117 Educating Patients: Creating Teaching Moments in Practice
CASE STUDY: MR. LOPEZ
Mr. Lopez is a new patient admitted to a long-term care facility from an acute inpatient stay for a fractured right hip following a fall at home. He is a Hispanic 82-year-old who has been diagnosed with early-stage demen- tia and hypertension, and he wears hearing aids. His medications include donepezil, metoprolol, lisinopril, oxycodone, and melatonin. He has start- ed physical therapy with a walker. Mr. Lopez has a history of falling three times at home within the previous five months. He is widowed and had been living with his 50-year-old daughter and her husband prior to being admitted to the hospital. Mr. Lopez will not be returning home until he has stayed at the facility for at least three months. His daughter arrived at the facility shortly after Mr. Lopez did.
Question 1: What are some strategies that will promote building rapport and successful communication? What are some initial considerations when going in to meet Mr. Lopez? Commentary on question 1 : Mr. Lopez should be welcomed to the facility and asked how he would like to be addressed. Inquiring about his language preference for communi- cation and learning is essential. There may be concerns about his ability to hear in addition to the effects of aging and his dementia. It is also important that Mr. Lopez has his hearing aids in while awake. The environment should be as quiet as possible, with effective lighting. Sitting with him at eye level, speaking clearly, and talking at a slower pace show respect and can also assist with communication. Being empathetic, courteous, and responsive is import- ant. Active listening and paying attention to body language, including that of Mr. Lopez, are vital for communication. Plain language, open-ended questions, and dialogue are important. Participation should be encouraged to the extent that he wishes, including the involvement of his daughter. There is stress and anxiety associated with transitioning to a new environment. Moving to a long-term care facility may also cause feelings of grief, dependency, helplessness, and hopelessness. The independence that Mr. Lopez may have had has now changed. There are safety concerns related to his falls and dementia. Pain from his hip fracture is another consideration that can affect his communication and learning. Questions are needed to find out about his cultural needs. Assessments of health literacy and learning style should also be done. Mr. Lopez can speak English, but it is his second language. He prefers to communicate and learns best in Spanish. He moved from Mexico to the U.S. when he was in his teens and is Catholic. He is a retired laborer, and his highest education was high school and completion of a trade school. His health literacy is tested with the Short Assessment of Health Literacy tool, Spanish version, and he scored a 7. His learning style is a combination of visual and tactile. Mr. Lopez says he would like his daughter included in any teaching. He says it’s important to him to regularly attend church services and keep his Bible, crucifix, and rosary near him.
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