Week 3 Day 13 Entry 2

One pt my supervisor and I saw yesterday was a 41yo Sudanese man whose native language was Dinka. The pt had moved to Australia 3 years ago, and was diagnosed with Parkinson's 8 months ago. During his time in Australia the patient has been residing with his cousin who also speaks predominately in Dinka. This meant that he did not speak much English, combined with microphonia and slurring of speech which comes with Parkinson's disease. Therefore this was my first face to face pt where there was a significant language barrier. Most of the time the pt would have an interpreter (as his cousin was unavailable to accompany him) but due to costs and some understanding by the patient, this service had ceased. Not only was this pt's native language a consideration, his culture, attitudes and beliefs were also an issue. To a certain extent the Dinka culture and way of life revolves around roles of women and men in society, in which men are predominately responsible for the welfare of the community. In this respect I had to be cautious not to be patronising or condescending as my actions may be offensive.

I think the Rx session ran smoothly and the situation was dealt with appropriately. I was sure to introduce myself and explain my role in his Rx. I allowed the pt sufficient time to mount a response and to process any information. When I spoke to the pt I ensured my speech was clear and my sentences simple and concise. The only part of the session where the pt was uncomfortable was during the balance Ax. One of the balance tests (the Pastor Marsden) involves testing the pt's balance reactions in response to a pull back on their shoulders from behind. In this situation the pt was afraid of falling and refused to participate in the test. The pt did not trust my supervisor or my ability to save him from a fall. In this situation more effort should have been made to reassure and the pt to make him feel more comfortable and at ease with the test procedures. Instead, I did not perform the test and said I would test it some other time when the pt was feeling more confident/steady.

Throughout the Rx session I felt very comfortable with the pt as he was patient and friendly during our attempt to communicate and understand him. I also had the support of my supervisor to assist with translation during discussion. In the future the presence of an interpreter may make communication easier and the Rx session more efficient.

From this session I learnt that it is necessary to take the time to ensure you understand the pt and have patience when communicating and discussing the pt's concerns. Although this may be a very time consuming process, it improves the pt's compliance and develops rapport and you demonstrate an interest in their wellbeing.

Things have gone well so far this week, yet I still feel as though I have room to improve in the area of documentation and subjective assessment. I need to refine my 'A' and 'P' of my SOAPIER documentation, as the hospital format for this in is slightly different to what I am used to. I also need to work on attaining specific patient goals, which can sometimes involve a lot of prompting and lengthy discussion to establish their motivation etc. Over the weekend I plan to look at my notes on dementia and depression to help me understand the characteristics of some of my patients.