This blog was written by Jane Kent Clinical Specialist Occupational Therapist.
As we start to look ahead and work out our recovery plan moving forward from the initial response to the Covid-19 pandemic, now is a time for reflection: both individually and as a team. As an individual practitioner there is something that has lately really struck me; something that as Occupational Therapists we are taught about from the very start of our careers. It is a tool we all use regardless of the setting, but, one that after many years in practice I do not necessarily give much conscious thought to. Paradoxically, it is possibly the tool I use the most and the resource I take everywhere. It is me!
The ‘Therapeutic Use of Self’ is a fundamental theory underpinning Occupational Therapy practice and one that can certainly shape any interaction with our patients. Although I may not be consciously thinking about how I use my ‘self’ during patient therapy sessions, I am aware that I naturally alter and adapt my approach to suit each individual such that I can build rapport and motivate them to benefit the most from a chosen intervention.
During the Covid-19 pandemic our normal day to day pace in the acute hospital setting has changed. Whist, yes, the acuity has increased and the hospital has been busier- the pace of what I have done as an Occupational Therapist has shifted. People are generally in hospital longer as they fight the virus and are often not able to return home until they receive a ‘negative swab’ due to the risks associated with discharges to care homes and further interaction with home based care companies. Whilst this poses challenges for our patients, families and safety for the hospital site- it nonetheless provides us with more time to treat our patients and provide their much needed rehabilitation.
As Occupational Therapists, it is crucial to our role that we take the time to really consider the person we are treating. It is important to recognise the significance our personality and behaviours will have on the success of the therapy process. In the current times this is even more vital due to the introduction of PPE, particularly face masks and visors. Often a warm smile as we approach can be the opener that puts a patient at ease, showing we are friendly and open to conversation; something many patients are missing during their stay. I still approach with that same smile, even if they cannot see it, I hope it is reflected in my eyes or my overall demeanour.
I have always felt that enabling patients to talk and asking them ‘what matters to you?’ is essential in order to provide truly patient centred care. This is the time we find out key elements of information that can make all the difference to a successful and safe discharge. A snippet of conversation can lead to an onward community referral that may otherwise have been overlooked which could enhance a person’s longer term quality of life once home.
During Covid-19, with less family involvement, it has been clear how vital time has become. Patients are often scared, lonely or bored with so little interaction and no visitors to look forward to. So how we interact with them is of paramount importance. I found that I’ve given more of myself during this crisis; taking the time to sit with patients, talk about their lives and allow them small insights into the person I am too. We become equals.
My treatment sessions often start with general conversation, asking about cards or photos on their tables, developing conversation from there to find out what is important to them and crucially build trust.
An example of such an interaction is a gentleman who had a prolonged stay on the intensive care unit. Once moved to the ward, my colleagues and I talked with him extensively about his family and friends, his work and various other topics. We were careful to keep our body language open and relaxed and sessions were calm and slow paced reflecting his needs to deal with fatigue and anxiety. As a result of how we presented ourselves he commented on how he trusted us and although we were carefully pushing the boundaries of what he was comfortable doing in terms of physical rehab, he was willing to try his best and the results were evident. In a short space of time the quality of his movements and his desire to set small achievable goals around functional tasks were incredible. However, had we not adjusted our approach and given him time and a friendly face (all be it behind a mask and visor), had we rushed him or not considered other aspects that were in the forefront of his mind I believe the results would not have been so positive. This approach may not have worked with other patients, some do not want to open up, preferring their therapy sessions to be to focused on the task in hand. It’s our ability as Occupational Therapists to recognise this and adjust accordingly that ensures the best results for those we treat.
As Occupational Therapists we are also the less formal link between patients and their families. If patients are unable to tell us their history it is the Occupational Therapist who will contact family and find out more about them. If they are not engaging, we ask relatives: ‘what motivates them, and what do they enjoy?’ Key to our intervention is finding an element to personalise their treatment to ensure that we are able to interact appropriately. Early on during the pandemic an elderly man with advanced dementia was admitted to the ward. He was reluctant to participate, often getting frustrated and scared when we tried to encourage him. However, through discussions with his son and FaceTime calls for joint sessions, we were able to learn more about him. I learnt about his love for his garden and his plants and so our sessions always involved discussions about what he grows, what he enjoys watching from his chair, what was flowering in my garden and most importantly what I’d done wrong and a lesson in how to grow plants more successfully! Through these discussions the barriers of clinician and patient were broken down, we were equal, we both had something to teach each other and his willingness to participate increased.
As Occupational Therapists we are not bound by strict clinical boundaries to our interventions; we can be creative, we can ‘think outside the box’ and shape our interactions to maximise the effectiveness for our patients. While I’m aware the time constraints we have with patients and the pressures for discharges will no doubt return before long, it is essential we consider how best we manage our therapeutic use of self and maintain a conscious awareness of the effect we can have.