On the last day of my fieldwork
I was able to sit down with an elderly gentleman, in his early eighties, to perform the goaling process. This man is still married, but stated that, “at times I wish I wasn’t because my wife is mean
to me.” He has three kids, two boys and one girl all in their late forties,
early fifties, who come and visit him on a regular basis. He has nine grandchildren,
who he adores greatly. He attained his high school diploma back in the late nineteen
thirties. With his high school diploma he became a carpenter for thirty-seven
years, until he retired in 1975. Then after retiring from carpentry he worked
part time at the local department store, as a greeter until three years ago. He
was admitted into rehab because he had fallen and was having problems with balance and coordination.
This gentleman was admitted
into rehab on Tuesday morning. My clinical instructor and I went into his room
for an evaluation that afternoon. My clinical instructor introduced herself and
then introduced me as a student who was there for the week. She asked him if
he would mind me participating in their session together. He agreed to allow
me to partake in their therapy, and was instantly talking and interacting with me. I
began to learn about him and his occupational history. He answered the questions
for my clinical instructor and would talk to me in between to tell me about his family and his life. I was glad to hear about his experience. Later that day my
clinical instructor thought he would be a good participant in my assignment because he was still cognitively aware, he had
reasonable goals to obtain during his week in rehab, and he really seemed to enjoy talking about himself.
Then on Thursday, when we met with him again for his morning therapy my clinical instructor asked him if I could perform
the goaling process with him on Friday morning. She then allowed me to explain
to him what the goaling process was and why I was going to administer it to him. I
explained to him that this was an effective way to find out what his goals were and give him the chance to prioritize those
goals for importance to him. I explained that the goaling process gave the therapist
and himself direction for a client centered therapy, but he was not scored on this interview.
He quickly agreed and seemed excited to be participating.
I believe I established
rapport with this patient because I made eye contact and showed interest in him from the very beginning. He could tell that I respected him and I could tell he respected me.
I also believe that he was comfortable with me because he was comfortable with his surroundings. He knew where he was, why he was there, and was shown respect from the other caretakers in the hospital.
Unfortunately, the goaling
process session only took about twenty minutes to administer. I believe it could
have taken longer, but I was only allowed fifteen minutes because of the small amount of time and the large amount of patients
that needed to be seen that day. I also did not have to ask him occupational
history questions that I had already maintained from my initial meeting on Tuesday.
It was difficult for this man to come up with more than five goals. He
automatically spit out five goals within the first few minutes. To obtain the
last three goals I used my knowledge about him and his occupational history that I obtained from Tuesdays’ meeting with
him, and since I knew some things about him I was able to question him on three more goals pertinent to him. Therefore to maintain all the necessary information I would say I talked to him for a good forty-five minutes
to obtain his occupational history and perform the goaling process. It just wasn’t
a consecutive forty-five minutes.
I knew my time was running out and I was having a very difficult time figuring out any other questions to ask him to
obtain any more goals. Therefore I moved on to prioritizing the goals. I told him we were going to rank these goals from number eight to number one, with eight being the least
important goal to him, and one being the most important goal to him. He first
stated that wanting to go home was number one. I reminded him that we were working
backwards. Then he replied that all the goals were important. So I asked him, which one of the eight he could do without if he needed to.
Once he got down to four goals he said they were all equally important. I
asked him what he needed to do to accomplish another goal. For example, his number
one goal was to go home, I could tell by how often he mentioned that he was ready to go home.
Before he could leave, he had to first increase his balance and be able to function in his daily activities of living
independently. Each time it was very difficult for him to choose between each
goal. At the end he seemed pretty distressed about how he had prioritized them
and I thought he might have felt that he had made a wrong decision. I explained
to him that there was no wrong way of prioritizing these. This was purely his
opinion. I also told him that the goals and the prioritization would change with
time. Some things may be important to you now and may not be at a later date. I ensured him that this was not set in stone and would change frequently.
I gave him the list and asked him to look over it that day. I told him
I would stop by that afternoon to pick up the list. Since I couldn’t leave
him with a pencil, I told him to keep in mind any changes that he wanted to make for later in the day when I returned. I felt bad making him remember those changes and not being able to leave him with
a pencil, but it wasn’t allowed for safety issues so I figured this was the best option.
When I returned to his room that afternoon he had changed some of the numbers but still had the same goals. This time he seemed more confident in his prioritization. I
could tell that he had really put some thought into prioritizing his goals. When
I left I told him I would not be there again, but I would try my best to get him the final list by that weekend. When I asked him I wanted him to hand out the list to twenty people he seemed hesitant at first. However, I explained to him that he could give it to his therapist, doctors, nurses, social worker, family
members, and friends. I told him that sharing this information was necessary
because it made those people around him aware of what was important to him and it also made him liable to complete those goals.
Unfortunately I was unable to hand him his final list, but I did go home and type up a list for him and email that
list to my clinical instructor that night. I was hoping that he would receive
that list on Saturday. He was scheduled to go home on Monday so I knew I had
to get this to him as soon as possible. It was important to me that he received
the list and the option to follow through on these goals. I called my clinical
instructor on Monday and asked her if she had distributed the list to him on Saturday and if he had any questions when she
did so. She said that he received the list and was very excited to have the final
copy himself. She said he gave one to her right after she gave him the twenty
copies. She even put one in his medical file for his team to observe and keep
in mind for his weekly meetings. So as far as I know he has started to publish
his goaling list to friends and colleagues.
Personal Observations Regarding the Goaling
Since this participant
seemed so excited to participate I think the goaling process was very helpful for him.
It really just seemed that this man had assumed the patient role and really just wanted to get back home and live independently. He was so worried about getting the right score on the process, so he could return
home. Once he realized that this was purely for his own sake he seemed much more
relaxed and relieved about the whole process. He had a sense of happiness
with the control over choosing his own goals and having adequate time to do so. Since
my clinical instructor stated that he had given her a copy of his goals and followed through on his publishing, I think this
process was very helpful and important to him.
I don’t think I could
have asked for a better first attempt in performing the goaling process on a complete stranger. However, even with such a great person to administer the process on I feel I lacked in the communication
skills of effectively recording goals. There were many instances when I didn’t
know what to ask him to pry those goals out of him. Then when writing down those
goals I didn’t feel confident in recording the goals that he wanted. I
was very worried that what I was writing wasn’t what he meant to convey. It
was also difficult to record and separate the goals at first because he was saying so many in his first few sentences when
we talked. I believe it would have been a lot harder on many other patients there
in the hospital, and with practice I will begin to strengthen those weaknesses and be able to administer this process proficiently.
I think this would be very difficult to administer on anyone with cognitive difficulties. It really seems that one must have a lot of self-conception to effectively benefit from the goaling process. I was also worried about giving the patient a false sense of hope. Therefore it may be a high risk to administer this to people who suffer from depression because of the
effects of failure on their stature.
For me it is difficult to turn a negative goal into a positive, without putting your own perspective into the goal. It may be hard at times not to pass judgment when recording the goals. Also, it was hard for me to interpret the patient’s goals.
Was I writing down what they wanted? I really had to ask them if what
I wrote down is what they were meaning when they said that goal. Finally, at
times, it would be difficult to just keep your mouth shut. When my patient was
having difficulties in coming up with more goals, I didn’t want to influence any of those goals for him. I wanted to make sure they were purely his goals, not mine. If
a patient were struggling with the goals, it would be difficult not to mention some common goals of other people.
Since the gentleman seemed satisfied with this process I am very glad that I was forced to do this assignment. Not only did it help me practice my interviewing skills, but it also helped him to
identify his goals and prioritize them to his standards. It really seemed to
give him a sense of satisfaction.
#8. He wants to go fishing again.
#7. He wants and needs to fix his own food.
#6. He really enjoys spending time with his Grandkids.
#5. He wants to maintain having someone to talk to.
#4. He wants to be able to bathe himself Independently.
#3. He wants to go to the bathroom Independently.
#2. He wants to increase his balance
#1. He wants to go back Home.