2.4 Exercise: Analyse teamwork

Read the case study and example plan, then enter your responses to questions and check against suggested answers.

Case study

Jack is a 20-year-old snowboarder who suffered orthopaedic injuries as well as a severe traumatic brain injury in an international competition. He has a right hemiplegia and significant difficulty communicating. His family is planning for him to return to living with them in Australia, but Jack has indicated that he wants to go back to Utah. He has made good recovery from his orthopaedic injuries.

Following discussion with Jack, his older brother, Jason, and their parents, there were two ideas that seemed to be appropriate to start on. The first was that Jack would be “well enough to attend his brother’s wedding in a few weeks”. The second was he would “be able to move back into his own bedroom (upstairs) when he first comes home.”

The barriers to Jack being able to attend Jason’s wedding were discussed with the family and the therapy team. The main barriers identified were:

  • his walking (he can only manage to walk 20 metres at present before he needs to sit down) and
  • Jack’s difficulty with communication.

Although his family agreed to take a wheelchair for when he gets really tired, Jack doesn’t think he’ll need it. While attending the wedding, Jack wants to be able to greet his cousins by name and practice some social conversations, because when they last came to visit him in hospital, he couldn’t speak with them at all.

Plan 4 is an example of how the client goal is structured using interim goals.

In this plan, he is extending the distance he can walk. Jack can see some progress when he walks to the coffee shop with his family members and orders the coffee himself. The steps are linked with the client goal (e.g. Plan 4, Goal 2).

Plan #4

Date of plan: 5 May

Plan period: 5 May to 3 June

Client goal: Get to Jason's wedding on 3rd June

Although his family is prepared to be flexible about taking him and a wheelchair to the wedding, Jack believes he will walk. He has agreed to focus on his walking and speech because he wants his cousins to see that he’s getting better.

Interim goal: Jack will walk to the coffee shop in the hospital foyer and order a coffee when his parents or brother visit him.

Client step Action plan

Client step 2a: Each day, Jack will increase his walking distance and identify places he can rest.

  • Jack will continue daily physiotherapy program and complete his prescribed exercises.
  • Jack’s family members will check in with the physiotherapist before they take him for a walk.
  • The social worker and occupational therapist will work with Jack and his family to introduce the wheelchair for use at another social event so they are familiar with its use and that it may be less likely to trigger an outburst at the wedding if he is too fatigued to walk.

Client step 2b: Jack will focus on speech intelligibility by participating in therapy sessions and talking to his grandfather on the phone once per week.

  • Jack will continue to attend three speech pathology sessions per week.
  • Jack will practice his speech therapy strategies when talking with ward staff and his family.
  • Jack’s practice on the phone with his grandfather, who will provide feedback as to his intelligibility.

Client step 2c: Jack will practice his cousin’s names and social greetings. Jack wants to practice this himself by recording and listening on his mobile phone.

  • Psychology sessions will assist with Jack’s adjustment and maintaining motivation.
  • The speech pathologist will help set up the practice work for Jack.

Progress: At the end of this phase, everyone discussed Jack’s progress, whether he achieved the main goal, or what was only partially achieved.

The plan and details were devised with Jack, his family and the therapy team. They agreed on what would happen, how it would work and roles for everyone – including Jack.

This is only one goal, so it may be included in a more holistic plan.

Jack is not ready to move back to Utah, and has adequate insight to recognise this is a long term goal – so he may be happy for the goal not to be written into his current plan.

Discussions between Jack, his family and his rehabilitation coordinator to confirm this is a goal for Jack, and to identify steps they can focus on now that might help him achieve this in the longer term. Peer support may be involved in assisting Jack to understand and accept this position.

In addition, the team will be discussing if this goal indicates a lack of insight or non-acceptance of disability; and whether they need to include actions to help with insight, understanding of the injury, acceptance and adjustment to disability, etc.

There may also be discussions with Jack’s family to help them understand why he has this as a goal, and the importance of not crushing hope at this early stage. Plus, if there is a chance Jack could return to Utah, the team can discuss with the family the importance of supported decision-making, choice and control, dignity of risk and helping them manage any potential risk averse behaviour.

No, it just means that the team has negotiated with Jack to focus on shorter-term goals for now.

Interdisciplinary – team members doing their own actions, but working towards the same goals.

  • Good collaboration and team conferencing
  • Sharing progress and feedback
  • Avoiding making Jack repeat himself to each team member
  • Relating their own therapies and interventions to his long and short term goals

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