Core competency test To gain a certificate in the Stroke Core Competencies, complete the test. You should allow approximately 30 minutes to complete this test. To pass the test and gain your certificate you need to answer all the questions correctly. This certificate can be used as evidence of continual professional development (CPD). Please provide some personal information before proceeding with this Module Test. This information is required for creating your certificate and will also assist us in evaluating the website. Each of the Managed Clinical Networks (MCNs) in Scotland will be given the names of those who have been awarded Module Test Certificates within their areas. We do not collect or share information on the number of times a person attempts the Test, or where a certificate is not awarded.Name* First Last NB Your name is required for creating your certificate. Email* Do you live / work in Scotland?* Yes No Are you:* Employed by Scottish Ambulance Service Employed by NHS Employed by University or other Higher Education Employed by Local Authority/Private/Voluntary sector A student A carer or other Do you work in a:* Hospital Community Name of service (eg ESD, GP surgery): Enter your service nameWard no. / name:* You work in:*Nursing / residential homeHome care / communityPrivate hospitalCharitable organisationChoose your work environmentIs this ward a Stroke Unit?* Yes No Hospital name* Name of institution:* Enter the name of your institutionTown / City:* Enter the town / city where you workNHS Board*Ayrshire and ArranBordersDumfries and GallowayFifeForth ValleyGrampianGreater Glasgow and ClydeHighlandLanarkshireLothianOrkneyShetlandTaysideWestern IslesEnglandWalesIrelandNorthern IrelandCanadaUSAAustraliaNew ZealandOtherSelect your NHS BoardYou are an AHP student a Medical student a Nursing student Carer* Carer Person who has had a stroke Your profession*Academic researcherAdministratorDoctorDietitianHealth Care AssistantOccupational TherapistOrthoptistPhysiotherapistRegistered NurseSocial WorkerSocial Care WorkerSpeech and Language TherapistTherapy AssistantOtherSelect your professionProfession (other)* AfC Band*Band 2Band 3Band 4Band 5Band 6Band 7Band 8AfC not applicableSelect your AfC bandUniversity / College*Aberdeen UniversityDundee UniversityEdinburgh UniversityEdinburgh Napier UniversityGlasgow UniversityGlasgow Caledonian UniversityQueen Margaret UniversityRobert Gordon UniversityStirling UniversityUniversity of the West of ScotlandOtherSelect your University / CollegeCountry*EnglandWalesNorthern IrelandIrelandCanadaUSAAustraliaNew ZealandOtherSelect your countryThis Master case scenario consists of 18 parts. Each part contains a multiple choice quiz, you should answer each question in the quiz yes or no. When you have answered all the quiz questions you will be able to proceed to the next part. If you answer any part incorrectly you will be asked to revise certain core competencies and points will be deducted. Please keep a note of these Core Competencies. Please note to pass this scenario and receive your Stroke Core Competency Certificate you must answer ALL 18 parts correctly. You should allow approximately 30 minutes to complete this scenario. Core Competency Test Part 1: Mr Willis Mr Willis, aged 64 years old attends the well man clinic. He says he feels fine but was told to attend by his wife. His mother is still alive and well aged 93 years however his father died suddenly aged 54 years of a presumed heart attack. He enjoys watching television and betting on the horses – he dislikes walking. He smokes 15 cigarettes each day and drinks three pints of beer most days. On examination he is very overweight and his blood pressure is high at 193/105. Part 1. Q. Which of the following actions are appropriate for Mr Willis?1.a. Reassure him that all is well and that he should just carry-on as normal* Yes No 1.b. Warn him that his lifestyle is not very healthy* Yes No 1.c. Advise him to cut down his smoking but his alcohol consumption seems OK* Yes No 1.d. Suggest that he should get his blood pressure measured on another occasion soon* Yes No 1.e. Advise him to get his cholesterol and blood sugar tested* Yes No 1.f. Suggest switching to red wine since it will protect his heart.* Yes No 1.g. Advise him to take regular exercise and to try to lose weight* Yes No 1.h. Suggest that he takes plenty of salt to prevent cramp* Yes No 1.i. Offer him support to give up smoking* Yes No 1. Answer. Mr Willis did not receive adequate advice about preventing heart attacks and strokes and as a result suffered a heart attack the following year. You have answered one or more questions incorrectly. You should revise Core Competency 3: Reducing the Risk of Stroke.1. Answer. Well done, Mr Willis’ risk factors have been properly assessed and treated and as a result his risks of future heart attacks and strokes have been greatly reduced. He stopped smoking and reduced his alcohol intake. He buys a dog and now walks for at least an hour each day. As a consequence he has lost several kg in weight. His GP prescribed blood pressure tablets. He attends the nurse every few months for a check up. Core Competency Test Part 2: 5 years later Mr Willis has remained well for five years. He is now aged 69 years. He phones the clinic to report an episode earlier that morning when his right arm and leg had suddenly gone numb for 20 minutes but then had completely recovered. He now feels fine. Part 2. Q. Which of the following actions are appropriate for Mr Willis?2.a. Explain that it was probably due to a trapped nerve but to report back if it happened again* Yes No 2.b. Advise him that it may have been a “mini stroke” which might require some specific treatment* Yes No 2.c. Tell him to mention it to the doctor when he next comes in for his blood pressure check* Yes No 2.d. Reassure him that it sounds like one of his migraine attacks and to take some paracetamol and go to bed* Yes No 2.e. Ask him to come into the clinic immediately to see the doctor* Yes No 2. Answer. Unfortunately, as Mr Willis did not see the doctor immediately, he suffered a major stroke. You have answered one or more questions incorrectly. You should revise the Core Competencies.2. Answer. Well done, Mr Willis is seen by his GP and as a result of prompt assessment and treatment he avoids having a major stroke in the next few weeks. The GP immediately gives Mr Willis some aspirin and he is told to continue taking this daily as prescribed. The GP also gives Mr Willis cholesterol lowering tablets in addition to the antihypertensive drugs and refers him to the local hospital for extra tests. Core Competency Test Part 3: The next day The next day Mrs Willis phones the GP surgery to report that Mr Willis has collapsed whilst having lunch and is on the floor, unable to move his right arm and leg and unable to get up.Indicate whether each of the following actions are appropriate or not. Part 3. Q. Which of the following actions are appropriate for Mr Willis?3.a. Reassure her that it sounds like a faint and to lift his legs above his heart* Yes No 3.b. Make him comfortable and reassure them that the doctor will call later that day* Yes No 3.c. Ask her if his face is drooping on one side, he can speak normally and lift both arms up and keep them there.* Yes No 3.d. Sit him up and give him a brandy to stimulate his nerves* Yes No 3.e. Tell her this could be a stroke and that she needs to seek medical help immediately* Yes No 3.f. Lie him on his back and give him mouth-to-mouth resuscitation* Yes No 3.g. Ring 999 and ask for an emergency ambulance* Yes No 3. Answer. Unfortunately, you have not recognised that Mr Willis has probably had a stroke and that he requires urgent medical assessment and treatment. You have answered one or more questions incorrectly. You should revise the Core Competencies.3. Answer. Well done, your advice and fast response in phoning 999 has ensured that Mr Willis will get to the hospital as soon as possible. Stroke is a medical emergency. Core Competency Test Part 4: At the hospital Mr Willis arrives at the hospital. You assess him using the FAST (Face, Arm and Speech Test) test to see if it is likely he has had a stroke and whether he may be suitable for clot busting treatment. Indicate whether each of the following actions are appropriate or not. Part 4. Q. Which of the following actions are appropriate on admission to hospital?4.a. Assess him immediately* Yes No 4.b. Ask him to smile or show his teeth* Yes No 4.c. Ask him to sprint across the room* Yes No 4.d. Ask him to lift both arms up to the horizontal to see if one drops* Yes No 4.e. Ask him to tell you his name and what has happened – listen to see if his speech is slurred or muddled* Yes No 4.f. Ask him when he first noticed the symptoms* Yes No 4.g. Check if his pulse is Fast – at least 100 per minute* Yes No 4. Answer. Unfortunately, you have not recognised that Mr Willis has had a stroke and his condition has deteriorated. You have answered one or more questions incorrectly. You should revise the Core Competencies.4. Answer. Well done, this confirms that his face does not move properly on one side, he has weakness in one arm and cannot speak clearly. He is likely to have had a stroke but as he has had the symptoms for about 7 hours emergency treatment with clot busting drugs is unlikely to be appropriate. Core Competency Test Part 5: Confirmation of stroke The doctor confirms that Mr Willis has had a stroke but then rushes off to another emergency. Mr Willis is unable to communicate – his daughter asks you to tell her what is wrong.You tell her that the doctor thinks that Mr Willis has had a stroke and that: Part 5. Q. Which information would you give Mr Willis's daughter?5.a. Stroke is due to a blocked blood vessel in the heart* Yes No 5.b. Stroke is usually due to a burst blood vessel in the brain* Yes No 5.c. Stroke is due to an interruption to the blood vessels going to the brain* Yes No 5.d. Strokes usually come on slowly and recover quickly* Yes No 5.e. Strokes are often caused by stress and overwork* Yes No 5.f. Some brain cells are deprived of oxygen and therefore don’t work properly* Yes No 5.g. Strokes usually come in threes* Yes No 5.h. Strokes usually come on quickly but take a very variable time to improve* Yes No 5. Answer. Unfortunately, you have not given Mr Willis’ daughter accurate information which leads to confusion. You have answered one or more questions incorrectly. You should revise the Core Competencies.5. Answer. Well done, Mr Willis' daughter thanks you for your clear explanation. Core Competency Test Part 6: Admission Mr Willis requires further tests and treatment in the hospital and the doctor asks you to arrange a bed for him. Indicate whether each of the following actions are appropriate or not. Part 6. Q. Which of the following actions are appropriate or not?6.a. Ringing around the surgical wards to ask if they would accept him* Yes No 6.b. Asking the bed manager to find a bed on the medical unit* Yes No 6.c. Ringing the acute stroke unit to see if they can admit him* Yes No 6.d. Send him up to the coronary care unit* Yes No 6.e. Arrange for him to stay on a trolley until the next day* Yes No 6. Answer. Unfortunately, as Mr Willis is not admitted to a stroke unit promptly he develops several medical complications which slows his recovery and he is now unlikely to return home. You have answered one or more questions incorrectly. You should revise the Core Competencies.6. Answer. Well done, the stroke unit has a bed and accepts Mr Willis. They ask whether the brain scan will be done on the way up to the unit. You ask the doctor to arrange this. Core Competency Test Part 7 As you pass Mr Willis on the stroke unit he asks you for a glass of water. Indicate whether each of the following actions are appropriate or not. Part 7. Q. Which of the following actions are appropriate or not?7.a. Go to the kitchen to get a glass of water for him* Yes No 7.b. Tell him that you are in a hurry and to get it for himself* Yes No 7.c. Ask him if he has any problems swallowing – if he says not then give him the water* Yes No 7.d. Look around the bed to see if there is any indication of his current ability to swallow safely* Yes No 7.e. Find a qualified member of staff who knows him to ask whether he can have a drink* Yes No 7. Answer. Mr Willis is unable to swallow water safely. As a result of this incident he develops pneumonia and is very unwell. You have answered one or more questions incorrectly. You should revise the Core Competencies.7. Answer. Well done, the sign above the bed indicates that Mr Willis does not currently have a safe swallow. The nurse in charge confirms that the he is only able to take thickened fluids with supervision. Your appropriate actions prevent him having a frightening coughing fit and a life threatening pneumonia. Core Competency Test Part 8 Mr Willis is sitting in his chair eating lunch. He calls you over and asks whether you could get him a glass of water. However the nurse has put a full glass next to his fork on his right side. Indicate whether each of the following actions are appropriate or not. Part 8. Q. Which of the following actions are appropriate or not?8.a. Tell him not to waste your time* Yes No 8.b. Tell him that the glass is near his right hand* Yes No 8.c. Ignore him since he is clearly confused* Yes No 8.d. Move the glass to his left side* Yes No 8.e. Ask a member of the multidisciplinary team to check his visual fields and assess for visual neglect/inattention* Yes No 8. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.8. Answer. Well done, Mr Willis has a left hemianopia so he cannot see the glass. In addition, he neglects his left side so is not very good at scanning across to look into his left visual field. Encouraging him to look to the left is a good thing but equally, it is important that he finds his drink so he does not become dehydrated. Core Competency Test Part 9 Mr Willis is lying in bed and asks you to take him to the toilet urgently. Indicate whether each of the following actions are appropriate or not: Part 9. Q. Which of the following actions are appropriate or not?9.a. Tell him that you are too busy and to wait till a nurse comes* Yes No 9.b. Tell him that it is good to try to do things for himself and not to rely on other people* Yes No 9.c. Find the nurse responsible for his care and ask for their help* Yes No 9.d. Ask Mr Willis if he can walk. If he says he can then get him out of bed* Yes No 9.e. Look around the bed area for any indication of his abilities to transfer and walk* Yes No 9. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.9. Answer. Well done, the sign above the bed indicates that Mr Willis cannot currently transfer or walk safely. You find a nurse who, with a colleague, transfers him onto a commode with a hoist. He manages to maintain his continence and dignity whilst not being put at risk of injury. Core Competency Test Part 10 As you walk past a side room on the stroke unit you see Mr Willis lying on the floor next to his bed. He is not moving and his eyes are closed. Indicate whether each of the following actions are appropriate or not. Part 10. Q. Which of the following actions are appropriate or not?10.a. Call for help* Yes No 10.b. Walk quickly on since you have not had your first aid training* Yes No 10.c. Roll him onto his back and thump his chest to restart his heart* Yes No 10.d. Shout his name to see if he responds* Yes No 10.e. Immediately start mouth-to-mouth resuscitation* Yes No 10.f. If he doesn’t respond to his name, give him a gentle shake* Yes No 10.g. Check that he is breathing* Yes No 10. Answer. You have put Mr Willis at risk by not responding appropriately to this situation. Before starting cardiopulmonary resuscitation (CPR) it is vital that you carry out an assessment using the Basic Life Support Sequence. You have answered one or more questions incorrectly. You should revise Core Competency 6.10. Answer. Mr Willis had collapsed having choked on his dinner. The resuscitation team were called. They found a sausage blocking his airway. Once this was removed he quickly regained consciousness. Because of your prompt action he survived and went on to make a good recovery. Core Competency Test Part 11 Mr Willis, who has had communication problems since his stroke, is crying and upset. You discover that he has wet the bed.Indicate whether each of the following actions are appropriate or not. Part 11. Q. Which of the following actions are appropriate or not?11.a. Talk to him and explain that incontinence sometimes happens after stroke but that it often gets better* Yes No 11.b. Ignore him so as not to cause embarrassment* Yes No 11.c. Explain to him that sometimes it is more difficult to control one's emotions after a stroke – sudden crying often occurs but improves with time.* Yes No 11.d. Change the bed linen and tell him not to do it again* Yes No 11.e. Suggest that a urinary catheter should be put in* Yes No 11.f. Talk with Mr Willis and staff to try to identify the factors which may be contributing to his incontinence* Yes No 11. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.11. Answer. Good, even if Mr Willis has problems talking it does not mean he does not understand your explanation. It is important that people understand that incontinence and uncontrolled crying are common affects of strokes and, that like most other effects, they usually improve with time. Also that there are often several factors which contribute to the problems – if these are dealt with then the problem often lessens. The team identify that Mr Willis is constipated which makes control of urine more difficult. Also, the buzzer was not within reach so he could not alert the nurse that he needed the toilet. Having dealt with these issues he remained continent. Core Competency Test Part 12 Mr Willis’s family have brought in an electronic tablet device for him to watch his favourite nature programmes on. However, he discloses to you that he is struggling to watch them as his mind keeps wandering. Indicate whether each of the following actions are appropriate or not. Part 12. Q. Which of the following actions are appropriate or not?12.a. Tell him to persevere as things will definitely get better* Yes No 12.b. Suggest that the stroke may have affected his attention and reassure him that this is very common* Yes No 12.c. Ask Mr Willis for his consent to reduce possible distractions including closing his door to reduce external noise, and reducing the number of items in his immediate bed space* Yes No 12.d. Tell him to watch Emmerdale as this is more exciting than boring nature programmes* Yes No 12.e. Ask him if he has any worries or concerns that the team can help him with* Yes No 12.f. Suggest that he reads a book instead* Yes No 12. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.12. Answer. Core Competency Test Part 13 Mr Willis is unable to transfer without help. He has been sitting out in a wheelchair for a couple of hours but now complains that his bottom is sore. Indicate whether each of the following actions are appropriate or not. Part 13. Q. Which of the following actions are appropriate or not?13.a. Arrange for him to be helped back into bed by staff with the appropriate skills* Yes No 13.b. Tell him that sitting up is good for him and to stay as he is for as long as possible – give him some paracetamol for the pain* Yes No 13.c. Once back in bed ensure that his bottom is examined to look for signs of pressure damage* Yes No 13.d. Review the cushion on his wheelchair to check if it is giving adequate pressure relief* Yes No 13. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.13. Answer. Well done, Mr Willis thanks you for making him more comfortable. His bottom is red so that the cushion on his wheelchair is changed to one which relieves more pressure. The factors which might contribute to pressure sores are reviewed by the team. Core Competency Test Part 14 Mr Willis has an obvious right sided weakness and is lying in bed having slipped down on his pillows. Having checked with the nurse in charge you ask him whether he would like a cup of tea. He looks at you blankly but does not answer. Indicate whether each of the following actions are appropriate or not. Part 14. Q. Which of the following actions are appropriate or not?14.a. Position yourself in front of him so he can see your face and ask him again, speaking clearly and slowly* Yes No 14.b. Assume that he is not thirsty and move on to the next patient* Yes No 14.c. Check with the nurse if he has a hearing problem or wears a hearing aid. Look to see if he is wearing a hearing aid* Yes No 14.d. Show him the cup and ask him again* Yes No 14.e. Pull him up by both arms so that he is sitting upright to make it easier to drink his tea* Yes No 14.f. Ask the nurse to help sit him up to drink his tea* Yes No 14. Answer. You have answered one or more questions incorrectly. You should revise the Core Competencies.14. Answer. Well done, Mr Willis is deaf so he did not answer first time. However he can lip read when you sit in front of him. Also gesturing with the cup made it clearer. He needed to sit up more to drink his tea but because his right arm is floppy / weak it is at risk of injury if not handled and positioned properly. Your appropriate actions have helped prevent him becoming dehydrated or sustaining a shoulder injury. Core Competency Test Part 15 Mr Willis is lethargic, incontinent, not eating or drinking much and unwilling to participate in therapy. Indicate whether each of the following actions are appropriate or not. Part 15. Q. Which of the following actions are appropriate or not?15.a. Check if he is dehydrated* Yes No 15.b. Tell him that lethargy is inevitable after stroke* Yes No 15.c. Ask him why he is not eating and drinking* Yes No 15.d. Assess his mood* Yes No 15.e. Check that he does not have an infection* Yes No 15. Answer. Mr Willis deteriorates slowly over the next few days, develops a pneumonia and dies. If the patient becomes less well it is very important that common and simple causes of the deterioration are sought and treated effectively. You have answered one or more questions incorrectly. You should revise the Core Competencies.15. Answer. Well done, Mr Willis is dehydrated. His swallowing is reassessed and found to be OK. He has no signs of an infection. He explains that he is embarrassed about being incontinent and therefore has been trying not to eat or drink. He feels much better having been given some fluids. His mood improves and he starts to participate in therapy again. Core Competency Test Part 16 Following his discharge from hospital Mr and Mrs Willis return to the out patient clinic. Mrs Willis takes you aside and complains that Mr Willis seems like a different person since the stroke. He is distant, cold, and often cries. Sometimes he gets very angry and swears a lot. “Its not like him.” Indicate whether each of the following actions are appropriate or not. Part 16. Q. Which of the following actions are appropriate or not?16.a. Sympathise with her but explain that it is simply that he is very unhappy* Yes No 16.b. Explain that stroke can affect people’s emotions and personality, however, often with time these effects lessen* Yes No 16.c. Seek his permission to refer him to a psychologist* Yes No 16.d. Ask whether she would like you to arrange the liaison nurse to call* Yes No 16.e. Suggest that if he can’t control his anger she ought to consider moving out* Yes No 16.f. Explain that swearing is often a problem where people’s ability to communicate has been affected by a stroke* Yes No 16. Answer. Mrs Willis gets increasingly stressed and when Mr Willis is admitted to hospital a few months later with a urinary infection she refuses to have him home. Mr Willis is admitted to a nursing home for long-term care. You have answered one or more questions incorrectly. You should revise the Core Competencies.16. Answer. Well done, the liaison nurse and psychologist are able to explain the reasons for his problems. An antidepressant has reduced the frequency of crying and Mr Willis is now more willing to go out. Mrs Willis feels better able to cope, less isolated and is optimistic about their future. Core Competency Test Part 17 During one of your visits to his home, Mr Willis indicates he wants to speak to you. You cannot understand what he is trying to say as his words seem to be coming out in the wrong order. Indicate whether each of the following actions are appropriate or not. Part 17. Q. Which of the following actions are appropriate or not?17.a. Ignore him since he is obviously confused or demented* Yes No 17.b. Explain politely that you have not understood and ask him to repeat what he said* Yes No 17.c. Give him a pen and paper to see if he can write* Yes No 17.d. Pretend you understood him, nod, smile and walk away* Yes No 17.e. Hand him the picture board which is sitting on his bedside table* Yes No 17.f. Ask the speech and language therapist for advice about how best to communicate with him* Yes No 17. Answer. Mr Willis has aphasia and he simply wanted to communicate that he needed to go to the toilet. You failed to facilitate communication with him and as a result he was incontinent and he feels low and depressed. You have answered one or more questions incorrectly. You should revise the Core Competencies.17. Answer. Well done, Mr Willis manages to indicate using his picture board that he needs to go to the toilet. You alert the nursing staff who take him to the toilet. Mr Willis maintains his continence and dignity and his mood improves. Core Competency Test Part 18 Mr Willis is sitting in his wheelchair with his right arm hanging down close to the radiator. There is a pillow on the floor however, he seems unconcerned. Indicate whether each of the following actions are appropriate or not. Part 18. Q. Which of the following actions are appropriate or not?18.a. Pick the pillow up and put it back on his bed but don’t disturb him* Yes No 18.b. Ask if he can lift his right arm onto the arm of the chair* Yes No 18.c. Carefully pick up his arm and place it on the pillow to support his shoulder* Yes No 18.d. Check his right arm for injury* Yes No 18.e. Move the wheelchair away from the radiator* Yes No 18. Answer. Mr Willis has a floppy arm in which he has no feeling. He cannot feel temperature or pain. Because his arm was unsupported his shoulder was at risk of dislocation and permanent damage. You have answered one or more questions incorrectly. You should revise the Core Competencies.18. Answer. Well done, Mr Willis has a floppy arm in which he has no feeling. He cannot feel temperature or pain. Because his arm was unsupported his shoulder was at risk of dislocation and permanent damage. Also his arm was at risk of being badly burnt on the hot radiator. Thanks to your appropriate actions he sustains no serious injury. Core Competency Test Part 19 Three months after the stroke Mr Willis complains to you that his hand is still very clumsy making washing and dressing difficult for him. Indicate whether each of the following actions are appropriate or not. Part 19. Q. Which of the following actions are appropriate or not?19.a. Offer to wash and dress him* Yes No 19.b. Explain that most of the recovery occurs early on and that he should give up on the affected hand and learn to use the other one* Yes No 19.c. Explain that often improvement after a stroke is very slow but can carry on for many months or even years* Yes No 19.d. Suggest he asks the doctor, physiotherapist or occupational therapist about the chances of gaining more function* Yes No 19.e. Suggest that, despite the difficulties, it is good to keep trying to use his affected hand* Yes No 19. Answer. It is thought that repeatedly trying to use the affected hand will encourage quicker and more complete recovery. Although in the majority of people most recovery occurs in the early months, in some it continues for many months or years. You have answered one or more questions incorrectly. You should revise the Core Competencies.19. Answer. Well done, it is thought that repeatedly trying to use the affected hand will encourage quicker and more complete recovery. Mr Willis continues to practice using his hand and within a few months has regained almost normal function. He can now wash and dress himself without any help. Core Competency Test Part 20 Mr Willis’s family report that he seems to understand what is being said to him but does not appear to be remembering these things despite being able to remember recent events. Indicate whether each of the following actions are appropriate or not. Part 19. Q. Which of the following actions are appropriate or not?20.a. Ask for consent to contact the relevant community stroke services, e.g. stroke liaison nurse, occupational therapy, neuropsychology for assessment of his memory* Yes No 20.b. Suggest that the stroke may have affected his memory for language and reassure him that this is very common* Yes No 20.c. Suggest that everyone struggles with their memory as they get older* Yes No 20.d. Suggest putting important information on paper or whiteboards using pictures rather than just telling him things* Yes No 20.e. Tell him not to worry as there is nothing he needs to remember anyway as everyone is doing things for him* Yes No 20.f. Encourage them to talk with Mr Willis about positive memories of the past to let him enjoy using his retained memories for reminiscing* Yes No 19. Answer. It is thought that repeatedly trying to use the affected hand will encourage quicker and more complete recovery. Although in the majority of people most recovery occurs in the early months, in some it continues for many months or years. You have answered one or more questions incorrectly. You should revise the Core Competencies.20. Answer. Well done, it is thought that repeatedly trying to use the affected hand will encourage quicker and more complete recovery. Mr Willis continues to practice using his hand and within a few months has regained almost normal function. He can now wash and dress himself without any help.