get to know barriers and factors influencing patient learning
3. consider the method/mode
4. allow practice/use/application
5. assess your teaching

Question 20

how do you determine what you need/want to teach the patient?

Answer 20

1. goals help you direct what you need to teach
2. begin with end in mind/final outcome
3. make the session objectives based on short term tasks/goals
4. use learning domains
5. know the components of education

Question 21

what are the learning domains?

Answer 21

1. cognitive
2. psychomotor
3. affective

Question 22

what is the hierarchy of cognitive learning domain?

Answer 22

moves from simple to more complex
◊ Knowledge (list, describe, name)
◊ Comprehension (summarize, discuss)
◊ Application (demonstrate, distinguish)
◊ Analysis (order, classify)
◊ Synthesis (create, design)
◊ Evaluation (assess, recommend)

Question 23

what is the hierarchy for psychomotor learning domain?

Answer 23

skill acquisition
						◊ Perception (detects, distinguishes)
						◊ Set (shows, begins)
						◊ Guided response (copies, reproduces)
						◊ Mechanism (organizes, performs)
						◊ Complex overt response 
						◊ Adaptation (alters, revises)
						◊ Organization (composes, creates)

Question 24

what is the hierarchy for affective learning domain?

Answer 24

learning attitudes, appreciation, and values
◊ Receive (identify, recognition)
◊ Respond (comply, perform)
◊ Valuing (consistently, demonstrates)
◊ Organization (justify, modify)
◊ Characterization (displays, serves)

Question 25

what are the components of an education goal/objective

Answer 25

1. audience - who
2. behavior - what
3. condition - when/how
4. degree of mastery - how well/how much

Question 26

how do you get to know the barriers and factors influencing patient learning

Answer 26

1. age/generational considerations
2. kolb’s wheel
3. learning theory
4. literacy levels and language
5. sensory status and cognitive status
6. motivation and self-efficacy

Question 27

what is the significance of Kolb’s wheel in barriers that influence patient learning

Answer 27

1. Scientist - why, personal connection
2. Professor - what are the facts
3. Friend - implications on well-being
4. Inventor - what if, will adapt information

Question 28

what is the significance of the learning theory with barriers that influence patient learning

Answer 28

1. behavioral learning: focus on simple tasks, repetitive; shapes behaviors through reward and punishment
2. cognitive learning: encourages reflection, explores connections, includes experiential/problem based learning
3. soci-cultural learning: learning as a cognitive and social experience; peer interactions, community based

Question 29

how do you assess readability for patient education materials?

Answer 29

• FOG and SMOG readability calculators
• assess education level
• assess preferred language

Question 30

what is the average level of education in the US?

Answer 30

8th grade, be sure to know the readability of your HEP documents for your patients

Question 31

how do you assess preferred language?

Answer 31

if you ask and it is not the same, then you provide access to certified medical interpreters and ensure to get the patient education materials in multiple languages

Question 32

what are different ways to assess sensory status and cognitive status?

Answer 32

1. hearing/eyesight
2. conducted as part of systems review
3. formal and informal
4. motivation and self-efficacy

Question 33

how do you do a formal and informal cognitive screen?

Answer 33

informal: ask, observe
formal: feel free to ask someone; mini-cog, MOCA, MMSE - general cognition, visual screen, hearing screen

Question 34

how do you assess motivation and self-efficacy

Answer 34

ensure patient is ready to take in the information you are going to give them
self-efficacy = the confidence one has about their capability to produce certain results

Question 35

what is the importance of methods and modes in patient education?

Answer 35

• methods vary based on the target domain (cognitive. psychomotor, affective)
• different strategies have varying retention rates

Question 36

list of retention rates with different strategies/methods for patient education

Answer 36

lecture - 5%
reading - 10%
audiovisual presentation - 20%
demonstration - 30%
discussion - 50%
practicing - 75%
teaching others (best retention) - 90%

Question 37

what are some important active learning principles?

Answer 37

1. have learners work with the content
2. include reflecting and interacting with the material
3. help the learner do the learning
4. follow content delivery with interaction time
5. active learning strategies

Question 38

what are different active learning strategies?

Answer 38

1. reciprocal teaching
2. action learning
3. role plays
4. debriefing

Question 39

how do you allow practice/use/application for patient education?

Answer 39

• prepare to teach family member or patient
  1. what do you need to teach
  2. what are the barriers
  3. what factors need to be considered

Question 40

how do you assess your teaching

Answer 40

formative assessments

summative assessments

Question 41

what is a formative assessment?

Answer 41

ongoing assessment

• progress toward accomplishments of objectives
• feedback to instructor about teaching

Question 42

what is a summative assessment?

Answer 42

final assessment

-ask yourself if the goal has been met

Question 43

what is the significance of using a checklist/guiding framework with patient education?

Answer 43

• used to learn and structure patient education
• a way to assess student skills in a patient
• SEGUE

Question 44

what is SEGUE and what is it used for?

Answer 44

used to structure and assess a patient encounter
S = set the stage
E = elicit information
G = give information, treatment plan
U = understand the patient's perspective
E = end the encounter