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Hello, and welcome to “The Missing Link for SLPs” podcast. Today’s episode starts the first in a series called “Hey Professor.” I’m calling it that because I can’t tell you the number of times I’ll be walking down the hallway and the student will run up behind me, “Hey, Professor, one more quick question!” Or at the end of the class, “Hey, Professor, one more thing.” And these are some times where the best discussions come from. So, I really wanted to start capturing some of these questions and discussions in these episodes here. So look for the “Hey Professor” series.
This is the first episode in that series, and today I thought we would tackle what I call SLP Scripts. Now we know what scripts are, with our work with language kids and adult clients, and things like that. And the script is a way of planning what you’re going to say in given scenarios. I developed scripts working with my students, because I had so many students who would say, “Hey, Professor, what do I say to a family member? Or what do I say to a doctor? What do I say here? What do I say there?” So today is going to focus on scripts.
And the important thing about scripting is keeping those conversations Lean and Agile, not long and convoluted and going in every shape and direction. It’s knowing what you want to say at the start of your conversation, and having those first clear thoughts articulated because then once you say that, then the conversation is going to take its natural course, and then you can follow the conversation wherever it needs to go from there. So SLP scripting is how to start those Lean and Agile conversations.
As a medical SLP, there are three different scenarios where you’re going to want to become a master at SLP scripting.
- One of them is with the patients themselves, and how do you introduce yourself? How do you explain what you’re doing?
- Another situation is with other teams, the members of the medical team, like what do you say to a radiologist when you’re starting your video swallow study? What do you say at rounds?
- And the third situation or setting is what do you say to family members or caregivers and so we’re going to cover those today. We’re going to cover them more in depth as we go along as well. But today, we’re just going to provide an overview of some of these.
SLP Scripts for Working with Patients and their Caregivers
Since the patient is who we are all about, I’m going to start with what to say when you walk into a patient’s inpatient room, or video class, or to a swallow study, or when you start an outpatient evaluation. The outline I like to follow is an acronym called AIDET and it is well known in the medical communities that I work in. A stands for acknowledge, I stands for introduction, D stands for duration, E stands for explanation, and T stands for Thank you. This will be up on my website, you should be able to go download an example of what it is pretty soon [inserted below post-production]. You can also go find it anywhere on the web, AIDET. So all of the scripting that you’re going to do when you first meet your patient or their caregiver Is with AIDET in mind.
AIDET is a well known tool used throughout medical facilities, improving communication with patients, families, and visitors.
Acknowledge the patient and any family/friends/caregivers in the room with eye contact, a smile and an appropriate greeting.
Introduce yourself, your role, your expertise.
Give the patient and others in the room an idea of how long the evaluation or session will take.
Establish clear expectations by providing an explanation of your evaluation or session.
T hank You
Be sure to thank the patient and their family/friends/caregivers for working with you, for letting you take care of them, and for their time.
Five Essential Medical SLP Scripts for Introductions
So here are five essential medical SLP scripts when you’re entering a patient’s room for an evaluation or a therapy session.
To introduce yourself to an inpatient for clinical bedside swallow evaluation, you would say, “hello,____” and use their name. “My name is Liz. I’m a speech pathologist who works with swallowing difficulties and I’m part of the medical team here at Sacred Heart Hospital. Your doctor wants me to evaluate how safely you’re swallowing. I’m going to give you a variety of things to eat and drink and discuss with you how you can eat and drink safely, avoiding choking and pneumonia. This will take about 20 minutes. Any questions before we start?” You look them in the eye, you get at their eye level. You say it slowly and clearly and be approachable as they ask those questions.
If you want to introduce swallowing therapy – so somebody else has already done the evaluation and you’re coming in to do the session or you’re returning the next day to get the swallow therapy evaluations done – you would say, “Good morning. My name is Mattie, and we’re working together today because of your swallowing problems. I’d like to introduce you to some ways to eat and drink more safely, and without choking or feeling like something is stuck. We’re going to be working together today for about 30 minutes. And I’d like you to talk with me while we’re working together and let me know what you feel is going down okay, and what isn’t. But before we start, is there anything that you want to talk to me about today? Any troubles that you’re having with eating or drinking? Any other questions before we start?” And then wait for that patient’s response. So you’ve told that person who you are what you’re going to be doing, about how long it’s going to take, and you ask them if they have any questions.
The next one, introducing yourself to an inpatient for a speech language or cognitive evaluation. “Hi, my name is Bailee. I’m a speech pathologist and a part of the team here at this hospital. I’m here to work with you today and see how well you’re able to talk and understand what people say to you. I also want to check out how clearly you’re thinking. I’m just going to ask you some questions and have you do some things for me. This is all going to take about 20 minutes. Any questions before we start?” And then pause and wait for the questions; it’s important, especially with the cognitive evaluation. People are worried that if you test cognition, you’re going to somehow rule them incompetent. Those are most of the questions that come back at me after that. They’re worried that you’re going to take away some of their rights, their freedoms or privileges. And so those are the questions that come after I introduce myself.
The next script is introducing yourself for speech language or cognitive therapy. “Hi, Liz, my name is Leah and I’m a speech therapist. Because of your stroke, your ability to talk, think and understand is changed. And I’d like to show you some ways to talk and think more clearly. This will help you understand more of what is happening around you, and help you use your words to communicate what you really want and need. Ready?” At this point, you can ask if she has any questions or he has any questions, but you’ve given a short brief introduction of what you’re going to do.
When you introduce yourself to a caregiver, slightly different approach, you’re communicating with somebody who is very concerned about the person in that bed, hopefully. And you say, “Hello, my name is Rachel. I am a speech pathologist and part of the math team here at the hospital. My job is to make sure your family member is eating and drinking as safely as they can to avoid pneumonia, and to be able to communicate his basic wants and needs. I’m going to be working with Jim for about 20 minutes. Do you have any questions?”
If the patient is alert, ask your patient if they would like their caregiver to stay or if they would prefer their privacy. If the patient is hinting at privacy, then encourage the caregiver to take a break and return when you’re done. Lean and Agile conversations are the key to scripting because the purpose of scripting is just to give that introduction, tell who you are, what you’re going to be doing, how long it’s going to take, and then go from there with the questions.
Three Essential SLP Scripts for Wrapping Up
Still working with the patient, here are three essential SLP scripts for when you’re wrapping up your evaluation or therapy session.
So option one, this is the option that you’ll use if another speech pathologist will be returning for further therapy. “Thank you, Jim, for taking the time to work with me today. We’ve just finished our evaluation. I’ll be back to see you again tomorrow, [or state who else will be back], and we will continue on working on improving your ability to swallow more safely [or name what you’re going to be working on.] Do you have any more questions for me?” Short, sweet, and to the point, you’re stating clearly that you’re done. You’re stating what your next plan is and who’s going to return and when they’re going to return. And you’re stating what you’re going to work on when you do return. And you’re following up with questions.
Now, if you are not returning for further intervention because there is not warranted, you would say something like this. “Thanks, Greg, for taking the time to work with me today. We’ve just finished our evaluation and based on how well you did, I would not recommend that speech therapy come back and work with you anymore. Would you agree?” And then wait.
If they agree, (they should agree if that’s what you’re recommending), continue the conversation, saying, “great, great, I’m glad you agree. Again, my name is Susan, and I’m a speech pathologist with the rehab team. Please reach out to anyone on the medical team such as your nurse or another therapist, if you have any further questions or concerns, and have a great day.”
If the person does not agree, then address those concerns. But you see how that script opens up those conversations? And again, the script is – you’re wrapping up, you’re just confirming what you did, what the next step is, and where you’re going to go from there.
So when you’re working with a family member and talking with the family member, and you’re wrapping up a session, it can be a little bit different. And often these conversations take place because the family because the patient is not doing as well medically, and is not alert enough. And so your direction, your conversation is now going to be directed more at the family member.
You always think whether you’re talking directly with the patient or with a caregiver, you do that last part of the ADEIT acronym, which is the “T” which is “Thank You!” And here is a script for wrapping up a session with a family member. “Thank you for letting me work with your family member today. At this time because he is recovering from his stroke and his level of alertness is so low, it’s not safe to complete the evaluation as ordered by his doctor, but I’ll check back on him later today.”
Say what you can check back on them. “I’ll make a note of this in his chart and let his nurse and medical provider know, do you have any questions for me now?” “Again, my name is Susan and I’m a speech pathologist with the rehab team. Please reach out to anyone on the medical team such as your nurse or another therapist if you have any further questions or concerns for me, and have a good day.”
So it’s common sense. But sometimes when you’re in new settings, your mind just doesn’t think clearly. And that’s why I created the SLP scripting. There’s nothing magic about it. You walk in, you say who you are, what you’re doing, how long it’s going to take. And your conversations are just Lean and Agile, they’re clear, and they’re kind. So those are conversations that take place with patients and the family members.
When you are introducing yourself to a patient for a video swallow study, you’re going to be either in the room when the patient comes in and the med tech brings the patient in, or you enter the room after they’re ready to go. And here again, you introduce yourself. I say, “I’m Mattie, I’m part of the team here that’s going to be doing this swallow study. And we’re going to take a look and see where the food goes down. And if it goes down the wrong way, why and what we can do about it.” And then you go from there.
The next sentence is to explain what I’m going to do. And I’ll say, “I’m going to be giving you some food and drink mix with barium. And this is our camera. And this is our monitor, and we’re going to be able to see when it goes down where it goes down. And if it goes down the wrong way, why? So just follow my directions. You’re going to hear the radiologist and I talking a bit in the tech and I talking a bit and we’ll be throwing some terms back and forth. But at the end of our study, when all is said and done, I’m going to review these videos with you and go over the recommendations and everything that we have found. And we’ll go from there. Do you have any questions for me before we start?”
And that is the final conversation or SLP script that we’re going to work on today with the patient.
2. SLP Scripts for Working with Medical Personnel
I wanted to briefly touch base with SLP scripts when you’re working with other medical personnel, such as introducing yourself at rounds. So here you’re talking to the patient, but you also have other members of the medical team present.
So, “Hey, Professor, what do you say at rounds?”
Option one is if you’re going to be performing an evaluation. You say, “Hello, my name is Ali and I’m a speech pathologist working with you today. Today, I will be taking a look and testing how safe you’re eating or drinking, or fill in the blank here with what you’re going to be evaluating. I will also be looking at how well you’re able to talk and understand what’s happening around you.”
Option two is if you’re going to be completing a therapy session, not an evaluation. “Hello, my name is Anne and I’m a speech pathologist working with you today. Yesterday we evaluated how well you were eating and drinking. And today we will be working on ways to make sure you continue to eat and drink safely.” So do you see how it’s very short and sweet and to the point? Who you are, what you do, and what you’re going to be targeting.
I have two “Hey Professors” left that I want to target before we are done with this episode for today. And one of them is what do you say to a nurse when you walk up to the floor?
“Hey, Professor, what do I say to the nurse?” So you introduce yourself, “Hi, I’m Nikki, the speech pathologist who will be working with the patient to room 243. I have orders for a swallowing evaluation. Is now a good time? Is there anything I need to know before I start? How’s the patient doing today?” So you’re just opening up that conversation with that nurse. You’re telling her who’s going to be going into the room. She should be watching very closely who goes in and out. She’s gonna tell you if there’s any other testing things going on like x rays or anything like that. She’ll tell you how the patient’s doing. She’ll tell you her concerns.
This is also a good opportunity for you to then turn around and ask her how the patient’s taking their medications, if they’re having any swallowing difficulties and things like that. But you see how SLP scripts really narrow those first two, three sentences down into what you’re doing.
3. SLP Scripts for When a Patient Passes On
The last “Hey Professor,” that the students often ask me is, “Hey, Professor, what do you do if you walk into a room and you find a dead body?” And there are three different scenarios for this. And it’s happened to me a few times, but not a lot of times.
The first scenario is if you walk in and you believe a person has passed on and you’re the first one to find that person, you want to quickly turn around and go notify anybody at the nursing station. It doesn’t have to be that person’s nurse. Preferably it is. But you’ve already checked with the nurse to see how that patient’s doing. It could be the charge nurse, somebody who is going to be able to respond to you. Don’t run down the hallway, don’t run screaming or anything else like that. But you do go notify somebody ASAP and say, “I believe the person in room 219 needs you to go look at them.” And then that nurse will go and take it from there.
We are not qualified as speech pathologists to call the time of death or anything else like that. You do need to know DNR/DNI, in my opinion, before you go into a room, you should know that about your patients and then be able to respond appropriately.
A second scenario is, there have been times when I’ve walked into a patient’s room and the patient has just passed, and nursing is in there and they are attending to things. And at that point in time, it’s clear that the person has passed. You just ask nursing if there’s anything that you can do to help.
And the third scenario is you can walk into a patient’s room who’s passed, thinking you’re going to do therapy, because something hasn’t been communicated down to you. Or you go just to touch base with the family because most likely a swallowing patient and you stick your head in there, you realize what’s happened then, and you offer your condolences.
In all of the SFP scripting that you do, in summary of today’s episode, make sure that your communication is lean, agile, clear and compassionate.
So, there’s our first episode of our “Hey Professor” series.
I hope today’s conversation has created some aha moments for you and motivated you to become a better SLP, continuing to connect some of those missing links between what you know and how to use that knowledge.
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