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A list of 5 short-term and 3 long-term goals regarding my leadership skills and areas I would like to improve on

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Reflection on LPI and Leadership Assessments

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Reflection on LPI and Leadership Assessments

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In this document, I reflect on prior TUS assessments, leadership assessments, and my strengths and areas in need of improvement as a leader.

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Results of a Leadership Styles Quiz from Week 1

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Here are personal definitions of leadership and advocacy that I have constructed after our 5 Practices of Leadership lecture.

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Responses to my Leadership Practices Inventory

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Responses to each item in the LPI

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Here are results from an online quiz determining leadership styles that come naturally to me and which styles need further development.

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This is a screenshot of feedback that I had received after completing a template on a pediatric condition with a peer in my Health Conditions class; I feel that this assignment increased my knowledge in several areas of OT.

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This is my grade for a kinesiology skills check in week 8 of the semester, a test that I was very worried about.

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This artifact is feedback that I received after running a group in class with my peers during week 9 of the semester. This group was enjoyable and receiving positive feedback was very rewarding.

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This artifact is a screenshot of part of an email from our kinesiology professor the day before out third exam. This email taught me about professionalism in forms I hadn't considered before.

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This artifact is a list of muscles that I had studied prior to our third kinesiology exam in week 10 of the semester.

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This artifact is a screenshot of feedback I had received after completing an occupational profile/interview with a standardized patient, an assignment that I had learned a lot about professionalism in OT from.

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This art project was done for my first occupational analysis worksheet, where we had to create an occupational analysis for the activity of making a paper mosaic.

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This photo is of my group's Diverse Voices poster on the day of poster presentations. This project taught me a lot about the soul of professionalism in OT

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This artifact is a photo of Portland Headlight that I took during week 3 of the semester, while in between classes taking a much-needed break with one of my peers.

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This artifact is a summary of a run I went on in mid-July. This was one of the first instances where I had looked at an activity that I love to do through the lens of OT and brought course concepts to life in my free time.

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TUS Resource- an OT who works with kids explaining therapeutic use of self

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What is Therapeutic Use of Self?! | SHOtheOT

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TUS Resource- Using Humor

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TUS resource- showing empathy even on a bad day

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It's been a long, busy day, and charts are piling up. The patient you see next says they're feeling lousy and want an antibiotic. This is the fourth person today to whom you will need to explain that antibiotics aren't effective in viral illness. The previous three all left unhappy about their visit.

You're feeling rushed and frustrated. You know taking the time to listen to this patient is important, but you aren't sure how to show empathy to patients when you're feeling so stressed yourself.

We've all been there. Here's a look at what empathy looks like in a clinical setting and how to express it, even on your off days.

What is clinical empathy?

An Academic Medicine article defines empathy as "the distilling or connecting of feelings and meanings that are associated with a patient's experience while simultaneously identifying, isolating, and withholding one's own reactions."

Put more simply, empathy is the ability to understand and share the feelings of another person emotionally. It is a necessary part of any doctor-patient relationship, and its expression creates an alliance between you and the patient, assuring them that you care about them.

Sometimes this communication comes easily, but other times it can be quite challenging. However, it's a skill worth mastering. Research shows that there are numerous benefits of expressing empathy. It can result in improved doctor-patient relationships and patient satisfaction, according to study results published in PLoS One, as well as increased adherence to medications, according to a study published in the Journal of Research in Medical Sciences. It can also lead to decreased malpractice claims, according to an article in Emergency Medicine Journal.

Empathy in physician communication

How should a physician respond to the above patient who wants antibiotics? Here's an example of how to show empathy to patients - or not.

Expressing empathy
It sounds like you feel terrible! There are some awful viruses going around, and it looks like you caught one of them. Unfortunately, antibiotics aren't going to work here. I would give you an antibiotic if I thought it would do anything other than give you a stomachache and diarrhea. Being ill is so frustrating, I know, but I have some ideas that could be helpful and may reduce your symptoms while we wait for the virus to clear.
Lacking empathy
You have a virus, and antibiotics don't cure viruses. We can't give out antibiotics unless we know it's a bacterial infection because unneeded antibiotics contribute to resistance and other physical problems. You can take a decongestant and anti-inflammatory, and you should get some extra rest while you wait it out.
Neither of these responses is clinically wrong. However, they will produce different outcomes. The first acknowledges and validates the patient's discomfort, while the second robotically expresses facts. Expressing empathy will do more to build trust with the patient, even if they're frustrated. If you were sick, which response would you prefer to hear?

What's more, without empathy, the patient may leave angry, still convinced that they need an antibiotic because they don't think you listened when they were saying how bad they felt.

7 tips for showing clinical empathy to patients

Some have suggested that empathy shortfalls may result from physicians not understanding - or growing hardened to - what it's like to be in their patients' shoes. That's why one Florida doctor had his emergency medicine residents "become patients," entering the system and interacting with staff, as Emergency Medicine News reported.

Other medical professionals have looked to their own experience as patients, or even in patient-like situations, to regain access to the patient point of view. For example, one physician assistant wrote in the Journal of the American Academy of PAs about how the parallels between being a patient and getting a tattoo - from setting up the appointment to experiencing vulnerability - prompted her to reflect on "the many chances [she] had missed to communicate the empathy [she] felt for someone and allow them to be vulnerable, to ease their burden."

Indeed, sometimes it's the realities of a practice and the pressures of our personal lives - more than an overarching failure of empathy - that get in the way of making that essential human connection with a patient. If you are physically and mentally depleted, sleep-deprived and stressed, it becomes challenging to meet the needs of others.

But even if you are rushed with a patient, a few simple communication strategies and cues can help your patients feel heard.

Try to integrate these pointers into even the busiest of your clinical days.

Start the appointment by making eye contact

Eye contact is essential for establishing a connection, yet the use of electronic medical records have made this increasingly difficult. Look up when you ask questions. When you look down at the computer, continue commenting to show that you're not distracted - or better yet, explain to first-time patients why you're using the computer during their visit.

Let your patient know you're listening

Give a nod or paraphrase what you hear them saying to demonstrate that you hear and understand them.

Be aware of your body language

Are you asking questions with your hand on the doorknob or your arms folded across your body? Are you standing? Sitting down doesn't take extra time, and it shows you aren't rushed.

Be curious about your patient

Ask questions so you understand more than just your patient's presenting issue. Ask how their symptoms are affecting their lives. This makes them feel heard and cared for while allowing you to see the whole picture.

Record details that humanize your patient

This means going beyond checking off boxes on the electronic medical record. What's impacting their life right now? A sick mother? An impending move? Not only will your patient feel connected when you remember to ask them about this next time, but the more you know about their life, the easier it is to feel empathy.

Show support to your patient

Recognize how a patient feels and acknowledge their fears and anger. Support them by responding to both their emotional and medical needs.

Look deeper for ways to empathize with your patient

This is especially important if you find yourself being judgmental. Find out a patient's story and identify common ground.

Medical training focuses on the technical skills that make us great diagnosticians, but it can often fall short on teaching us how to connect with patients. Human connection is an essential component of health care delivery, and the improved outcomes that accompany it benefit us all.

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How to show empathy to patients - even when you're stressed

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Empathy is an essential part of the doctor-patient relationship but stress can interfere. Here's how to show empathy to patients in seven simple steps.

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TUS Resource- case study showing the meaning of TUS

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For graduate students who are just barely diving into their OT school studies, concrete and unchanging topics such as medical terminology are much more understandable than intangible concepts.

At least, in some programs, we can physically see and touch the terms through cadaver labs and dissection. It is why the medical model is so nice because we can observe diagnoses and symptoms in our patients/clients.

The one concept we have a harder time grasping until we've developed it in practice is "therapeutic use of self."

Instead of using our perspective to view hard facts about the client, the environment, or the occupation (and then documenting it), we now have to look inward and use ourselves to produce meaningful purpose and communication.

So What Exactly IS Therapeutic Use of Self?

As a profession, could we be any more vague?

What does it exactly mean to incorporate a "therapeutic use of self" into practice?

One of the great theorists in Occupational Therapy, Gary Kielhofner, along with several of his colleagues, explained the concept beautifully (Kielhofner, 2004; Schwartz, 2003 as cited by Taylor et al. 2009):

"Early occupational therapists viewed the therapeutic use of self as a means for encouraging clients to engage in occupation."

The most widely cited contemporary definition of therapeutic use of self describes it as a therapist's "planned use of his or her personality, insights, perceptions, and judgments as part of the therapeutic process" (Punwar & Peloquin, 2000, p. 285 as cited by Taylor et al. 2009).

Of course since 2009, "therapeutic use of self" has evolved in the clinical setting and dedicated researchers acknowledge that in the growing literature.

Therapeutic use of self is what creates a meaningful relationship between the therapist and the patient in order to produce meaningful participation and progress in occupations that matter to the patient.

Instead of concentrating on evidence-based research, we're going to talk about utilizing therapeutic use of self in practice in an actual therapist-patient interaction.

A Case Study

Cynthia is a 48-year-old female patient residing at a skilled nursing facility. She was admitted following a 4-day hospital stay after sustaining a right lower extremity femur fracture as a result of a ground level fall in her home.

Lauren is the occupational therapist at the skilled nursing facility and has just received the order to evaluate Cynthia.

According to the medical chart, Cynthia has orders for non-weight-bearing precautions on her right leg for the next 4 weeks. Because of her ORIF (open reduction internal fixation), she is sponge-bath only for at least 2 weeks until doctor approval for showers.

Cynthia has a history of bipolar disorder, uncontrolled Type II diabetes, multiple falls, and substance abuse. Nursing staff has already informed therapy about Cynthia's non-compliance with her current precautions and attempts to avoid treatment of all varieties.

Think about what it takes to establish a relationship with a new friend and what the motives would be for solidifying that connection. You would first get to know that individual, asking questions regarding their hobbies, their job, their friends and family, etc.

In exchange, you would offer information about yourself, find the similarities, and harbor trust. Of course, developing a relationship with a patient has its own framework and limitations in order to maintain professionalism.

Collecting Information Through Communication and Observation

During the evaluation, the therapist needs to collect information or "insight" about Cynthia verbally and through observation:

Is Cynthia alert and aware?

This should be considered due to her history of mental illness. Regular medications will also affect her awareness and her willingness to participate in therapy.

Was she completely independent in her prior level of function?

The therapist should have some suspicion that independence was limited in some capacity due to her history of falls.

What are Cynthia's routines and hobbies?

These are tasks outside of her required daily tasks such as showering, dressing, and toileting. Reviewing required tasks during intervention time repetitively will get old and Cynthia could lose interest in attending therapy sessions.

By using hobbies that are relevant to treatment and that Cynthia enjoys, the therapist can strategically hook her into therapy in order to increase functional progress.

What are Cynthia's priorities and functional goals for treatment?

The therapist needs to let Cynthia have the say in her own treatment, or else intervention is meaningless and much less enticing for her. The therapist needs to take a little and then give a little like you would in any other relationship.

If the therapist dictates the patient's goals and how they are to be addressed without the patient's input, then it just cultivates a one-sided relationship that won't produce results.

Does Cynthia exhibit any type of manipulative behavior that could negatively impact her participation in therapy?

This can happen for any patient, but it is especially important to identify this barrier with patients with mental illnesses. In order to prevent a straight-up refusal, the therapist needs to be prepared with counter-offers and education in order to encourage participation.

Does Cynthia have any close family members or friends she wishes to be included in her therapy?

Progress can occur when a patient's family attends sessions to show their support.

Additionally, therapists can get a feel for what communication styles are effective for Cynthia based on how close family and friends communicate with her. Communication styles include tone, volume, word length per sentence or command, etc. They would know what makes the patient happy, angry, nervous, or sad.

How does Cynthia respond to the therapist's communication style?

Does Cynthia reciprocate conversation with the therapist's style or does she shut down? Does her anxiety increase or does she seem at ease? Does she respond more positively to blatant commands or to mild suggestions? While the therapist is communicating, they need to have a keen eye for subtle changes in the patient's behavior as they speak.

What information about the therapist could be offered to Cynthia?

In order for Cynthia to portray trust, the therapist needs to place a few cards on the table and provide some personal information that the patient could relate to. Providing simple favorites and life experiences can make a positive difference.

With the above information, the therapist could make some valid judgments and perceptions about the patient's participation in meaningful tasks, know when to change or maintain their therapeutic use of self, and promote progress in order for her discharge back home.

_________________

I hope this case study helped shed some light on the meaning and usage of therapeutic use of self in practice. I hope it also gave you some ideas of how to apply it in your practice.

Do you have any of your own examples of how incorporating therapeutic use of self helped in your OT practice? Please feel free to share in the comments below.

Additional References and Resources

Taylor, R.R., Lee, S.W., Kielhofner, G., & Ketkar, M. (2009). Therapeutic Use of Self: A Nationwide Survey of Practitioners' Attitudes and Experiences. American Journal of Occupational Therapy, March/April 63(2).
Using Therapeutic Use of Self to Maximize Occupational Therapy Outcomes (Seniors Flourish Podcast) Lifelong Learning with OT: Therapeutic Use of Self

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Therapeutic Use of Self: What Does That Even Mean for OTs? | myotspot.com

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For graduate students who are just barely diving into their OT school studies, concrete and unchanging topics such as medical terminology are much more understandable than intangible concepts. At least, in some programs, we can physically see and touch the terms through cadaver labs and dissection.