Case Study: John’s Journey

John’s History

John came to Cygnet Pindar House in July 2020 from a brain injury ward, after suffering from a hypoxic brain injury as a result of a cardiac arrest. He was extremely unsettled and required up to four staff on occasions to support and assist him. John has a percutaneous endoscopic gastrostomy (PEG) which he had inserted after his brain injury, and a Urostomy bag which he had fitted after suffering from cancer of the bladder earlier in his life. Both of these served as a trigger for anxiety, distress and aggression for John.

When John came to us

Upon admission John was diagnosed with dysphagia; the impaired functioning of eating and swallowing so initially he could not eat anything orally. With treatment and further assessment, John was able to start to eat food orally however would often cram food into his mouth, did not chew correctly and was unable to use and recognise cutlery. A diet was then recommended which sadly ruled out some of his favourite food, to minimise the risk of choking.

John was often confused to the extent that he could not tell us where he was, although he remembered his family and knew that his wife was ill. Talking about his family sometimes had a positive effect on John, however, this could also make him upset and angry. John suffered from a poor sleeping pattern, resulting in his mood dipping in the day and him becoming physically aggressive. Alterations to his medication and his medication times, alongside other interventions helped to address this.

John’s functional communication skills were impaired, suffering difficulty in his ability to retrieve words and express his basic needs verbally. To support John the speech and language therapist made visual resources and he was then able to make choices using images, however, this was not consistent. John’s cognitive communication skills were severely impaired. As a result of his confusion, he was unable to participate in any group therapies and could not hold meaningful conversations with staff or peers.

“As John’s keyworker, I am so proud of the progress he has made and of the strong man he has become. Our team will forever be singing The Stranglers!”John’s Keyworker, Senior Support

John’s Care

The multi-disciplinary team (MDT) and staff at Cygnet Pindar House took a step by step approach to help John. He was encouraged to attend small group situations, one-to-one sessions and informal chats, talking about shared interests. The team’s efforts slowly began to show a difference in John and his mood began to lift. He started to show an interest in birds, so a bird feeder was placed outside of his window so he could watch the different birds come to feed. John began to take notice of his surroundings and talk to staff about the different birds visiting the feeder.

John also began to build up positive and trusting relationships with his nursing team, remembering them by name, which was lovely for the team to hear. He also started to enjoy listening to music as he was trying to go to sleep, which had a positive effect, and often John could be heard singing along. Due to his extreme disorientation when he woke, mainly at night, an ‘orientation board’ was used with John when he opened his eyes. Staff would tell John the same statement each time, that he was at Pindar House in Barnsley, that he was safe, and that his family were ok. Slowly this too had an impact.

John began to take an interest and participated in his own rehabilitation, he found it overwhelming at first and often would not contribute. With some encouragement John began to contribute to his Named Nurse Session’s, Speech and Language Therapy, Occupational Therapy and Psychology. He contributed to his care plans which was a massive sign of progress with John, and an indicator that he did not feel as hopeless and low as when he first arrived. His rate of eating and ability to safely use cutlery also improved and the eating behaviours that put him at risk of choking massively reduced.

John today

John is now able to participate in social situations that involve eating and he has commented that his quality of life has improved as a result.

John’s functional communication skills have improved; he no longer requires visual resources to make choices, and is able to express his basic needs and wants verbally at all times. John now routinely attends group therapy sessions and makes thoughtful contributions to discussions with peers and staff with minimal support. He now demonstrates an interest in other people’s thoughts and ideas and his excellent sense of humour is hard to miss in conversation.

“Since my return to Cygnet Pindar House I can see a massive improvement in John. He is more settled in his mood and mental state, a very chatty pleasant gentleman. To see the improvement he has made, the way he is now becoming independent in his activities of daily living and see him engaging in activities he once enjoyed, is a credit to the staff at Cygnet Pindar House and their hard work.”Clinical Team Leader

More recently, John has started to enjoy going to the park with staff and looking at the different birds. Staff are over the moon with John’s progress and his ability to now initiate conversations.

John states his goal now is to return home, which, in the view of the staff at Cygnet Pindar House, is entirely appropriate given John’s current presentation, and staff believe that John will continue to progress when he returns home. We would like to wish John all the best in the future.

Nursing and care dependency scores from when John was admitted to most recent review score, Jan 2021

This diagram reflects John’s nursing and care dependency assessment at admission and in January 2021. On admission the level of support John needed for much of his activities of daily living was extensive shown here in purple. The orange areas indicate how independent John is now – requiring little or no support on a daily basis.

Nursing and care dependency scores diagram

(UK FIM+FAM) The Functional Independence Measure and Functional Assessment Measure is a global measure of disability widely used in neurorehabilitation settings

This graph shows John’s level of function on admission compared to January 2021 where significant gains have been made in all measurable domains indicated on the green part of this splat graph.

*Name has been changed to protect his identity.

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