Module 7 – Care Planning/ Restorative Care/

Documentation/Working in the
Community Assignment

General Directions:

A. Take Home Assignment.

B. The assignment will count for 40% of your final mark in Module 7. C. A
minimum mark of 21 out of 30 (70%) must be achieved to pass.

Name: ______NABINA MALLA___________________________________________________

Due Date: ___2024-08-20___________________________________________________

CASE #1

Mrs. Gregg is a 55-year-old widow who has had an active career as a lawyer. She is an
avid reader. She is an independent woman who has had to adapt to many changes in her life.
She enjoys crafts and sings in the choir at her church. She has an adult son and daughter, and

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two grandchildren who visit her frequently. She lives in her own home, a small bungalow in
the city.

You are assigned to give care and support to Mrs. Gregg, who had a stroke two weeks
ago. She is paralyzed on the left side and has difficulty speaking. She is able to hear well and
can understand when you speak to her. The long-term goals for her care include:

• regaining mobility
• regaining speech
• being as independent as possible
• preventing complications such as contractures and pressure sores

You are required to assist her to participate fully in all activities of daily living, and assist to
meet her physical, safety, and psychosocial needs.

1. What information would you want to find out about Mrs. Gregg and her home before
beginning her care? (2 marks)

● Home Environment: Are there any possible modifications that need to be made in her
home to make it comfortable for a person like her with mobility issues—for example,
ramps, grab bars, and widened doorways to accommodate wheelchair passage?

● Support System: Who will be there for her—family, friends, and other caregivers—when
you are not able to?

● Medical History and Current Medications: Are there other underlying medical
conditions, allergies, or medications that have to be managed in her care?

● Communication needs: Given her difficulty in speech, how does she like to
communicate? Are there any devices or methods that may assist in communication?

2. List the types of information that you would expect to obtain from the care plan. (2 marks)

● Specific care tasks: detailed instructions concerning how to assist her in movement,
speech exercises, performance of daily living activities, and personal hygiene.

● Safety Measures: Goals to avoid possible complications such as contractures and

pressure sores, including repositioning schedules and use of assistive devices.

● Nutritional needs: Any special diet because of her stroke or special ways of feeding.
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 ● Psychosocial Interventions: How to help her with her emotional and mental welfare by
keeping her engaged socially and in activities of interest, such as crafts or choir.

3. In the following problem, explain briefly the feeling expressed by the client and the actions
for the Personal Support Worker to take (2 marks each).

Situation 1

Mrs. Gregg continually uses her knife to eat with and is generally unable to
choose the correct utensil and unable to cut her meat. She has difficulty getting food to
her mouth. She resists help. One day she threw her plate across the room.

Client’s Feelings

It can be inferred that Mrs. Gregg will get frustrated and overwhelmed about her inability
to do simple things that she could have easily done before, like eating on her own. The
loss of independence and difficulty in movement coordination may make her helpless,
embarrassed, and angry. The plate-throwing act insinuates that there must have been a
buildup of the feelings of anger, frustration, and bitterness, maybe a result of the
resistance to acceptance of help and struggling through adjusting to the new limitations.

PSW Actions (physical and emotional help)

● Reassurance and Empathy: Calmly approach Mrs. Gregg, acknowledging feelings of

frustration, then verbally reassure that it is okay to ask for help and you are there for her
without judgment.
● Promoting Independence but Providing Assistance: Encourage people who have
difficulty coordinating their hands to use an adaptive utensil in order to feed themselves.
Offer assistance in ways that will not be humiliating to her—a dietician might do this by
cutting up her food into manageable sizes and guiding her hand toward her mouth to
bring the food to her lips.

● Calming Environment: The dining environment should be calm, or possibly without any
distractions, to make the atmosphere less stressful while eating meals. It would allow
Mrs. Gregg to feel more at ease and not experience pressure.

● Emotional Needs: Provide companionship with Mrs. Gregg to engage her in expressing
feelings and emotions by offering emotional support. This might be facilitated through
proper active listening, finding little ways of giving her back the sense of control over
everyday activities.
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 Situation 2

Mrs. Gregg has expressed a desire to read, but she is unable to understand the
text in her old books. She asks you to help her practice words. She says that she has
trouble passing the time and that she expects to return to work in several weeks.

Client’s Feelings

She is probably feeling quite determined but frustrated. Her interest in reading and
practicing words suggests that she is motivated to recover her neuropsychological
functions and resume normal activities, including returning to work. At the same time, her
frustration over not being able to comprehend what she reads will likely make her very
anxious to recover and unsure about her future. The statement also says that it has been
hard to pass the time, so she could be feeling bored, restless, and even isolated by current
limitations.

PSW Actions (physical and emotional help)

● Encourage and Support Cognitive Rehabilitation: Assist her in developing reading skills
through the use of easier texts or larger print, to build her confidence. Do some practice
reading with her—slowly, very patiently—and give lots of encouragement to motivate
progress.

● Introduce alternative activities: Engage her in other mentally stimulating activities that
she may enjoy or find fulfilling to do and spend time on, such as word games,
audiobooks, or simply listening to music, to reduce feelings of boredom.

● Set Realistic Expectations: It should be subtly reminded to her how much time it takes
to recover and that she should take small daily successes rather than rushing back to
work. Provide her emotional support when she says that she is ready to return to
normalcy by expressing the same, but convince her she has to give herself a little more
time to recover.

● Establish a Routine: Assist Mrs. Gregg in establishing a routine day that will include
reading practice, time for physical therapy, and some leisure activities. Having a
structured day might help her oversee her life better and decrease anxiety over her
recovery process.

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 Situation 3

One day when you approach Mrs. Gregg, she is crying and says she doesn’t
want to get up. She says, “None of this should have happened to me. What did I do to
deserve this?”

Client’s Feelings

Mrs. Gregg is in deep sadness, despair, and probably some amount of guilt. Her
statement, "None of this should have happened to me," does imply some difficulties in
acceptance and raises questions as to why she has been dealt such a situation. The
underlying feelings could be of grief due to loss of independence, fear of the future, and
a possible feeling of injustice or helplessness. She may be depressed, feeling quite
hopeless about her current condition and the chances of recovery.

PSW Actions (physical and emotional help)

● Offer Compassionate Listening: Sit with Mrs. Gregg and listen with compassion without
interrupting her at all. Acknowledge the feelings by saying something like, "I'm so sorry
you're going through this. It's okay to feel this way."

● Offer Emotional Support: Let her know that her feelings are real, normal, and
appropriate. It's okay to have bad days. Express that you stand with her in recovery and
she doesn't have to fight alone.

● Gently Encourage Participation: Bring up rising in the morning and having breakfast
together as a small activity. Emphasize that even small actions can positively add to her
recovery, but don't push her if she's not ready.

● Consider Professional Support: If Mrs. Gregg's emotional condition fails to get better or
keeps worsening, contact the health team or advise her to reach out to a counselor or
psychologist who will help her digest her feelings and come to rest in her situation.

● Do some calming activity: Take out some time to spend with her and spend that time in
what she enjoys or likes to be calmed by it. It might mean sitting together with her and
just listening to her favorite music, sitting around and doing crafts, or just keeping quiet.

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 Situation 4

Mrs. Gregg insists on getting up by herself and moving independently from her
chair to the bathroom. She uses a walker. Occasionally she falls. She is a private person
and does not want you to attend her in the bathroom.

Client’s Feelings

Mrs. Gregg is likely to feel very strongly about independence and dignity in such private
matters as using the bathroom. Her insistence on moving independently would therefore
suggest that she values independence and probably has a hard time requesting help in
doing things for which earlier she had no problem at all. These occasional falls, however,
show overestimation of her present physical capacities, which could have its roots in
denial or frustration about such limitations. She may feel quite ashamed or vulnerable
about needing assistance with such personal matters.

PSW Actions (physical and emotional help)

● Respect Her Privacy and Independence: Honor her need for privacy by
overlooking as much as possible respect for her wishes. Let her know that you do
respect her wanting and needing to be independent and that you will support
her in whatever way she is comfortable.

● Emphasize Safety: Express your concern for her safety and, at the same time,
offer a compromise. You could be there if she ever needs any help, or you could
put in some bathroom safety features like grab bars and a shower chair. If she
does this, then she will have given up a portion of her independence to the risk
of falling.

● Encourage Use of Assistance Devices: Recommend the use of assistive devices,

such as a walker or transfer belt. Offer to practice using these tools together so
that she may feel more confident about being able to move safely.

● Be Open About It: Discuss with her the risk of falls and the consequences. Frame
it in a manner that will empower her to make decisions for health and safety, all
without making her feel that you believe she is incompetent.

● Provide Gentle Supervision: There could also be discreet supervision offered,

where a carer would help someone to then stay within calling distance or just
outside the bathroom door for providing assistance in times of emergency
without entering into her private space. Reassurance in such cases should be
given that it is mainly for her safety and not to take away independence.
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4. Using all of the above information, describe how the following factors might affect Mrs.
Gregg’s relearning of speech and mobility. Use case study information to help answer
questions. (3 marks)

a. Age
Mrs. Gregg is 55, and this can be a double-edged sword for her relearning of
speech and mobility. However, at the relatively young age of 55, she may retain more
neuroplasticity—the ability of the brain to reorganize and form new connections—of a
degree significant in recovery after a stroke, which could help her in her relearning of
speech and regaining mobility. On the other hand, she may still recover more slowly
than someone who is younger, and at her age might add additional issues, such as pre-
existing physical degenerative changes related to age, which may affect her stamina and
strength to cope with rehabilitation.

b. Individual characteristics: personality

For example, this strong independence and drive, as evidenced by her
insistance to move independently and her desire to go back to work, in itself could be an
asset or hindrance in Mrs. Gregg's recovery. Her determination can drive her to work
hard in speech and mobility relearning and push for her goals. However, this very
resistance to the need for help and the frustration of limitations may become a
counterproductive factor. Her private nature may make her want to avoid seeking the
necessary help, and that could slow her recovery rate. Maintaining a balance between
her desire to be independent and acceptance when help is needed will play a significant
role in her rehabilitation.

c. Environment
Mrs. Gregg lives in her own home—a small bungalow in the city—with
opportunities and challenges for her recovery. The very familiarity and comfort of her
home may increase ease and motivation during rehabilitation. The home environment,
however, may need to be adapted to make it safe and conducive to her relearning of
mobility. Such adjustments could involve grab bars, removal of trip hazards, and ease of
access for a walker. Although she lives with her adult children and her grandchildren
frequently come by the house, which would presumably give her emotional support,
they will also need to strike a balance between how much help they can offer and how
much independence they should allow her to have. It could also be the case that
community-based services available locally would become very instrumental in her
recovery.

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5. Describe five (5) ways in which the PSW can promote Mrs. Gregg’s self-esteem and
motivation during her daily routines. (5 marks)

a. Participation in Decision-Making: Engage Mrs. Gregg on issues that concern her

care, such as setting daily goals or choosing activities. This will give her a sense of
control and ownership over the recovery process.

b. Celebrate Small Successes: Reward and applaud Mrs. Gregg for any progress,
however minor, whether it is completing a physical therapy exercise or learning a
new word. This will help build up her confidence and motivational levels.

c. Encourage Independence: Let Mrs. Gregg do as many daily tasks by herself as

possible, without intervening unless her safety is at stake. This would imbue
autonomy and aid in the preservation of her dignity.

d. Emotional Support: Show sympathy towards her and display empathy whenever
necessary. This type of encouragement and soothing of feelings will help in
sustaining the positive attitude of Mrs. Gregg throughout the recovery process.

e. Positive Environment: Mrs. Gregg should be surrounded by a positive

environment, either by listening to favorite music, visits by family/friends, or
activities she enjoyed doing. A positive environment will make her mood light, thus
increasing her participation in daily routines.

6. Define Restorative Care and what role it would play in helping with Mrs. Greg’s
rehabilitation. How could the PSW assist with this process? (2 marks)

Restorative care is a type of care that aims to help patients achieve maximum
independence, functionality, and quality of life during or after a health setback, such as a
stroke. It combines treatments involving physical, occupational, and speech therapies with
emotional support to revive lost abilities of a patient and help in adjusting to permanent
changes.

Contribution to Mrs. Gregg's Rehabilitation:

Restorative care will help Mrs. Gregg to improve her mobility and speech, also
prevent the complications of contractures and pressure sores. It aims to make her more
independent in her daily activities and improve her sense of well-being so that she may
resume regular daily living with as near normalcy as possible.

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 How the PSW Can Assist:
The PSW can help with restorative care by assisting Mrs. Gregg to do her
exercises as prescribed by the doctor, encouraging her to practice talking, and supporting
her consistently in performing daily activities. The PSW can also be helpful for checking on
her progress and following up with the care plan accordingly, providing emotional support
that would serve as motivation throughout her rehabilitation process.

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