Is the patient alert and oriented?

That was the first official “hospice type” question I learned when I was a hospice chaplain way back in the late 90s. (Yup, last century!)

Are they alert and oriented times 1, times 2, times 3, or times 4?

Ah, it gets more complicated! Here, as I understand it, are the key questions for determining if a patient is alert and oriented:

1. Who are you?
2. Where are you?
3. What time is it?
4. What just happened?

These are very basic, universal, and essential health care questions—and not just meaningless jargon—to aid in discerning the current mental status of a patient. Ideally, we all “know” these four answers. I am Larry. I am in Fresno, California. It is about 5:00 in the morning (or it’s an early Tuesday morning if you’d prefer me to be general about when I wrote some of these words). And, finally, not all that much is happening in my (see #1) home (see #2) at this pre-dawn hour (see #3), other than I just heard our kitty Milo slink down the hallway, probably headed toward the back of the house to bother my slumbering wife.

In hospice, #4 is often less a concern. Many hospice patients won’t necessarily know what “just happened” because of medication or temporary disorientation from the recent and unsettling changes in their lives. Even in so-called normal circumstances, we are hard-pressed to recall what has happened earlier today or earlier in the week. What did you have for breakfast this morning? What about your lunch selections three days ago? Details can blur for everyone. Read More →

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