CBOA

key conditions

key conditions

HCP (History, Clinical Presentation):

• Fast+

• Right-sided weakness

• Slurred speech

• Facial droop

• NIH Stroke Scale 2 for Ataxia and Sensory

PMH (Past Medical History):

• Hypertension

• Type 2 Diabetes

Scan Results:

• Left internal capsule hematoma 9 x 13mm

• Surrounding edema

• Midline shift

• Left Intracerebral hemorrhage (hypertensive bleed)

Hematoma:

• Definition: Blood accumulation under the dura mater, a brain tissue layer (Pierre & Kondamudi, 2023).

• Symptoms: Can lead to headaches, nausea, confusion, personality changes, drowsiness, and loss of consciousness (NHS, 2021)

Intracerebral Hemorrhage:

• Definition: A type of stroke caused by brain bleeding due to ruptured blood vessels (Rajashekar & Liang, 2023).

• Effects on Kyle: Right-sided weakness, sensory issues, and coordination deficits due to the hemorrhagic stroke.

Ataxia:

• Definition: A neurological disorder affecting coordination (NHS, 2021).

• Type: Cerebellar Ataxia in Kyle, affecting balance and coordination, caused by cerebellum damage (Seladi-Schulman, 2023).

Hypertension:

• Definition: Blood pressure higher than "140/90mmHg or more" (NHS, 2023)

Type 2 Diabetes:

• Definition: Condition leading to high blood glucose levels (NHS, 2020).

inital ax (social hx and medical

• Demographics: 43-year-old male, taxi driver, husband, father to a 2-year-old daughter, resides in a house with 5 front steps.

• Home Features: Slope and stairs inside with a left handrail.

• Functional Status Before Stroke: Independent in activities of daily living (ADLs), unaided mobility, baseline cognition and communication, used glasses for driving, self-medicated, non-smoker, non-drinker, and had functional use of both hands (right-handed).

First Assessment - Medical Evaluation:

• Orientation: No concerns.

• Cognition: No concerns.

• Apraxia: No concerns.

• Vision Tracking: No concerns.

inital ax (rom/strength, mobility adls, BI/MRS, capacity)

• Range of Motion (ROM) and Strength: Functional Active Assisted Range of Motion (FAAROM) for left upper and lower limbs, full power and coordination in both. ROM mostly 3/5, with some areas at 4/5 in the right upper limb, co-ordination deficit in digits. Right upper limb at 3/5 mostly for ROM and power, co-ordination deficit.

First Assessment - Tone and Sensation:

• No tone and sensation deficit on the right side.

First Assessment - Mobility and ADLs:

• Able to reposition on the bed.

• Required all care in bed.

First Assessment - Functional Scales:

• Barthel Index: Unable to perform ADLs independently.

• Modified Rankin Scale: Scored 5 (severe disability).

First Assessment - Capacity/Best Interest:

• Patient has capacity.

standardised

Standardized Initial Assessment - Pros:

• Provides objective data.

• Evidence-based.

• Time-efficient.

• Useful for comparisons, e.g., baseline vs. initial assessment.

Standardized Initial Assessment - Cons:

• Lack of flexibility.

• Limited cultural sensitivity.

non standardised

Non-Standardized Initial Assessment - Pros:

• Flexibility.

• Culturally sensitive.

• Holistic.

• Patient-centered.

Non-Standardized Initial Assessment - Cons:

• Subjective.

• Lack of consistency.

• Time-consuming.

standardised justification

In Kyle's case, a standardized initial assessment is appropriate as it provides evidence-based, efficient, and easily comparable data. This approach allows for streamlined interdisciplinary communication and straightforward evaluation.

person centred

• Empowers the client.

• Results in a personalized care plan.

• Encourages collaborative practice (NHS, 2023).

Kyle's Requests and Adjustments:

• Kyle requested to see family using a wheelchair, and MDT approved it, ensuring safety.

• Kyle was too fatigued for a morning gym session, so it was rescheduled for later in the day.

• In the upper limb session, goals were set in collaboration with Kyle, focusing on sensory work, mobility, and transfers.

Occupations

• Meaningful activities can improve physical, cognitive, and psychosocial components of performance (Gray, 1998).

Kyle's Situation:

• Kyle, a taxi driver, can't drive for a month due to his stroke.

• This may lead to Occupational Alienation – feelings of isolation, powerlessness, and estrangement.

• Co-ordination and strength deficits affect ADLs, causing Occupational Disruption – temporary disturbance with negative impacts (Wilcock, 2006; Molineux, 2017

Goals

SMART Goals in Healthcare:

• SMART goals are specific, measurable, achievable, and relevant (Ogbeiwi, 2018).

• Pros: Clear and effective for a fast-paced healthcare setting.

• Cons: May oversimplify and not address emotional needs.

Goal Attainment Scaling (GAS):

• GAS goals are flexible and customizable.

• Pros: Offers adaptability.

• Cons: Complex and limited comparability.

Justification for SMART Goals:

• SMART goals are suitable for acute OT settings.

• They are easily simplifiable and allow for straightforward evaluation.

kyles goals from initial

Kyle's OT Goals from Initial Assessment:

• Complete the Oxford Cognitive Screen (OCS) assessment before discharge.

• Improve functional use of the right upper limb by 20/10.

Treatment Planning from Initial Assessment:

• Review SOEOB, STS, + standing once off GTN.

• Sensory bombardment (TI) for decreased sensation on the right side.

• Functional task practice for right upper limb weakness and Ataxia.

SMART Goals after Object Use and Recognition in Bed:

• To be able to W/D by 13/10.

• To complete the kitchen ax by 13/10.

grooming analysis

• Activity Description: Combing hair using a comb, focusing on the pincer grasp technique.

• Client Profile: Stroke patient with potential motor and coordination deficits. Uses both limbs with equal power, can independently use a pincer grasp.

• Environment: Assessment conducted with the patient lying down.

• Tools and Materials: Primary tool: comb.

• Task Analysis: a. Preparation: Position patient comfortably in a lying-down position, ensure comb is within reach. b. Grasping: Use a pincer grasp (thumb and index finger) to hold the comb. c. Manipulation: Move the comb through the beard, requiring hand-eye coordination and fine motor control. d. Force and Power: Patient can use both limbs with equal power, ensuring appropriate combing force without overexertion.

grooming ax findings goals saftey and justification etc

Safety Considerations:

• Monitor the patient closely due to the risk of dizziness or discomfort in a lying position.

• Ensure the comb has no sharp edges or broken teeth to prevent accidental injuries.

Assessment Findings:

• Patient can independently comb using a pincer grasp, demonstrating fine motor control.

• Ability to use both affected and unaffected limbs with equal power indicates functional bilateral coordination.

Recommendations:

• Continue grooming practice to maintain and improve fine motor skills.

• Consider practicing in a seated position if tolerated for real-life grooming simulation.

• Ensure a hazard-free and accessible environment to maximize independence.

Goals:

• To be able to do W/D activity by 13/10.

• To complete kitchen activity by 13/10.

Justification:

• Occupation-based interventions can enhance social participation, well-being, self-identity, and quality of life (University of New Hampshire, 2023)

games overview

Session Overview:

• Goal: Improve sensory perception, movement, dexterity, and strength in Kyle's right upper limb.

• Components: Sensory exercises led by the therapy assistant, therapeutic games led by the occupational therapist.

• Outcome Measure: 9-hole peg test used to assess Kyle's progress.

Sensory Exercises:

• Materials Used: Gloves, flannel, towel, and comb.

• Tactile Work: Improve sensation in the right upper limb.

• Glove Rubbing: Used gloves to stimulate tactile sensations.

• Flannel and Towel Rubbing: Varied tactile experience, resulting in "pins and needles," indicating sensory improvement.

games outcome goals and game types

• Nine-Hole Peg Test: Assesses manual dexterity, fine motor skills, and hand-eye coordination. Post-session test results indicated improved functionality in the right upper limb.

Therapeutic Games:

• Connect-4: Enhances fine motor skills, hand-eye coordination, and strategic thinking. Improves hand dexterity and upper limb coordination.

• Structuro: Requires precision and control, supporting improved control over the affected limb.

• Kerplunk: Involves fine motor movements and concentration, helping to work on upper limb strength and coordination.

Therapeutic Goals:

• Improve sensory perception in the right upper limb.

• Enhance fine motor skills, dexterity, and hand-eye coordination.

• Strengthen the right upper limb.

• Enhance overall upper limb functionality.

games progress/outcome

Progress and Outcomes:

• Improved sensation, dexterity, and strength in the right upper limb.

• Post-session 9-hole peg test showed increased functionality and fine motor control in the affected limb.

Recommendations for Future Sessions:

• Continue sensory activities and therapeutic games to further improve sensory perception, dexterity, and strength.

• Gradually increase the complexity of games and activities to challenge the upper limb.

• Monitor progress with regular assessments, such as the 9-hole peg test, and adjust the therapy plan accordingly.

games justification

• 9-Hole Peg Test (9HPT) Initial Score: 2.51 minutes on the Right Upper Limb (RUL).

• Therapeutic Games Played: Connect-4, Structuro, and Kerplunk, focusing on building strength, dexterity, shoulder abduction, and elbow flexion in the RUL.

• 9-Hole Peg Test (9HPT) End Score: 1.30 minutes, indicating improvement.

Justification:

• Sensory tactile work and motor training can enhance sensory function and improve movement control for daily hand activities (Carlsson et al., 2022).

• Game-based rehabilitation can be engaging and provide personalized motivation for stroke patients (Hung et al., 2016).

other possible interventions

• Constraint-Induced Movement Therapy (CIMT):

Pros:

• Evidence-Based: CIMT is evidence-based, involves constraining the unaffected limb, and can improve motor function (Kwakkel et al., 2015).

Cons:

• Intensive and Demanding: Requires intensive, one-on-one therapy for several hours a day, which can be physically and mentally demanding for the patient. Not suitable for all stroke patients, especially those with co-existing health conditions.

barthel and copm

• Barthel Index (BI):

Pros:

• Evaluates basic activities of daily living (ADLs) (Shah, Vanclay, & Cooper, 1989).

• Offers a quick assessment of a patient's independence in self-care tasks.

Cons:

• Less comprehensive than some other measures.

• May not capture subtler changes in function.

COPM (Canadian Occupational Performance Measure):

• Assesses client outcomes in the areas of self-care, productivity, and leisure (Law et al., 1990).

Pros:

• Patient-centered, allowing patients to identify and prioritize their own goals.

• Comprehensive assessment of self-care and other activities.

Cons:

• Requires the patient's active participation in goal setting.

• Can be time-consuming to administer

outcome measure justification

Barthel Index Justification:

• Immediate Needs: Applicable to a patient with left hemorrhage and right upper limb deficits.

• Focus on Functional Independence: Aligns with ADL needs.

• Time-Efficient: Suitable for quick evaluation in the acute stroke ward.

• Clinical Decision Support: Guides care plans and resource allocation.

• Relevance to Progress: Monitors early-stage recovery effectively.

• Patient-Centered: Addresses essential aspects of daily life promptly.

Nine-Hole Peg Test (9HPT) Justification:

• "Test for hand dexterity, as it can objectively qualify and quantify" stroke recovery (Jobbágy, Marik, & Fazekas, 2018).

• Pros – focuses on fine motor skills, standardized.

• Cons – Lack of sensory assessment.

home

Discharge Destination Options:

Home:

Pros:

• Familiar Environment: Reduces stress and anxiety.

• Independence: Promotes autonomy and daily routine resumption.

• Support System: Access to family for emotional and practical support.

• Cost-Effective: Potentially more cost-effective than other options.

Cons:

• Limited Professional Support: Requires outpatient visits for therapy.

• Potential Distractions: Home environment may hinder focused rehabilitation.

• Safety Concerns: May need adaptations for home safety.

Community Rehabilitation:

Pros:

• Structured Rehabilitation: Focused skill-building.

• Access to Professionals: Access to healthcare professionals and therapists.

• Social Engagement: Reduces social isolation.

Cons:

• Transition Period: Adjustment to community rehab.

• Travel and Mobility: Mobility issues may complicate travel.

• Less Autonomy: Reduced autonomy compared to home.

Inpatient Rehabilitation: discharge

Pros:

• Intensive Rehabilitation: Accelerates recovery with daily sessions.

• 24/7 Care: Provides continuous medical and nursing care.

• Dedicated Environment: Minimizes home distractions.

Cons:

• Separation from Home: Emotional stress and disconnection from home.

• Limited Autonomy: More rules and regulations.

home discharge justification

Patient-Specific Considerations:

• For this patient, Home is a suitable option considering mobility and values.

• Address potential safety measures and adaptations at home.

• Inpatient rehab with 24/7 care may be overly cautious due to the patient's current health and mobility.

what i would do (IP rehab)

• Inpatient Rehab:​

• Outcome measure – 9HPT and Barthel index​

• Full washing and dressing assessment (Plan on next slide)​

• Kitchen assessment can assess occupational performance( Josman & Birnboim, 2001)  I would want to assess  function and cognition using it​

• Games session to continually improve movement and dexterity of RUL

what I would do (community rehab)

• Community Rehab:​

• Games session to improve movement and dexterity of RUL​

• Full meal preparation in Kitchen ax​

• Home-based exercise program to improve strength and ROM of RUL . I would encourage Kyle to self-monitor his progress (Pui Kei,  Mohd Nordin, & Abdul Aziz, 2020)​

• Outcome: (9HPT and Barthel Index)​

• Home modifications " aim to enhance safety and occupational performance in the home" (Aplin, de Jonge, & Gustafsson, 2015)​

• Refer him to a Stroke Support group to learn from others in similar situations (NICE, 2018)

Biomechanical Frame of Reference:

• Focuses on the mechanical aspects of the body to improve functional abilities.

• Emphasizes physical aspects, suitable for patients with motor deficits.

• Concentrates on enhancing strength, range of motion, and endurance.

• May not fully address cognitive and psychosocial factors.

• Could be overly prescriptive, neglecting individual goals.

(Citation: McMillan, 2011, pp. 179-194)

Neurodevelopmental Frame of Reference (NDT):

• Assesses and addresses issues related to posture and movement.

• Effective for patients with neurological deficits, such as stroke.

• Emphasizes movement patterns and postural control.

• Can be time-intensive and require frequent therapist-patient interaction.

• Not always practical in acute care settings with limited resources.

(Citation: Barthel, 2010, pp. 187-233)

Justification for NDT:

• Specialized for neurological conditions.

• Emphasizes movement patterns and postural control.

• Practical and structured approach.

• Addresses immediate motor recovery needs.

• Highly relevant for acute stroke patients

Occupational Therapy Intervention Process Model (OTIPM):

• Client-centered approach, focusing on individual needs and meaningful daily activities.

• Emphasizes the client's values, priorities, and meaningful activities.

• Promotes holistic assessment, considering physical, psychological, and social needs.

• Encourages collaborative decision-making between the client and therapist.

• Emphasis on occupation as therapy, vital for recovery.

• Goal-oriented model.

• cons: time-intensive

“approach assessment and intervention from a client-centered perspective, focusing on the individual's specific needs and meaningful daily activities”

(Citation: Fisher, 1998)

creek

Creek Process of Occupational Therapy: that emphasizes a client-centered approach, focusing on the client's occupational performance and participation (Creek, 2003)

• Offers a structured approach to assessment and intervention.

• Provides clear steps to guide therapists.

• May be more efficient in certain situations.

• Structured nature may lead to a less client-centered approach. (creek, 2003)

Justification - Why OTIPM Is More Suitable for Kyle:

• Given Kyle's complex condition, including sensory and coordination deficits and the need to regain independence in grooming and self-care, OTIPM aligns well with his specific needs.

• Client-centered approach prioritizes Kyle's values, priorities, and goals, crucial for a patient with a complex health history.

• Emphasis on holistic assessment aligns with the need for a comprehensive understanding of physical, psychological, and social needs.

• Active collaboration between Kyle and the therapist is essential for addressing his unique challenges.

• Focus on occupation-based therapy directly targets Kyle's goal of regaining grooming and self-care independence.

• Goal-oriented nature suits Kyle's need to regain specific functional abilities.

clinical reasoning 1

• Ethical reasoning – This form of reasoning considers ethical aspects and strives to find the most morally sound and appropriate solutions to issues, aiming to distinguish between what is right and wrong in addressing a problem (Butler, 2022)​

• HHAO1 and making Kyle aware of the risks of not using this transfer method. SOAP notes documentation and verbal consent gained to treat and use him as CBOA client. There is a chance of being unethical If I spend more time with this patient just because he is my case study​

• Procedural reasoning – It's primarily concerned with the practical aspects of the therapy process, such as the specific activities and steps involved in treatment (Fleming, 1991)​

• Following interventions used for Stroke such as the Washing/Dressing Ax, Kitchen Ax, RUL strengthening, Sensory practice and education

clinical reasoning 2

• Pragmatic reasoning – logistics such as cost, time, therapist’s skills, client wishes, and physical location (Mosby, 2013)​

• I saw Kyle during the afternoon for his grooming session as he was a low-priority patient on that day​

• Narrative Reasoning – disability as an illness experience, that is, with how a physiological condition is affecting a person's life    (Mattingly, 1991)​

• Social history ax and discussing occupations​

• Scientific reasoning –  on the facts such as impairments, disabilities, and performance contexts (Schell, 2019)​

• Ax ROM, power, research of his conditions 

• Local and National Policies/Legislation:

• Local and National Policies/Legislation:​

• The patient's care and rehabilitation are significantly influenced by local and national policies and legislation. In the United Kingdom, the National Health Service (NHS) Constitution plays a pivotal role. It outlines the patient's rights and responsibilities, emphasizing the right to receive treatment within a maximum waiting time. "suspected stroke to be admitted to a specialist acute stroke unit within 4 hours of arrival." (NICE, 2010). "

• local Procedures:

• local Procedures:​

• The local procedures at University Hospitals Coventry and Warwickshire, including stroke management protocols, therapy services, and discharge planning procedures, have a direct impact on the patient's care pathway. These local procedures are essential in ensuring the patient receives timely and appropriate interventions. "Help people with acute stroke to sit out of bed, stand or walk as soon as their clinical condition permits as part of an active management programme in a specialist stroke unit." (NICE, 2019)

• Clinical Governance:

• Clinical Governance:​

• Clinical governance within the healthcare institution is a fundamental aspect of providing high-quality care. It influences the patient's rehabilitation by ensuring that care is safe, effective, and patient-centered. Clinical governance supports ongoing quality improvement initiatives and patient safety, which are crucial for this patient's complex needs. E.g "multidisciplinary meetings at least weekly to plan patient care" (NICE, 2010)

• Funding & Resource Issues:

• Funding & Resource Issues:​

• Funding and resource allocation have a substantial influence on the patient's access to therapies, adaptive aids, and other necessary services. The availability of resources may impact the timeliness and extent of interventions. Efficient resource management is essential to meet the patient's requirements. "3 hours of motor recovery and functional rehabilitation per day" (Stroke Association, 2023). This isn't possible due to not enough OTs on the ward (Pragmatic reasoning)

rcot institutional

The Royal College of Occupational Therapists (RCOT) Code of Ethics plays a significant role in the patient's care. It guides the ethical decision-making process for the healthcare professionals involved in the patient's rehabilitation, ensuring adherence to professional standards and the provision of patient-centered care. E.g "3.5.3 For consent to be valid, it must be given voluntarily by the individual. They must be provided with all the information that is relevant to their decision and must have the mental capacity to understand and consent to the particular intervention or decision." (RCOT, 2021)

social

• Family Support:

  • Patient's Wife and Daughter: The patient's wife and two-year-old daughter provide emotional support and motivation in his recovery.

• Consideration of Social vs. Medical Model Perspectives:

  • Social Model of Disability (University of Oregon, 2023): Disability arises from societal organization, focuses on removing barriers, and aligns with inclusivity and equality.

  • Medical Model of Disability (University of Oregon, 2023): Disability results primarily from an individual's impairments, emphasizes medical diagnosis and treatment, and may not fully address societal impact. The patient resonates with the social model, emphasizing inclusivity and societal change.

• Open-Mindedness and Inclusivity:

  • The patient's open-minded perspective is reflected in his belief in respecting people of all religions and backgrounds, enhancing social connections and reducing social isolation.

• Family Involvement in Care:

  • The patient's mother, three brothers, and regular in-law visits create a strong family support network, contributing to his care.

physical environment

• Infection Control:

  • Risk: Infection control is crucial in a hospital setting, especially during grooming sessions involving contact with the patient's body and personal items.

  • Mitigation: Healthcare providers must adhere to strict infection control protocols, including hand hygiene, personal protective equipment (PPE) use, and proper cleaning and disinfection of grooming tools and equipment. (PHE, DHSC, and NHS, 2022)

• Patient Comfort and Consent:

  • Risk: The grooming session may lead to patient discomfort or anxiety, potentially impacting their cooperation and consent.

  • Mitigation: Prioritize patient comfort, provide clear explanations of the procedure, and obtain informed consent. Continuously address the patient's preferences and any discomfort throughout the session. (RCOT, 2021)

cultural environmet 1

• Ethnicity and Identity:

  • As a Pakistani-British Muslim, the patient's cultural identity is significant. Consider his dietary preferences and cultural traditions, such as offering culturally appropriate foods and acknowledging cultural and religious holidays in his care plan. This enhances his experience in the hospital.

• Language:

  • The patient is most comfortable communicating in English. Ensure that all care instructions and explanations are available in his language for effective communication and full understanding of his care plan. (RCOT, 2021)

cultural environemt 2

• Beliefs and Attitudes:

  • The patient values respect for people of all religions and backgrounds, aligning with inclusivity and diversity principles. Healthcare providers must create an environment where these beliefs are respected and upheld in his care. (RCOT, 2021)

• Cultural Competence:

  • Healthcare professionals should be culturally competent, understanding the patient's cultural practices and beliefs. Respect the patient's prayer times, dietary requirements (Halal), and consider arrangements for prayer facilities near his bed or necessary materials. (RCOT, 2021)

TA role

• Therapy Assistants (TA):​

• Sensory and Texture Work: TAs work on sensory perception and texture discrimination to improve sensory processing and awareness. (NHS, 2023)​

• GRASP Program: They assist with the GRASP program, focusing on hand and upper limb function. (NHS, 2023)​

• Grooming Practice: TAs support grooming practice, helping the patient enhance fine motor skills for self-care tasks. (NHS, 2023)

PT role

• Physiotherapists (PT):​

• Physical Rehabilitation: PTs are responsible for assessing and treating the patient's physical impairments. They work on improving mobility, balance, and strength.  (Stroke Association, 2023)​

• Functional Movement Training: They focus on enhancing the patient's ability to perform daily activities, such as walking, transfers, and posture control. (Stroke Association, 2023)​

• Gait Training: PTs help the patient regain walking abilities e.g.  HHAO1 for safe transfers as Kyle had a shuffling gait (Stroke Association, 2023)​

• Exercise Prescription: They design customized exercise practice programs to improve the patient's range of motion and muscle strength. This included bicep curls, and wrist flexion with a bottle of water. Gym session with parallel bar and mirror to do mini squats. (Stroke Association, 2023)

PTs and OT Collaboration:

PTs and OT Collaboration:

• Complementary Roles: PTs and OTs have complementary roles focused on different aspects of the patient's rehabilitation. PTs primarily address physical mobility and strength, while OTs focus on enhancing the patient's ability to engage in daily activities. (Bailey, 2023)

• Coordination: They coordinate their efforts to ensure that the patient's physical and functional needs are met. For example, PTs may work on improving the patient's strength and mobility, which can directly impact their ability to perform self-care tasks targeted by the OT.

• Shared Goals: Both PTs and OTs share common goals related to the patient's functional independence. They collaborate to help the patient regain mobility and fine motor skills for activities of daily living, such as grooming, dressing, and feeding. (Bailey, 2023)

TAs as Support:

TAs as Support:

• Extending Services: TAs play a supportive role in the rehabilitation process. They assist both PTs and OTs in implementing interventions and exercises designed to address the patient's specific deficits.

• Reinforcement: TAs can help reinforce the exercises and activities prescribed by both the PTs and OTs during therapy sessions. This continuity ensures that the patient receives consistent and structured care. (NHS, 2023)

• Sensory and Fine Motor Work: TAs, as mentioned, may be involved in sensory work and the GRASP program. These activities align with the OT's goals and can contribute to the patient's overall rehabilitation. (NHS, 2023)

Doctors:

Doctors:

• Role: Doctors are an essential part of Kyle's care team. They are responsible for the initial diagnosis, medical treatment, and ongoing management of the patient's condition (NHS, 2023).

• Diagnostic Tests: This includes ordering tests like the CT aorta and adjusting medications like GTN (Nitroglycerin) as needed. This affected his care as we had to wait until the afternoon to treat him.

Nurses:

Nurses:

• Role: Nursing staff play a central role in patient care. They monitor the patient's vital signs, administer medications, provide wound care, and ensure the patient's overall well-being. They also coordinate with other healthcare professionals to implement the treatment plan (Clare, 2020).

Small Handovers on the Wards:

Small Handovers on the Wards:

• Definition: Handovers include transfer of responsibility of a patient (Eggins, & Slade, 2015).

Pros:

• Timely Information: Provides a quick way to share essential information about the patient's condition and progress.

• Direct Communication: Enables immediate communication between team members directly involved in the patient's care.

Cons:

• Limited Detail: May not allow for in-depth discussions or problem-solving, especially for complex cases.

• Privacy Concerns: Patient privacy may be compromised in open ward environments.

Multidisciplinary Team (MDM) Meetings:

Multidisciplinary Team (MDM) Meetings:

• Definition: Healthcare professionals come together to discuss a patient's comprehensive plan (Time of Care, 2023?).

Pros:

• Comprehensive Review: Allows for a comprehensive review of the patient's case with input from various team members.

• Problem-Solving: Facilitates collaborative problem-solving and decision-making.

Cons:

• Scheduling Challenges: Coordination of schedules for MDM meetings can be challenging, leading to delays.

• Time-Consuming: May require additional time and resources.

MDT Meetings:

MDT Meetings:

• Definition: A broad range of healthcare professionals come together to discuss patient care (Rollet et al., 2021).

Pros:

• Interdisciplinary Collaboration: Encourages collaboration among OT, PT, TAs, and other healthcare professionals for a well-rounded approach to care.

• Structured Discussion: Provides a structured platform to discuss the patient's progress, goals, and interventions.

Cons:

• Resource Intensive: Requires dedicated time and resources, which can be challenging in a busy clinical setting.

• Potential for Information Overload: If not well-organized, MDT meetings can lead to information overload.

Electronic Health Records (EHRs):

Electronic Health Records (EHRs):

• Definition: EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users (HealthIT, 2019).

Pros:

• Real-Time Access: Allows all team members to access patient information in real time.

• Comprehensive Data: Provides a centralized location for patient data, including assessment notes, care plans, and progress reports.

Cons:

• Technical Challenges: EHRs can have technical issues or require extensive training.

• Potential for Information Overload: Data overload can make it challenging to extract essential information.

Justification for Current Strategies:

Justification for Current Strategies:

The current strategies, including small handovers, MDM meetings, and MDT meetings, offer a balance between efficiency and effectiveness in an acute stroke ward:

Timely Information: Small handovers are ideal for sharing time-sensitive information, ensuring that all involved team members are updated promptly.

Collaborative Decision-Making: MDM and MDT meetings provide a structured platform for comprehensive discussions, collaborative decision-making, and problem-solving, which are essential in complex stroke cases.

Interdisciplinary Collaboration: MDT meetings facilitate interdisciplinary collaboration, ensuring that the patient's care is holistic and well-coordinated.

Privacy Considerations: The in-person nature of these strategies allows for sensitive patient information to be shared discreetly and securely.