Renee Kinder

Is there anything more thrilling on a winter day than sledding down the neighborhood’s steepest hill, across freshly fallen snow, in an inner tube?

I think not.

Our home, or our “hill,” I should say is “the hill” in our neighborhood.

Every time snow falls I see families arriving with sleds, inner tubes, snow boards, plastic swimming pools, you name it. It’s all for the thrill of reaching ultra-fast downhill speeds before throwing yourself sideways into heaps of white powder, lest you risk smashing into a row of trees at the edge of the yard, or worse, the frozen creek.

I always warn new families: “Please make sure your kiddos don’t smack into a tree or land in the water!”

For the older kids, it’s always the same warning: “Don’t say you didn’t know or that I didn’t warn you when you end up in the creek!”

But getting stuck in a frog hole? Seriously. I never considered this a sledding risk … until this year.

Frog holes, I have now learned are hidden, underlying risks, yet dangerous ones nonetheless.

Similar to the thrill of sledding, therapists experience great joy when they see their patients learn a new skill or progress to that next level of functional ability. In these instances, of course, we must also ensure we have trained patients and caregivers and avoided any underlying risk of not doing so.

Let’s say, for example, we have Mr. Jones, a new individual admitted to your facility who is status post hip fracture and has also suffered a stroke during surgery and was left with left visual field neglect and dysphagia.

We, as caregivers, understand the “tree” and “frozen creek” risks. They become standard care practices. Make sure the individual understands their weight bearing precautions. We make sure they are aware of how to use the call bell and keep it in reach at all times. We place key items on the right side of the body due to visual neglect.

But what about the changes to our care practices when this patient improves/declines, or nears discharge and is ready for transition to the next level of care. What happens when their transfer status changes from Extensive to Limited Assist? Or How do we train when there are Swallowing Precautions in place requiring 1:1 assist?

What about training across care providers such as therapy and nursing teams? How do we assess understanding? How to we ensure COMPETENCY? Who is accountable for making all team members aware? Herein lies the risk for frog holes and a tale of a memorable snow day afternoon at the Kinder house.

“Get these kids out of the house,” I pleaded to my husband. “I need just 20 minutes to make everyone something to eat.”

He agreed.

Then, not five minutes after taking the kids out, he comes back in. He is mumbling. He keeps saying he is hot and that he did something to his hand.

None of my children apparently told Daddy about the risk of frog holes when sledding, they did not assess his sledding risks competency. He was left saying, “I didn’t know.”

The result: His headfirst, downhill, hand-on-the-side-of-the-sled ride resulted in his pinky finger dislocated, pointing out perpendicular. Frog hole. He literally got his finger stuck in a frog hole.

The kids’ response? “Daddy should have known better,” and, “We all know not to sled on that side of the hill because there are frog holes,” and even better: “He should have listened to us!”

Listening, unfortunately, is just step one of teaching, training and ensuring someone is competent to understand risks or to provide competent levels of care.

For therapists and nursing teams, we often learn, as my husband did after experiencing a frog hole, that we need a self-imposed reset. Painful? Sometimes, yes.

We can, however, reset our training practices.

Consider the training dialogue between a therapist and a nursing assistant working with Mr. Jones:

1.  Watch and Listen to me while I transfer Mr. Jones. He has suffered a stroke but has come so far and can now move from his bed to his wheelchair with supervision.

2.  Now Follow alongside me and let’s do this together. Remember, he still has some residual neglect on the left side, so we need to provide a tactile cue for the edge of the chair.

3.  Now that you understand the safest methods for transferring Mr. Jones, you Show Me.

Here’s to resetting your educational practices to minimize those “I don’t knows” and keep you out of a frog hole!

Renee Kinder, MS, CCC-SLP, RAC-CT, is Director of Clinical Education for Encore Rehabilitation and also serves as the Gerontology Professional Development Manager for the American Speech Language Hearing Association.