Orientation as a goal

Orientation Goals

Confession

I used to write orientation goals for most of my patients. Before you gasp, hear me out. Knowing today’s date (within a day or two…) is an easy thing? Knowing where the heck you are and why you are here is essential. Right?

Many of the screeners and evaluations we conduct with our patients assess elements of orientation. Most of my clients either missed questions regarding orientation miserably or were off just a bit. Regardless of their cognitive and communication strengths and weaknesses, I wrote the same goal. Patient will communicate awareness of orientation to self, time, location, and purpose for three consecutive sessions given use of external aids.

Seems like a good goal, right? It’s specific. It’s measurable. It’s assignable. It’s realistic…

Is orientation an appropriate goal?

Okay, maybe an orientation goal is not realistic for some of our patients. Before I write an orientation goal, I ask myself,

  • Will being oriented to place/time/etc. improve this patient’s quality of life or independence?
  • Does this patient have the ability to be oriented?
  • Would spending extensive time on orientation detract from spending time on areas that would have a greater impact?
  • Does the patient care about being oriented?

As I asked these questions, I found my answers often weren’t in favor of addressing orientation as a goal. When my patients are pleasantly confused and don’t care about the day or time as long as nobody calls them late for dinner, I don’t make orientation a goal – even if they think it is 1968.

Yet there are patients for whom orientation is a very important goal. These are my patients who answer orientation questions close but not quite right. These are my patients who are bothered by not being able to accurately answer such a “simple” question. These patients have goals of managing their own schedule for which awareness of time and place is crucial.

External aids for temporal orientation

I have been hunting for the perfect calendar to hang in patients’ rooms and come up short. There are calendars with gorgeous pictures and tiny numbers. If by chance my patient has excellent vision and is able to read the date in the tiny text, they will have to contend with glare bouncing off the glossy paper. Tiny numbers. Glossy paper. Extra cartoons, quotes, etc to distract. I could not find a calendar that was suitable for someone with older eyes and impaired attention, who will likely view it from their bed. So I created one.

I also recommend buying a cube of 2″ Post-it sticky notes. Cut out the middle (just fold in half sticky-side out) and stick on today’s date. I like this method better than marking off days, because it focuses on what today is rather than what today isn’t. It is also much easier to see than a faint pen line marking out a day. Caregivers and family members can help with moving the sticky note (even if they don’t have a pen handy). This calendar works perfectly with 2″ Post-it note frames.

Rachel Wynn
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Rachel Wynn

Speech-Language Pathologist at Gray Matter Therapy
Rachel is a speech-language pathologist and creator of Gray Matter Therapy. She started making noise as a patient-centered care advocate in 2013. She believes great care happens when patients are informed and engaged.
Rachel Wynn
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  • Maureen McCarron

    I was happy to read your approach to writing (& pursuit of) “orientation” goals. For many years I worked in rehab settings (home care & day programs) with developmentally disabled adults. Orientation was huge, for the staff, but seldom for the consumers! Ditto for my work in education settings with TBI adolescents and other cognitively compromised students. I agree wholeheartedly with your advice to carefully weigh the pragmatics of orientation work with geriatric consumers.

  • Michele

    So glad to hear that Orientation isn’t the most important thing! I see some people still trying to work on orientation when it’s just frustrating people. I’m a COTA and I see other people from OT working on orientation with them. It’d be great if OT and SLP would coordinate!