OT423: MIDTERM

Basic Awareness of self, The nature of effective helping, Communication, Communicating with Cultural Sensitivity ,Communicating with Persons Who Have Disabilities , IDENTIFYING AND RESOLVING MORAL DILEMMAS,

Therapeutic communication

Speaks, Listening, develops trust ,Having a level of self-awareness helps you have quality therapeutic communication

effective helping

the systematic application of mental health counselling and other professional skills into every day interactions by health care providers to help individuals who seek mental health care

Humanistic Communication

that places the patient in a position of informed, equal and inevitably responsible for any positive outcomes in the helping process.

“intervention“

Hemiparesis

Is weakness or the inability to move on one side of the body, making it hard to perform everyday activities like eating or dressing.

what factors impact behavior?

* Needs
* Values
* Cognition 
* Emotions:

Which one of these is appropriate in a therapeutic relationship?

* **Sympathy: you feel similar things** 
* Pity :(with a negative connotation)

INTERPERSONAL INTERACTION PROCESS- **EMPATHY**

1\.  self-Transposal 

2\.  crossing over – find ourselves in the same frame of reference/ their lived world 

3\.  A momentary merging of another person in a unique moment of shared meaning. 

Self-transposal

cognitive thinking of myself in the position of the other. Trying to imagine what it must be like for the patient.

\*\* This is not empathy.

sets the stage for empathy to occur.

\*appropriate. cog thinking of putting yourself

Level 5: Cliché’ Conversation. No genuine human sharing takes place.

“ its cold outside” elevator chat 

Level 4 – Reporting facts-almost nothing personal revealed.

Little pieces of factual information 

Level 3- Personal ideas and judgments- information is shared in response to the patient's conversation.

1. Starting to get to know your client 
2. Ask about family members 

Level 2- Feelings and Emotions- True friendship and caring require rapport is established. 

1. Can be friends with a pt. 
2. Rarity

Level 1 – Peak communication- openness, honesty, respect, and love are required.

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1. Intimate relationship 
2. Never be at the level 
3. Not appropriate

Communication

the purpose of giving and receiving information by means of gestures, words and tone of voice…”. The context must also be considered!

Communication component/ skills 

* Verbal expression
* Listening 
* Written 
* Non verbal expression 

active listening

* ==**Restatement**==- repeating the words of the speaker as you have heard them.


* ==**Reflection**==- verbalizing both the content and implied feelings of the sender. The purpose is to express in words the feelings


* ==**Clarification**-== summarizing or simplifying the sender’s thoughts and feelings and resolving confused verbalizations into clear, concise statements.

“I” messages, **Congruence:**

Indicates that the words and the music match. Congruence is present when

*what I say matches what I do and what I feel.*

* Ownership of your own actions and feelings 
* Avoid preconceived notions

Table 6.1:BELIEFS OF EFFECTIVE HELPERS

1\. Subject/ discipline

Effective helpers are committed to discovering the personal meaning of knowledge and converting it to belief. 

Was to know information 

Table 6.1:BELIEFS OF EFFECTIVE HELPERS

2\. Helpers FOR

frame of reference that emphasizes facts, things, organization, money, etc

Internal: feelings, values belief

External: money, organizational goals. 

Table 6.1:BELIEFS OF EFFECTIVE HELPERS

3\. Beliefs about people

* A source of satisfaction in professional work rather than a source of suspicion and frustration
* Your goal is really to facilitate 

Table 6.1:BELIEFS OF EFFECTIVE HELPERS

4\. Helper’s self-concept

* Therapeutic presence for the other is made possible by a strong sense of self, personal fulfillment, and of personal adequacy. 
* Personal boundaries and fulfillment 

Table 6.1:BELIEFS OF EFFECTIVE HELPERS

5\. Helper’s purpose

* They see themselves as altruistic, oriented toward assisting people rather than simply responding to selfish needs. 
* The big picture
* Altruism: selfless code of principles 

Table 6.1:BELIEFS OF EFFECTIVE HELPERS

6\. Beliefs about appropriate methods and approaches

* Effective helpers are more oriented toward people than toward rules and regulations or things.
* Ppl oriented, client-centered


* facilitate someone through their own choice and be masters of their own environment

Culture

Is the social behaviors and norms found in human societies. 

Culture shock

* As the stress experienced when individuals can not meet their everyday needs as they would in their own culture
* what you learn in your own culture does not work in a new culture 

**WHY ARE POPULATION SHIFTS SO IMPORTANT TO HEALTHCARE PROFESSIONALS?**

Its important to know race and age bc it gives us insight what population we will be working with .

IDEIA – individuals with disabilities education improvement act

An example of the federal government safeguarding the rights for the provision of **culturally competent** care for all children with disabilities.

**Culturally Competent**

* Cultural competence = cultural sensitivity= intercultural communication
* a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals to work in cross-cultural situations. 
* TALK TO YOUR PTS
* research
* continuing learning
* need to be sensitive to a client’s beliefs, attitudes, and behaviors regarding their illness, injury, or disability. 

Belief

What people think is true

Behaviors

What people do. 

Attitudes

How people feel about something 

Explanatory Model (Kleinman)

* Etiology, the onset of symptoms, pathophysiology, course of sickness, and treatment for the particular problem being addressed.


* On the cultural level, there may be differences between the explanatory model of the family and the explanatory model of the healthcare professional 
* enhance our PPI(patient practitioner interactions)

PPI

Patient Practitioner Interactions

Three questions a healthcare professional should ask when working with clients to avoid potential biases?

1\. How is this client like all human beings?

2\. How is this client like some human beings?

3\. How is this client like no other human being?

which one of the following is the best way to use an “I“ statement?

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* “You don't tell me you're running late.”
* “You were talking to that client for half an hour.”
* “I felt lonely when you did not come home to have dinner with me all week.”

Collectivistic

* “We“ identity
* high levels of communication
* Group goals 
* Surrounding circumstances
* Verbal communication 
* strong emphasis on relationships

ex: A fam that takes care of one another

Asia, Africa, Central and South America and Pacific Island Societies 

High Context Cultures

Collectivistic

Low Context Cultures 

Individualism

Individualism

* “I” identity 
* individual goals
* management of time
* privacy
* task oriented

ex: CEO of a company

The Concept of Face 

Maintaining a claimed sense of self-dignity or regulating a claimed sense of self-humility in interaction.

Monochromatic time

Low Context Cultures

set schedule from 9-12 lunch 1-5 dinner

Polychromic time

high context cultures

Based on human interaction

Personal space is perceived as private

Low Context Cultures

Individuals space is frequently shared with subordinates and centralized or shared in an information network.

High Context Cultures

OVERVIEW COMPARISON OF TREATMENT SETTINGS

* General Acute and Or Intensive- save my life
* Rehab Hospital – help me achieve max function 
* SNF/Sub acute rehab
* HHA/Assisted Living Facility-
* Acute Care 
* School-based-
* Hospice – control my pain 
* Outpatient- don’t keep me waiting 
* Public Health-


* Industry – get me ready to go back to work

Implicit Meanings in Culture

high context communication the vast majority of the information is already understood,

ex: The supervisor coming to see the facility, everyone knows the deal and behaviors might change.

ex: the concept of awkward silence

Nonverbal communication

These include gestures, positioning of the body, and tenseness of the facial expressions.

Personalismo

Getting to know the healthcare professional as a person and helps establishing rapport

Somatization 

Reporting physical symptoms when a person is experiencing psychological distress. Bc in some cultures where complaints of anxiety, worries, and depression are perceived as signs of weakness. 

Six Universal Aspects of Healthcare In All Cultures

1. Healthcare specialist @@applies a name to a problem@@
2. The qualities of a healthcare professional are important. @@The professional must be perceived as caring, competent, approachable,@@ and concerned with identifying and finding solutions to the problem
3. The healthcare @@professional must establish credibility@@ through the use of symbols and trappings of status that are familiar to the culture.
4. The practitioner places @@the client’s problems in a familiar framework.@@ \*\*(this implies recognition of the client’s explanatory model by the practitioner).
5. The healthcare @@practitioner applies a set of techniques@@ meant to bring relief.
6. Interactions between the client and @@practitioner occur at a special time and place.@@

**Language assistance services**

* The patients preferred language in writing and verbally offer language assistance services at no cost to each patient consumer with limited English proficiency.
* Research demonstrated using professional interpreter services significantly increases satisfaction with patient-provider communication. 

Spirituality as Culture and Health Care

* Spirituality is a basic human experience. 
* Connection with other people and environment
* Literature suggests that spirituality/ religion are linked with health outcomes

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What causes a disability?

* Learning disability 
* Amputation
* Schizophrenia
* Paralysis 
* Pain 
* Bipolar 

The Power of Words

* We need to remember real people have these disorders.
* Language is a powerful symbol. It demonstrates our understanding of concepts
* Language influences beliefs, attitudes, expectations, and the course of events.

Results of Labeling

* a negative stigma
* dehumanization
* disempower
* physical barriers

Active Vs. Passive tense

•“being confined to a wheelchair

•Using a wheelchair

Being Vs. Having

•Being a quadriplegic

•Person who has quadriplegia

**Disability**

A condition of the person.

**Handicapped**

Used to describe the accrued result of multiple barriers (emotional physical social environments) imposed by society which prevents an individual in assuming a desired role in society.

ICF

Framework that incorporates health conditions and their effects as well as environmental factors.

Aging with A Disability

•Life expectancy of persons with a disability have increased.

•Age related changes combined with the factors of a disability can lead to long term disabilities

•Asking clients questions about their daily routines habits and patterns can aid in identifying a secondary condition before it becomes a serious threat.

•^^How are you  sleeping?^^

^^•Any pain?^^

^^•Feeling tired?^^

Secondary Conditions

Persons with disability are more likely to report additional conditions.

ex:

•Chronic Pain

•Muscles spasms

•Depression

•Anxiety

•Isolation

**Healthy People 2030**

•**Vision**

A society in which all people can achieve their full potential for health and well-being across the lifespan.

•**Mission**

To promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people.

•**Foundational Principles**

The following foundational principles guide decisions about Healthy People 2030:

OT Implications

•Raise awareness

•Recognize perceptions and biases

•You are obligated to recognize the abilities of all people.

•Be aware of the influence of your language and general presence

Ethics

study of moral behavior 

Moral Decisions

right Vs. Wrong 

Descriptive Statistics \n

morals of a group or culture 

Normative Ethics

Establishing a moral system 

ETHICAL DECISION-MAKING IN THE 21ST CENTURY 

* Changing health care/human service  environments require efficiency, competence, attention to functional outcomes
* Services are commonly provided in fast paced environments – attn. to bottom line
* Need for competence performing multiple tasks and solving multiple problems quickly
* Departments are often small -  limited peer interaction/ supervision

Ethical issues

Situations which one believes to have moral challenges

Ethical analysis

helps identify issues and conflicts between values (often reflect personal, institutional; professional values)

* ex: Code of Ethics, Contracts, policies, etc.

Value based care

Pt. has to actually make progress → Outcomes

(replacing RUGs)

How can staff skills impact decision making?

* Here is my practice act(therefore I cannot do this)
* Give me continuing education credits to do this with further pts.

**Ethical problems** 


1. Ethical temptations
2. Ethical Distress

1. know what to do but you may stand to benefit and don’t want to do the right thing. 
2. know what you have to do but may be constrained 

Ethical Dilemmas

Deal with which is better or worse

4 behaviors that are progressively developmental required for mature moral/ ethical decision making

1. Moral sensitivity – know how you impact others
2. Moral judgment – what is right or wrong
3. Moral motivation – prioritizing moral vs. Personal values
4. Moral Character – implementation skills

ethical situation

situation that requires an ethical compass but not to a high degree

What PRESSURES TO COMMIT UNETHICAL BEHAVIORS 

* Value- based care 
* Healthcare reform 
* Patient demands 
* Payer demands 
* Financial burdens
* Heavy work load 
* Staff skills 
* Lack of resources 

NOK

Next of Kin

DME

Durable medical equipment

How to access an ethical dilemma ?

1. ETHICAL COMPONENT
2. CODE OF ETHICS
3. TRY TO FIGURE OUT WHAT WILL GIVE YOU THE MOST ETHICAL OUTCOME

**Compassion fatigue (CF)**

has been defined as the lessening of one’s ability to empathize due to exposure to trauma and suffering.

Compassion fatigue : SIGNS AND SYMPTOMS:

* short
* procedural
* count your time
* not the best listener
* don’t see the bigger pic
* resp filled with emotion

positive stress

can result from having many opportunities

ex: too many job offers

negative stress

an result from an inability to solve a problem

Stress developmental model 

Life situation → Perception → Emotion → Physiological Response → Disease

Perception

Can dictate your world concept , world view 

Burnout

Is a state of emotional and physical exhaustion that results from intense and long standing professional stress 

Burnout signs and symptoms:

* You may start with enthusiasm and optimism and then realize the demands of your job exceed your expectations. 
* Detachment 
* Drawing sharp boundaries between work and home 
* Withdrawal 
* Less creative treatment sessions 
* By the book responses 
* Less time spent with patients/ people 
* Engaging in compulsive behaviors 
* Applying for other jobs 
* Headaches 
* Stomach aches

Causes of Burnout

* Workload 
* Understaffed
* Overload of same type of conditions
* Unable to be creative due to lack of time 
* Role Ambiguity 
* Unclear job description 
* Unclear job expectations 
* Role Conflict 
* Large team with minimal communication
* physicians may make choices about care without the input from other health care professionals 
* The professionals self esteem 
* Inability to set clear boundaries with patients or staff
* New grads tend to set unrealistic optimistic goals for patients and then fail to meet them

Burnout Intervention

* Stay present/ stay in the now 
* Having a realistic perspective 
* Ask clarifying questions 
* Lowering staff to patient ratios 
* Doing less stressful tasks (reading journal articles, planning patient research, student education)  allows one to limit intense interactions. 
* Required vacation time
* Reg staff rotations (gaining variety) 
*  Taking your lunch break away from patient care areas

Teaching 

the process of instructing by precept, example, or experience

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Learning

* A process where there is change in a subjects behavior to a given situation brought about by his repeated experience in that situation.
* through change in a persons verbal and non verbal behavior. 

1. The Principles of Learning(Culture)

1\. Learning is influenced by the individuals inherent capacities, current assets and limitations, age, sex, interest, past and present culture group membership.

ex:

* teaching a baby to brush their teeth vs for adults
* culture:

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2. The Principles of Learning(distractions)

2\. Attention and perception influence learning

* *Make the environment minimally distracting*
* *Learners perceptions can be based on their past experiences*
* *Why must you consider this principle when facilitating learning.*
* learning in a loud env vs. quiet

3. The Principles of Learning(motivate)

3\. The learners motivation is important. 

* *Motivation is an internal process.* 
* *Motivation to achieve goals*
* *The teacher will attempt to determine the clients source of motivation* 
* facillate motivation is essential to achieve goals

4. The Principles of Learning(CC)

4\. Learning goals set by the individual are more likely to be attained than goals set by someone else.

* *Client-centered*
* *client focused attention*
* *Active participation is the goal setting process*
* doing something you want vs. what someone else wants

5. The Principles of Learning(why)

5\. Learning is enhanced when the individual understands what is to be learned and the reason for learning. 

* *The therapist will describe what the client should learn and why they are being encouraged to learn this information.* 

6. The Principles of Learning(DT)

6\. Learning is increased when it begins at the individual’s current level and proceeds at a rate that is comfortable for the individual. 

* *Meet the client at their current level* 
* *Evaluation will allow an OT to determine a client’s capabilities* 
* **development theory** : working on current level of client

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7. The Principles of Learning(A/B)

7\. Active participation in the learning process facilitates learning 

* Active participation includes
* **(A)** Learning through discovery 
* *Learning about something that was previously unknown.* 
* *Or they can lead to frustration, lack of learning* 
* *If done right cant promote curiosity*
* (**B)** Learning through doing 
* *Gaining skills through involvement*