Monday, October 1, 2018

How Listening to my Client Improved My OT Skillset

I remember that day when I was told by nurses and physical therapists that client X was "in a mood" "upset" and "not participatory."

I was told they were "independent" because they could navigate their oxygen and intravenous lines themselves; demonstrates untangling them around their body to transfer to a chair from the nearby hospital bed.

So I did a chart review to screen to see if I would evaluate one time only, based on the report I received from my colleagues.

When I walked into the client's room, I didn't introduce my name or discipline.  I first greeted them hello and asked "how are you doing?"

They proceeded to tell me "I'm fine; what do you want?"

I followed up by saying "I want to find out more about you.  I see you were admitted to the hospital for exacerbation of symptoms associated with cancer.  I would like to get to know you a bit more to see if  there is anything I can do to support your recovery to compliment what you are already doing now for coping with symptoms. Would that be okay with you?"

They began to tell me their story: long they have had the diagnosis
...what they have been able to do and not able to do in daily activity because of fatigue and pain
...what roles and responsibilities they played in the community and to family

Then they began to share their concerns the more I listened:

...their difficulty delegating tasks they didn't like to do in their day to day
...their difficulty organizing tasks in the day and feeling overwhelmed easily
...their report of finding themselves irritated often
...their report of forgetfulness
....their upset with doctors, nurses and therapists stating "they don't hear me. They listen but they don't hear me.  Instead, they tell me what they want from me."

After hearing all the client's thoughts, perspective and concerns over a 45 minute period, the client turned it back to me to state "thank you for hearing me; what can I do for you?"

I paused for a moment: all I wanted was to help them fill in the gaps they perceived as the obstacles, barriers or stumbling blocks to accessing meaningful activity.

So we worked together to identify all the things that we could work on.  Two things came out of it:

Identifying what we have control over
Asking what can we take action on now

I felt slightly out of my element that session because I walked in thinking I would interview and discontinue from OT services...maybe see if the client needed energy conservation and work simplification strategies for an exacerbation of respiratory related symptoms and fatigue.  Instead, I was taught the lesson that when you truly hear your client, you pick up on what they really need.

In this client's case it was two things:

1. a way to let go of some of the responsibility they took on (having too many occupations that weren't serving them well).

2. how to get organized and keep on the tasks they identify as important or of value.

It turns out the client had an pre-existing brain injury as well that was not identified in their medical history; the client told me that 40 years prior they sustained a TBI and never received any OT services for this.

So we worked on cognitive strategies to address the client's needs (not my plan or the other staff's plan, my client's plan).

The client expressed significant gratitude to have an intervention that fulfilled her request.  Not only could she plan a better system to be less hindered by fatigue emotionally and physically, she was heard.

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