Caring for patients with cognitive accessibility needs (Case study)

Andy is a 33-year-old man with Down syndrome who is being discharged from the hospital after being treated for a broken leg he is with his parent, Elena, who will be taking him home and helping with his care during recovery.

His nurse, Charisse, is preparing to review discharge instructions with Andy .
Before she enters Andy’s room, she keeps in mind that some patients find discharge instructions overwhelming because the instructions contain input from multiple members of the health care team. In Andy’s case, the hospitalist, physical therapist, orthopedic physician assistant, pharmacist, and nurse were all involved in Andy’s care.

To ensure Andy understands the instructions, physical therapy exercises, and follow-up appointments before he’s discharged home,

Charisse uses methods to increase cognitive accessibility by providing information in ways that make it easier for him to process, including use of plain language, slower pacing, repetition, and visual supports.

Now, Down syndrome is a genetic condition that can affect learning, memory, and processing of new information.

For some patients, working memory may be reduced, so when too much information is presented at once or too quickly, it can be harder to understand and remember.

This can lead to cognitive overload,

which can make Andy feel overwhelmed, confused, and anxious, and make it harder for him to retain discharge information.

Cognitive Overload can create problems after discharge. If Andy can’t take his medications as prescribed, remember signs and symptoms of infection to watch out for, how and when to do his physical therapy exercises, or the date and time of his follow-up appointments, he’s at risk of complications. For patients like Andy, making accommodations when presenting information is critical for his safety, recovery, and overall well-being.

Nurse Charisse sits at Andy’s bedside and begins his discharge teaching. She begins by explaining the discharge process by reading the first paragraph of the discharge instructions slowly and in plain language.

As she is talking, she notices that Andy starts to look out the window.

When she asks him if he understands, he appears confused and doesn’t really answer the question.

Charisse knows it’s time to change her approach. She asks some questions to determine how to best support Andy.

Charisse: “Would it help if I explained this step-by-step?"

Andy: “Yes, I think so.”

Charisse: “No problem. Would you also like if I wrote this in a different way for you?”

Andy: “Yes, please.”

Charisse: “I’ll be right back, let me grab a couple things.”

Charisse then turns to Elena.

Charisse: “Will you be helping Andy at home with his medicines, appointments, and getting around?”

Elena: “Yes. He’ll be staying with me while his leg heals, and I’ll help him keep track of everything.”

Charisse: “Great. I’ll review the instructions with both of you, and I’ll still check in with Andy as we go.”