Transcript Conventions

Italicised words - those which are emphasised by speaker
/ - very brief pause
... each pause represents approximately 1 second
[ ] sections which are inaudible on the tape. Where words are written in these brackets, then these represent an informed guess as to what was said.

Team 1's Introductions: Henry

OT(1)

Henry: his back has improved, it's stopped seeping, there's good progress. Query the prospect of going home in a wheel chair. ...

Review 2

OT(1)

Okay/ Henry .. last week his back had been seeping um/ possibilities to overcome this were discussed and we decided it was to be looked at on the ward round/ on Thursday.

Review 3

Okay is that all for Duncan?. Henry . that [tarin] tincture started seems to be/ improving and that's to the/ area on his buttocks that is seeping ... the supra pubic/ is mucky .. and Ward Dr. is going to follow that up. The area on his ankle's almost healed and his mood seems a bit depressed/ and he can cause . trouble in the dining room at night although there's um/ a positive to that he's also cheerful and can cheer up all the others this way.

Review 4

SNT

Henry: continue to mobilise slowly/ very small blood blister/ on great toe from his stocking. Discussion/ re mood/ ah/ wheelchair reviewed by OT and physio. Comfort/ cushion unsatis/factory . and the psych registrar was going to see him.

Team 2's Introductions: Pat

N3

Pat. (big sigh) management no change in presentation. Pat's had three documented periods of [aggression] where he's been [aggressive towards Jamie during a] game of pool. Made a gesture of his hands across his throat and down there/ down his stomach [..]; carries out present [.]. Interactions of self [ ] Social and family: Continues to be visited by guardians. Aunt contacted the unit Sunday night .The following day said she'd like [.] to be checked out. Pat has a red throat. He wants[..]/ (3) why does he compensate so much for [..] guardians [..]

Review 2

N1

(reading notes with difficulty) Pat/ (sigh) Pat: his/ current issues are/ are continue investigating his eventual/ transfer to the brain injury unit . His physical: no concerns . ah mental state nil change in/ presentation. Some frustration if kept inside during the bad weather/ occas/ occasionally/ flush/ flashes of brilliant humour . aaah .. and was virtually involved in a fight between other clients. Did not react violently/ violently and quickly forgot. His management: continue plan/ update ah/ became a little hostile after guardians'/ visit. Blaming same on being in this nuthouse. Soon calmed down. Guardians want to know if Pat's/ friend/ Julie can be present when Pat visits their house on his next home leave. Social and family: regular visits by family. Aaah/ no leave during this period. Ah/ update after weekend visit, visitor left behind some books on trailbikes and some on/ fish/ hunting. Aah is it appropriate that (sigh) Pat has hunting books in his room/ possession?/ query that.

Review 3

N3

... okay we'll move on to Pat. Ah, his current issues: case conference on the 25th of this month at 9 o'clock in the morning/ ah complex needs assessments to be arranged/ through ACC, day leave next Sunday. Ah, his physical: no no concerns there. Mental state: no change in mental state. Settled week/ with only one documented period of irritability due to Pat not/ being able to go out in the courtyard /upon his request .. ah commented on seeing service sign and saying "Anyone would think I attacked someone" . Also he requested scissors to cut his toenails and being told there was none available at the time/ stated/ "You should you shouldn't oh you couldn't stab anyone with these". Pat/ and Michael appear to enjoy each other's/ company and appear to interact well. His management: no change in his management. Attending groups/ visit by guardians Saturday, visit by uncle on Wednesday. There has been a a request by ah/his aunt this morning over the phone. She's requesting ah/ if Pat could have/ oh to go to the gym during a/ weekly programme on smoking .. ah that's from Dr/ forget his name (overlap) um

Review 4

N1

Pat aah/ competence needs assessment/ as has been arranged. Aah/ query family meeting. SSW1, has this been arranged? It says here CNS2 that you will attend a full family 22 July and/ whatever. Physical: seen by house surgeon re scarring about right knee/ aah (sigh)/ about statistics from/ query statistics related to [] ah orthopaedic review at the local hospital at Outpatients. [] also sent. Guardians are aware of the same, a review of the same. Mental state: no change in mental state on or presentation. Became frustrated during letter writing groups swearing and throwing arms in the air but was easily distracted from this/ after being directed to something of interest ie his book on car mechanics. Management: nil change in management continues with present regime as per plan. Social and family: visited by guardians/ Wednesday to Saturday. He had home leave on Sunday with two on one escort escorting nurses. Report/ not a successful home leave with some concern documented over guardians mostly uncle/ constantly asking Pat if he would remember/ or if he could remember various things. For example showed Pat photos of the past. Pat became mildly agitated and annoyed and stating loudly on several occasions, "I can't remember a fuckin' thing. My memory's failed". Aah/ this is an issue for the MD team. (2-3 people comment simultaneously and briefly) . Do the guardians need to be addressed re this? And his requests are a very long walk/ to get some food. (someone laughs) to have leave to go shopping and/ buy a - oh this is from his guardians - have leave to go shopping to buy a birthday present for his aunt ... mm.

Review 5

N2

Okay mm hm ah Pat ah he's finished his case conference on the 25th of the 7th and his family meeting on the 22nd of the 7th um ... okay mental state there's been no change in mental state on presentation ah one incident this week where/ Pat misinterpreted a conversation and challenged a nurse this morning [. ] Usual agitation, and irritability evident at times unless actually directed redirected. Generally occupies um time alone either playing playing pool or watching TV [tuning it to topics in which interested) ie motorbikes, fighting and hunting etc. Ah continues to acknowledge um/ from [.] and um/ yesterday when we tried to get his/ [blood]/ levels [..] / as the diagnostics lady was about to put the syringe in his arm, the needle in his arm he just/ went/ his anxiety just gradually increased. He got all agitated running around the room and swinging his arms a bit um/ so if those levels need to be taken again-well they need to be be taken- and we will have to/ look at some way of managing that either .. through an overall group approach or maybe possible sedation