1/24/11
Today I started my internship at DeGraff Memorial Hospital, in the Skilled Nursing Facility. I was only there from 3pm-5pm, as a general orientation. Lisa discussed with myself and Jenna (another girl interning from Canisius) what exactly we would be doing over the length of the semester. Jenna was more interested in the medical aspect of work, while I am more focused on the clinical/counseling aspect. We will both be shown how to do (and in the long run, expected to do on our own) BIMS, which are brief interviews for mental health status, focusing on a patient's cognitive state, and asking questions pertaining to memory. We were also shown admissions paperwork, and told that every Thursday DeGraff gets about 3-4 new patients. Another document we will be filling out was to evaluate a person's elopement/wandering risk, that is the danger that they will leave the facility. There is a wrist band that can be placed on these at-risk persons, and that will trigger a door to lock and an alarm to go off if they should try to exit the building. There is a similar precaution for the staircase, since there are some patients who should not use the stairs.
We took a tour of the facility, and were shown where the activities room was, where the beautician is, dining areas, etc. We were also shown examples of care plans for the patients, which is important for instance in dietary restrictions. Some patients for instance can only have thicker liquids due to difficulties swallowing, and others are diabetics. I was pretty nervous about this, but Lisa said we can always ask someone, or give them water if we are not sure.
One thing that happened that I will need to get used to was one patient began screaming. This patient is suffering from severe dementia, and reacts this way when anyone looks at her or tries to talk to her. Lisa said they have tried various medications and nothing has worked. This brought up the use of medications, and the false perception that nursing homes sedate their patients. I was happy to learn that at DeGraff, quality of living is of high importance, and we try to make our patients as comfortable as possible.
One other thing we discussed was going with Lisa to meetings with the medical director, and meetings with the families. I think it will be very difficult to handle some families, especially when you have a bleak prognosis (such as a patient needing to be put into long-term care, and not being able to be discharged). It's sad that some patients are unable to go home due to a simple inability to adminster their insulin, and insurance companies not willing to pay for home care. I hope that I will get some experience handling insurance matters and become familiar with the various forms of care available in the area. Many families are unaware of the programs available, and I hope to be able to help them. I go back tomorrow, so I will see how it goes!
1/25/11
Today I was at DeGraff from 11am-3pm. First I went with Lisa to do a BIMS (brief interview mental status). This was on a young, sub acute patient who was due to be discharged in the near future. It went well, he was able to answer all the questions, and there were no indications that there was cause for concern. Lisa said that they don’t always go so well however, especially with patients who have difficulty hearing, speaking, and have problems with their memory.
After lunch, we attended a discharge meeting, which happens every Tuesday. We discussed patients that were being considered to be discharged, how their progress was, and if/when they should be discharged. What was also taken into account (in addition to patient’s progress) was if there would be anyone available to take care of them if they were sent home. After the meeting, Lisa had to call a couple members of families who might/had agreed to take care of a certain patient. It was very important that we made sure the patient would be properly taken care of once he/she left our facility. We are also required to officially inform patients of their discharge, and give them a document. There were so many different forms of documentation that had to go into each patient’s binder, many of which are because they are required by the Department of Health. Hopefully by the end of this internship I will have a better idea of how exactly to document things.
There was a ceremony celebrating employees of the month, and one employee of the year as well. We didn’t stay long because there was a lot of work to do. Earlier in the day however, we had gone around, asking certain patients if they would like to be the one to hand the award to a certain staff member that they had a good relationship with. I like how at DeGraff we try to take care not only of the patient’s medical needs, but also their social and quality of life needs.
There was one issue that happened today, mainly that a patient came into Lisa’s office, and refused to leave. She was not causing any trouble, and was simply sitting there in her wheelchair, however she would not leave no matter how many people tried to coax her! I will have to get used to that, and I hope to get more experience in dealing with those sorts of situations (I’ve never encountered anything like that before). I ended the day doing some filing.
1/27/11
Today I was at DeGraff from 11am-3pm again. It was already fairly hectic when I arrived, and Lisa was juggling a million things. There were about 7 people that she needed to do mood evaluations on, however with the other things going on, I wasn’t able to see those before I left. While she answered emails, did paperwork, and other things, I helped out by doing some filing, and making packets of the documents she needed for the evaluations (risk of elopement, a.k.a. risk of wandering, a questionnaire to test cognition and memory, and risk of suicide).
After lunch, the rest of the day was spent in meetings with the patients and/or their families, which happen every Thursday (every 3 months for each patient). The purpose of these meetings is to update patients and their families about their progress, and discuss any concerns. The areas that were discussed fell under the scopes of Lisa (for social work), one of the nurses (for medicine updates), a dietician, and the director of activities (for updates on the involvement of patients in our events). I glad I was able to sit in on the meetings to see how interacting with the families and other departments of the skilled nursing facility works. All of the meetings went pretty well except for one patient, who has been struggling with depression, and also has issues with certain staff members. One thing I was surprised to learn was how many medications and supplements some of the patients are on. There are medicines for depression, high blood pressure, anxiety, incontinence, pain relievers, as well as supplements such as iron and Vitamin D. Pharmacy reviews are however conducted, during which medications are checked, to make sure that they are not on anything that is no longer necessary, or if the dosage needs to be changed.
I also got the chance to glance through the packets that families/patients receive upon admittance to DeGraff. There are so many forms and legal and health insurance matters that patients and their families need to stay on top of. It can be very confusing, and hopefully when I have more experience I will be able to explain the paperwork to patients and families, and make their transition into sub acute or long term care a bit easier.
2/01/11
Today I was at DeGraff from 11am-3pm. I spent the day with Colleen this time, the other social worker in the skilled nursing facility. I went with her to do a BIMS on a subacute patient, who had just been admitted the day before. I learned that the social worker has 3 days to do this initial paperwork, and when there are a lot of people admitted at once, or someone calls in sick, it can get pretty hectic. This BIMS went well, and the patient only had problems with some short memory aspects, due to the patient suffering from Parkinson’s Disease.
I was shown again the paperwork that goes into the patients’ charts and in which sections to find which documents/information, so I am becoming more familiar with that. Colleen, Lisa, and I then went to the discharge planning meeting which happens every Tuesday. It is a team effort to discuss concerns about patients being discharged, or if they should look at long term care or assisted living. We check to see if the patient has a support system, if they live alone, if they have psychosocial programs in place for when they go home (Meals on Wheels, VNA) etc. Based on their therapy progress and medical needs as well, some patients were not recommended to be discharged.
For instance, one patient was to be discharged the next day, to go home alone. This patient’s progress however was inconsistent, and the team decided that this patient would need much more supervision if discharged than was currently in place. It was very sad when we went to the patient to tell them this, and the patient argued and seemed very hopeless. The patient has the right to leave against medical advice, however this is what the DeGraff team tries to avoid. We heard a case in the meeting of someone who had just been discharged on Saturday and seemed to be doing very well, then ended back up in the hospital on Monday. Without a proper system of care in place, it is very likely that whatever caused the patient to be sent initially to the hospital could happen again (falling is often a problem in the elderly).
2/03/11
Today I was at DeGraff from 11am-3pm. I went with Lisa to do a few BIMS before lunch. When I go back on Tuesday, she said I will most likely be doing some on my own (with the less difficult patients). Sometimes the BIMS goes fast with patients who are alert and oriented, but other times it can take longer if the patient has trouble paying attention, or if they do not answer the questions right away and joke a lot. What I liked was that at the end of each BIMS, Lisa asked the patient if they had any concerns or problems they wanted to bring up, and how we could make them more comfortable there.
After lunch I made a couple display folders to put pamphlets in for families to take, made some copies, and other paperwork. I also went around to the sub acute patient rooms to check to see if they had a red binder (which should be in every sub acute room). Sometimes they were out in the open, sometimes they were hidden in a drawer (I was surprised that I was told it was ok to glance through their drawers to see if it was in there), and many rooms did not have them at all. I felt somewhat awkward interrupting patients when their families were in there, or if they were sleeping, but I guess that is what the aids and nurses etc. have to do, so I will need to get used to that. The one patient seemed annoyed that I was bothering her, and said “I don’t have it!” Some patients are stroke victims or have other mental deficits, which means that they do not have the social filter that most people have, and can say things or do things that are inappropriate (I have heard some stories). Many things I will need to get used to, but I guess that all comes with time and experience!
2/08/11
Today I was at DeGraff from 11am-3pm. There was a residents meeting, in which only certain staff members were allowed to be present, and the residents were able to voice any complaints or concerns. For the psychosocial admission papers of a new patient I went into an old chart (the patient had been here earlier) and pulled some information, to make the paperwork shorter for Colleen when she did the BIMS and mood interview of this patient.
I did a BIMS and mood interview on my own today with a couple patients. The first was alert and everything went very well. The second was very hard of hearing and had some cognitive deficits, so we were unable to do the mood interview. In cases like these, Colleen or Lisa would do a mood interview for the patient based on their own observations (if the patient was eating well, sleeping, etc.). I went to another discharge planning meeting as well, and think I get the hang of how it goes. It’s pretty much a team effort, everyone reporting information from their particular field (social work, nursing, dietary, physical and occupational therapy).
2/15/11
Today I was at DeGraff from 11am-3pm. I did two BIMS on my own (with Lisa in the room), and am pretty comfortable with it. She said on Thursday I will be able to do them completely on my own. I also did some filing. I saw the packet of documents that patients are given upon admittance (rules of living there, insurance info, etc.) and went with Lisa to have a sub acute patient sign some of them. Then we went to the discharge meeting, and then I went with Colleen on rounds.
We spoke to a patient about available services for home care, such as grocery delivery, Meals on Wheels, etc. and also did some admittance papers. Colleen showed me how to print out discharge papers and enter it into the computer as well, and how to do an elopement risk form. Of course any patient who is alert and oriented is allowed to leave against medical advice, however patients who are confused and are at risk of leaving have their pictures posted in the hospital portion and at the nurses stations, to assure their safety.
2/17/11
I was at DeGraff today from 11am-3pm. First I finished alphabetizing and putting away some files. They were letters that get sent to the patients and/or their families, notifying them of their quarterly update meeting that they are invited to attend. These are the meetings that happen every Thursday, just to keep up to date on how a patient is doing.
After that, I did some BIMS on my own. The hardest part was actually finding the patients! One was sitting in the lobby, another in the activities room, etc. Pushing a wheelchair is also something I had never done before, and I was very worried that I would accidentally push someone into the wall! Luckily that didn’t happen. Sometimes the interviews went very smoothly, other times it was difficult, especially with patients who had been feeling down and sad about having to stay at DeGraff. One patient began tearing up as we were speaking, and I felt so bad, I wasn’t sure what I could say. It’s very hard when patients want to go home, and they can’t, whether it is just for the time being, or whether they need long-term placement. The people I spoke with were for the most part very nice, and I think it must be hard to become close to patients as social workers do, and then the patients might get transferred somewhere else, or pass away. In the long run though I think it is worth it, to be able to help a person and their family, even if it is only for a short amount of time.
The last thing I did for the day (after going to a portion of the weekly Thursday meeting) was do admittance paperwork for a sub acute. I’m getting the hang of where to look in the charts and documents to find information needed for the psychosocial review, such as a person’s religion, smoking history, employment and family information, etc. The information that I couldn’t find I had to ask the patient, and I was somewhat nervous since I’d never done this interview before, I had only done the BIMS and mood interviews. I felt really awkward asking if the patient had had any drug or alcohol abuse history, and how they had been functioning before hospitalization (whether they had been independent or not). It’s the job of the social worker to get this information, and it is of course important, so I will need to get used to that.
2/22/11
Today I was at DeGraff from 11am-3pm. Lisa was on vacation so I spent the day with Colleen. I started by helping her fill out the little stickers that we have to put on the charts for the weekly discharge meetings. Social work focuses on if the patient lives alone or not, who they have for support, if they want/need any services such as VNA or Meals on Wheels, and also how they are adjusting to being at DeGraff (anxiety, behavioral issues, etc.). After that I went with Colleen to a sub acute’s apartment, as the patient had signed a release, allowing Colleen to go pick up some clothing. Normally this task falls to the family, however this person did not have anyone to help out, so it became social work’s responsibility.
After a quick lunch we attended the discharge meeting, which went as usual. Based off of the meeting, Colleen had me fill out discharge notices that we are required to give to patients once a discharge date is set. It says where the patient is being discharged to (home, another facility, etc.), why they are being discharged, and the date of discharge. Pretty much every document we fill out at DeGraff requires a signature, even progress notes, so I sign and then either Colleen or Lisa is required to cosign. We ran out of time as I had to leave for work, but what Colleen has to do afterward is put stickers on the original discharge notices (we gave patients a copy). Stickers are made for each patient, with their age, name, DOB and other important information, and the stickers must be placed on all documents pertaining to them. Afterward Colleen will put the original d/c notices in the patients’ charts, and write a note confirming that she gave the patient the notice, what the basic d/c plan is, and that the patient understands and agrees.
2/24/11
Today I was at DeGraff from 11am-3pm. I did some filing for the first half of the day, there were a lot of old folders that had to be alphabetized and boxed up. I also had to update one of the folders on the bulletin board, with recent meeting times. After I did this I went around, trying to find some people to do a BIMS and Mood interview, however either they were not in their room, their door was closed, they were sleeping, or they told me to come back another time. I went to find Colleen, and helped her with some admissions documents for a little while, then figured I would try again to find the patients for the interviews.
After a futile search of the rooms, I asked one of the floor nurses, and she helped me locate a couple people in the activities room. The first interview went fine, however the second was the most difficult I’ve ever had to do. The patient had their spouse there as well, and the patient indicated thoughts of suicide, and when I asked if they had a plan in place, if they were to hurt themselves, they said yes. I felt horrible asking these questions, especially with their spouse there, however that is why we have to do these interviews, because now we can get this person the help they need. I immediately reported to Colleen about this person, and she said that she would talk to the nurse manager, and bring it up at the next team meeting, if this person should be put on any psychotropic medications. What is possible is that because this person has very bad memory problems, and I was repeating a lot of the questions, maybe they did not understand exactly what I was asking. Lisa knows this patient better than I do, so she will have a better idea of what the patient’s mental state is. Either way, I know I did the right thing reporting it right away, because in situations like this, you can never be too careful. I know that there will more than likely be more difficult and emotional situations I will face in the future, but I also know that it’s worth enduring through them, to help patients and their families get the care (emotional and physical) that they need.
3/03/11
Today I was at DeGraff from 11am-3pm. I started off doing a couple BIMS/Mood interviews. I’m pretty comfortable with them, though usually I have to have someone help me find the resident if they are not in their room, because I don’t know what they look like. The one patient had a significant cognitive improvement, and Lisa mentioned that this person was recently put on Aricept (a medication to treat Alzheimer’s), which could be the cause.
After that I made some copies and updated folders, then we went to lunch. It was staff appreciation day, and Lisa explained to me what the history was. There had been a bill passed in order to try to consolidate some hospitals, nursing homes, and other similar things or to even shut them down, since there were many duplicates of places offering the same kinds of care in the same areas. DeGraff proved however that they deserved to stay open, whereas Buffalo General and Gates are going to become merged. Lisa explained that if DeGraff Memorial were to close, the skilled nursing facility would still stay open, however certain shared services they would have to find somewhere else.
After lunch I attended a family meeting for the one patient’s family whom I had interviewed last week, and determined risk of suicide and depressive thoughts. Lisa told myself and the family that she had offered this patient counseling and asked what she could do to make their stay more comfortable, and all the patient wanted was to be discharged (which at the moment is unfortunately impossible). The patient is currently on Cymbalta, an antidepressant. After this meeting I did more filing and BIMS/Mood interviews.
3/08/11
Today I was at DeGraff from 11am-3pm. I started off doing some BIMS/Mood interviews. For the most part they went great, one person has difficulty hearing and concentrating, but they were all very nice. After lunch I went with Colleen to the discharge meeting, and then I wrote up a couple discharge papers, gave the copy to the patients, and put the original in the patients’ charts, then wrote a progress note in social work’s section. I did this all on my own, I was very happy that I am comfortable enough now to do documentation like this, find patients for BIMS, etc. Hope everything continues to go well!
3/10/11
Today I was at DeGraff from 11am-3pm. I started off doing some BIMS/Mood interviews. The first one was very fast, the patient was alert, oriented, and pleasant. The second was a bit more difficult because although the patient was alert and oriented, the patient had a history of depression. They seemed to be coping well (a.k.a. not a suicide risk) but I still feel unsure of what to say when they say they’ve been feeling down, and wish I could help more. The last person I interviewed was smiling and friendly, but cognitively was not really there. The patient got a very low score on the BIMS, and Lisa told me to not even try a mood interview, since this person wouldn’t be able to answer. For instance, when I asked about the year, or if the patient could repeat the words back to me I had previously said, I got answers that had nothing to do with the question.
After lunch, I helped Colleen by filling out some admission paperwork for 2 new sub acutes. I am still new at this, so it took me a little while to find all the information I needed, then to visit with the patient and get information I couldn’t find from their chart, and to also conduct a BIMS/mood interview. Since it took me so long to fill out preliminary information, interview the one patient, and make a progress note, it got close to when I had to leave, so Jenna said she could do the second one. I guess she went into the room, and the patient said she didn’t want to do it right then, so Colleen will need to do it tomorrow. That is one thing that can be annoying sometimes, is finding time to talk to the patients when they are not at lunch, busy in the activities room, sleeping, or unwilling to talk. I had to wake up one patient I interviewed!
3/15/11-3/22/11
I was at DeGraff for 4 hours on 3/15 and 3/17, and 5 hours today 3/22. I am getting into a good routine there, I continue to do BIMS/Mood interviews, and am pretty comfortable with prepping admissions paperwork for new patients, and then speaking with them to any additional information I can’t find in their charts. Everything seems to be going well, although I don’t think I will ever know just what to say when I speak to patients who are depressed and wish they could go home but can’t. There was one patient who had no history of depression, but indicated that perhaps they thought they would be better off dead, and wished that they could pass away. I immediately told Lisa, and I learned that there is actually something in the DSM regarding depression due to medical illness. That is entirely understandable, I would be depressed too if I had to go through half of the things that some of our patients have endured. The patient did state that they thought their mood was improving, so hopefully things will get better for them. A psych evaluation can also be ordered for patients Lisa or Colleen are concerned about.
Today Lisa also told me a little bit about how she interacts with the insurance companies, and I learned for instance that some things such as IVs, wound levels 3-4, and some injections are covered, while other things such as eye glasses or a hearing aid might not be covered depending on the insurance. I think if I do become a social worker, I will have to do a lot of research to make sure that I understand everything well enough to help a patient or his/her family, because it was a bit confusing to me even, how HMOs function in combination with Medicare, etc.
I am really enjoying this internship, and I like that I am now able to actually do things like fill out paperwork and interview patients, or even just do filing to help out Lisa. I feel like I’m learning things that will help me if I end up working in a similar setting. I hope things continue to go well!
3/24/11
Today I was at DeGraff from 10am-3pm. I did BIMS/Mood interviews, and then did chart reviews and interviewed two new sub acute patients. One of the residents I interviewed was very nice and friendly, and we talked for a little while. This resident unfortunately is in between levels of care due to vision problems, and although Lisa would like to move her to a lower level of care, it’s not possible right now. I am glad I had the chance to interview this person and start the day off pleasantly, because the other interviews I did after that were very sad and depressing. Two of the people I spoke with said that they had thoughts that they might be better off dead or of hurting themselves, but did not have any plan in place (one other person refused to answer this question, but seemed depressed as well). One of these two had a very flat affect, meaning that they did not have any facial expression. This person also did not look at me or make eye contact at all. That was the first time I really encountered that in an interview with someone who was cognitively alert and oriented, so it was a little unsettling and sad, especially since the patient’s family was in the room, and mentioned that they’d noticed this person had been depressed since a recent surgery. I still feel uncomfortable introducing myself for the first time, and then having to ask such prying questions, but if that’s what I have to do to see that someone gets help that they need, then I am glad to be making a difference.
3/25/11
Today I was at DeGraff from 10am-2pm. Colleen showed me how to do the social work part of the care guide and care plan on the computer. It involved explaining our interventions such as saying we will continue to have weekly meetings with the goal of discharge to home, and putting a patient’s demographic information, psychiatric issues, etc. The care guide is a quick overview about the patient’s care requirements that is taped to the door of a patient’s closet as a brief reference. The care plan is more in depth. After we did a couple care plans, she went over how to enter the MDS, which is entering the responses from the mood interview and BIMS, and sometimes some additional questions.
Before lunch, we went to the activities room to help serve at a fish fry being held for the patients. Some family members were there as well, and it was a nice event. I felt somewhat awkward at times because after I served everyone I wasn’t sure exactly what to do. For instance, I cut up the fish for one resident that I knew, but that was because Colleen asked me to. I wasn’t sure who required help with what, since I am not full time and don’t know the residents as well as Lisa or Colleen do, and I didn’t want to keep pestering them asking if they needed anything. I also didn’t realize the brake was on on one lady’s wheelchair when I was trying to move her a bit so another resident could get through. I really hope I get more comfortable wheeling people around, I still feel weird doing that. I go really slowly especially when turning them for instance, because I don’t want to accidentally run them into a wall!
After lunch I prepped some admission paperwork, but didn’t have a chance to interview the new patient because they were in therapy. I did make a phone call to follow up on finding a Health Care Proxy that a patient thought they had. The one hospital I called didn’t have it but the second did, so I left a note for Colleen to fax a request over for a copy. I like being able to do useful things like find an HCP or speak with families of the patients, and I wish I were able to stay longer at DeGraff, because I feel there is a lot more that I can learn.
3/29/11
Today I was at DeGraff from 11am-3pm. I felt very productive, I did 5 BIMS/Mood interviews, and 2 admissions. The one patient I was told beforehand was very mean and irritable, and I was somewhat nervous going into the interview. The patient’s son was there, and I think that kept them somewhat in check, but after a few questions the son asked if I could finish another time because the patient was getting agitated. This person had been diagnosed with anxiety, and I could tell how visibly anxious they were, even though they were on an anxiety medication.
The other BIMS went pretty smoothly, a couple of them I had trouble understanding, one especially because they were a stroke patient. They were very nice though, one was mentally retarded, but one of the sweetest people I have met so far there. This person lives in a group home, and just wants to go back so they can see all of their friends again. I am not sure which is more upsetting, speaking with a patient who is very depressed, or a patient who is not depressed but feels sad and has been away from home for awhile. Some people have been in long term care for over 10 years, and some sub acute patients have been in the hospital since December. I hope if I am ever in the same situation, I have some of the perseverance and optimism that I see in some patients, because they are truly inspiring.
3/31/11
Today I was at DeGraff from 12pm-4pm. It was a pretty slow day, we had a farewell party for one of the therapists who is leaving, and then I did some admissions paperwork and interviewed a new sub acute patient. I went with Lisa to the team planning meeting, where there were two families that came in. The first one was slightly difficult because the patient had an ulcer on their foot that had opened up, and the family was upset because they had spent some money on a pair of shoes that had been custom fitted for this patient. The family however had not notified DeGraff about these shoes, and the shoes had partially contributed to the problem. This was one of the more difficult families I had encountered, and they said things such as we were making empty promises, and were passive aggressive. What made me sad was that they said they wanted to relocate this patient to a place closer to their home, and although it was clear the patient did not want that, the patient did not speak up. I’ve noticed that in family meetings, the patient often becomes quiet, despite the fact that they might be normally outgoing and sociable. I think they feel a lot of pressure from their family members, but it made me sad because I am sure this patient has become comfortable at DeGraff and made friends, but is too nervous to say that to their family.
Lisa asked if I wanted to present the BIMS/Mood interview results to the second family, but I was very nervous about it so Lisa took the lead. I wasn’t sure how much for instance I was allowed to say, because this patient had indicated thoughts that they would be better off dead. Lisa related this to the family member though, and after observing how she handled the situation calmly and confidently, I think I will be ready to take over this aspect for the next family. One reason I didn’t want to do this was because I could not remember 100% who this patient was I interviewed! I felt so bad, but I meet patients for the first time when I interview them, and I usually do a few interviews a day so it’s hard to remember exactly who is who unless I am told their room number. If I were there more often I think this wouldn’t be so much of an issue, but unfortunately due to my job and other course work, I can’t really come in more than 8 hours a week.
4/05/11—4/14/11
I was at DeGraff for 4 hours on 4/05 and 4/07, and 4/14. My routine is pretty much set now. I go in, and there is usually a list of BIMS/Mood interviews for me to do, some admissions paperwork, and sometimes filing. Sometimes I go to the discharge or family meetings, other times I do interviews etc. during them (the benefit is that during the d/c meetings, patients are not in therapy so it’s much easier to find them). I am pretty comfortable doing all of the interviews that I need to do, and filling out the paperwork, though sometimes in the more difficult cases I have to still ask Lisa or Colleen what to do.
I had a couple difficult interviews that I was unable to finish. One was aphasic, and I could not understand anything that this person was saying. I tried as best I could, but there was no way to get a clear answer. The other patient was a schizophrenic, and I wasn’t sure how much information I would be able to obtain, such as a primary care physician. It became apparent very soon that this person was cognitively impaired, for instance, this person could not remember how long they had resided in a group home. The patient started to say things like that they wanted to marry me, and I was unable to redirect them back to the questions for assessment, so I had to end the interview. I was somewhat uncomfortable, because I had never encountered anyone like this. I was not sure if the person would become physically violent, so I tried to end the interview as gently as possible, by saying I had other interviews I had to do, and luckily the patient was calm and friendly. I really wish that Colleen or Lisa had done this interview, not so that I wouldn’t have to do it, but so that I could observe how they handled this patient, so that in the future I could be more prepared as to what I should say in these situations.
4/19/11
Today I was at DeGraff from 11am-4pm. When I got in, Colleen was leaving because she was feeling very sick. Lisa is on vacation, so it was just me and Jenna for the day. We went to the discharge meeting and presented for SW. Since neither of us know all of the patients, we pretty much just read off of Colleen’s notes. I was not very confident at first, and I wasn’t sure when I was supposed to jump in. They were all going so fast, I was just trying to keep up! By the end I think it went ok though, I made notes for Colleen about who needs referrals for VNA and who she needs to plan family meetings for.
I did a couple assessments today, and they went pretty smoothly. After the meeting Jenna and I did discharge notices, and then I handed them out and made notes in the charts while she did some care plans. I also did some filing and dropped a couple things off at various places in the building, so I did a lot of running around today. I just hope that the notes we left for Colleen were clear enough, I would have stayed longer but we had to leave at 4 so someone could lock the office up.
I’m not sure how Colleen and Lisa do all the paperwork they have to do and still meet with patients and families, the discharge notices alone took forever! I still wish that I had time to be there more often so I could be more familiar with all the patients. For instance, when I dropped off the d/c notices, some patients asked questions that I didn’t know, so I just let them know Colleen would be in tomorrow, and made a note for her to go speak with them.
4/21/11
Today I was at DeGraff from 11am-3pm. I did a couple BIMs before lunch, then after lunch I did a couple admissions. The one I was shocked to see how many different psychotropics this person was on. This patient has depression, anxiety, and ADHD, but showed no indications of depression in the Mood interview, so either the medications are working, or perhaps this person was not being completely honest because they did not know me. I then did care plans/guides on the computer, and think I might be comfortable enough to do some on my own, as long as someone gets me to the initial screen I need. All in all nothing out of the ordinary happened today.
April 21st-May 10th
I finished up my last 5 days at DeGraff to complete my 120 hours. It was pretty much the same things I’d been doing, BIMS/Mood interviews, social work initial evaluations for new admits, care planning, and some filing. I no longer get nervous about speaking with patients or waking them up, and am completely comfortable asking even the tougher questions that determine risk of suicide. There was also a tea party hosted by social work in honor of nursing home week at which I helped out. It was a lot of fun, and there was a piano player playing old songs that some of the residents and families even started to sing to!
This internship has helped me to see that I do want to go into social work as a profession, and really enjoy working with the geriatric population. It’s a hectic job, and the social worker is pretty much the person everyone goes to when they have a question, but despite the stress, I think I would enjoy a job like that. All in all, it was a great experience, and I hope that after I eventually get my MSW I can get a social work position somewhere within Kaleida Health, because they truly are the best system around.
