Click-to-copy cognitive-communication documentation for SLPs in skilled nursing. Free, no login.
Judgment and inferencing: below 40% on this date in medical appt related scenarios (what if the transport company doesn't arrive, what if your phone has no battery, etc). Decr in acc possibly d/t complexity of verbally presented tasks. Automatic speech: 60%, 20 possible opps to enhance ability to initiate requests for desired items and assistance.
Verbal p.s: 80% through indep activation of call light and comm of pain once call light was answered. Patient successful in her request for pain meds and indication of location of pain to nursing staff.
Orientation to person, place, time, and situation assessed: patient oriented x --- . --- cueing required for --- .
Sustained attention to a functional task measured at --- min before redirection required. Patient required --- redirections across a --- min task.
Immediate recall: ---/--- items. Delayed recall at --- min: ---/--- items with --- cueing. Recognition cueing improved recall to ---/--- .
Functional problem solving trained via --- scenarios (call light use, requesting assistance, medication timing). Patient accurate in ---% of opps.
Safety awareness assessed: patient identified ---/--- hazards in the environment and required --- cueing to recognize --- . Findings comm to nursing 2/2 fall risk.
External memory aid introduced (--- ). Patient required --- cueing to reference the aid and demonstrated --- carryover across the session.
Patient's insight into deficits remains --- as evidenced by --- . This directly limits carryover and safety, and skilled SLP is required to address it.
Sequencing of a --- step functional task completed with ---% accuracy. Patient required --- cueing for step --- .
Auditory comprehension of --- step commands: ---/--- accurate. Accuracy decr to ---% with the addition of background noise.
Patient initiated a request for --- indep in ---/--- opps, supporting the goal of functional comm of wants and needs.
Divided attention trained via --- . Accuracy fell from ---% to ---% with the addition of the secondary task, indicating limited automaticity.
Patient required --- cueing to use the call light appropriately and --- cueing to comm the location and severity of pain to nursing.
Cueing hierarchy faded from --- to --- across --- sessions for --- , indicating skilled progress rather than session-limited performance.
Skilled SLP required to select and fade the cueing hierarchy in real time based on the patient's response, and to determine which compensatory strategy is appropriate given the patient's --- deficits.