Establishing Therapeutic Alliance

What is a therapeutic alliance?

to build rapport with a patient

What is rapport?

the feeling of mutual trust and respect between people (good or bad)

How do you build rapport?

make a collaborative effort toward a meaningful goal

What is the therapist's responsibility while building rapport?

to meet the patient where they're at

What is patient care?

treatment that the therapist does with a patient not to a patient

What should be the therapist's behavior regarding every interaction with a patient?

professionalism

What are healthcare providers frequently called to do?

advocate for their patient

How do you maintain a healthy balance between compassion and objectivity?

remain detached from patients' emotions in order to make good clinical decisions without become too impersonal

What is bias?

the disproportionate weight in favor of or against a group, concept, or belief

What is explicit bias?

conscious bias

What is implicit bias?

unconscious bias

What are the common negative biases in healthcare?

-race & ethnicity

-immigrant status

-gender

-sex

-sexual orientation

-age

-HIV & AIDS

-mental health

-substance abuse

-obesity

-disability

What are the effects of bias?

cultural and personal backgrounds lead to values and beliefs which lead to perceptions which lead to expectations which lead to clinical decisions which lead to patient outcomes

What is one mechanism to uncover implicit biases?

use the implicit association tests through Havard University Project Implicit

What is race?

physical and biogenetic traits

What is ethnicity?

group cultural identity or expression

What is sex?

the biological distinction between females and males

What is gender?

the state of identifying as male or female

What does LGBTQIA stand for?

lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual

What is heterosexual?

someone romantically attracted to the opposite sex

To invite inclusivity and minimize assumptions, how should initiate your encounter with a patient?

"Hi, my name is ____ and my pronouns are ____. What do you prefer to go by?"

What is sexual orientation?

who you are romantically attracted to

What is transgender?

identifying with a sex other than your biological sex

What is cisgender?

identifying with their biological sex

What is ageism?

stereotyping and discriminating against people based on their age

What is elderspeak?

simulating the tone and style of "baby talk"

What are signs of critically judging others?

-relying on routine treatments without considering the patient's specific needs

-using humor that makes fun or belittles the patient

-using unauthorized nicknames for the patient

-referring to the patient by their diagnosis or treatment

-using depersonalizing terms referring to the patient

What is harassment?

unwelcome verbal or nonverbal conduct that is based on a negative bias

What is sexual harassment?

unwelcome sexual advances or other verbal and physical offenses of a sexual nature

What do verbal and nonverbal messages affect?

therapeutic alliance and therefore the patient outcome

What is effective communication?

improves patient outcomes, petters patient satisfaction, improves treatment plans, and decreases risk of legal action

What makes up verbal communication?

vocabulary and paralanguage

What is paralanguage?

pitch, tone, volume of verbal communication

What do patients with communication difficulties have the right to?

a qualified medical interpreter during healthcare

What is appropriate etiquette when a patient needs an interpreter?

-speak directly to the patient

-speak slowly and clearly

-keep sentences short

-avoid using family members as an interpreter

What are some tips for effective verbal communication?

-check to see if patient is wearing communication device

-speak clearly and concisely

-use layman's terms

-use gestures and body language

-verify that they understand important concepts

-avoid critical or judgemental statements

-do not refer to people by their diagnosis

-avoid overly personal conversation

What is a better way to say victim?

survivor

What is a better way to say suffering from?

diagnosed with/experiencing

What is a better way to say stroke victim?

person who has had a stroke

What is a better way to say sticken with polio?

person who has polio

What is a better way to say afflicted with cerebral palsy?

person with/diagnosed with cerebral palsy

What is a better way to say suffers from parkinson's disease?

person who has parkinson's disease

What is a better way to say mute, dumb?

unable to speak/unable to communicate verbally

What is a better way to say confined to a wheelchair?

uses a wheelchair for locomotion needs

What is a better way to say handicapped or disabled?

has a disability or impairment

What is a better way to say normals?

people without disability

What is a better way to say blind?

has a visual impairment

What is a better way to say deaf?

hard of hearing or hearing impaired

What is a better way to say an epileptic?

person with epilepsy or person with a seizure disorder

What is a better way to say fits?

seizures

What is a better way to say alcoholic?

person with alcoholism

What is a better way to say victim of domestic violence?

person who has experienced interpersonal violence

What is a better way to say schizophrenic?

person with schizophrenia

Why is body language important?

people remember actions better, helps us find truth

How can you prevent patients from feeling judged?

replace "why" questions with "what" questions

What are some tips for listening?

-look at the person who is talking

-focus on what the person is saying

-avoid multitasking

-allow time for the person to process and respond

-understand what the person has communicated to you

-maintain physical distance

How long may patients with forms of dementia or traumatic brain injuries take to understand and respond to what you've said?

30 secs or more

How much may patients with a cognitive impairment process what you say?

about 1/3

How can eye-level affect your interaction with your patient?

positioning yourself at eye-level with your patient can foster a secure-feeling enviornment

How should you enter a patient's personal space?

with caution by. reading nonverbal cues

What is caregiver burden?

overall physical, emotional, and financial costs of caregiving that can in turn affect the well-being of the patient

What term is being used instead of caregiver?

care partner

What does care partner imply?

equality and a shared experience; it acknowledges the key role patients play in their own care

What is burnout?

work that started out as meaningful, important, and challenging but became unpleasant and unfulfilling

What are symptoms of burnout?

-emotional exhaustion

-depersonalization

-reduced sense of personal accomplishment

What is compassion fatigue?

when care providers are exposed to repeated interaction requiring lots of empathetic engagement

What are some ways to identify burnout?

-boredom

-frustration/anger

-dissatisfaction with work

-low productivity

-stress symptoms

-distancing/withdrawing

-decreased creativity

-anxiety

-depression

What is stress management?

creating balance between the stressful demands you experience and the resources available to you

What are some stress management activities?

-setting boundaries

-engaging in physical activity

-maintaining supportive personal relationships

-engaging in mindfulness techniques

Which patients' care is more regulated?

the client population received as the most vulnerable (ex: minors)

What is the Patient Bill of Rights designed to do?

-ensure that the healthcare system is fair

-give patients a way to address problems

-encourage patients to get treatment

-emphasize the importance of therapeutic alliance

What are the patient's rights?

-participate fully in treatment decisions

-receive full information disclosure

-protection of their privacy

-respect and nondiscrimination

What does HIPPA stand for?

Health Insurance Portability and Accountability Act

What does HIPPA do?

a federal law designed to protect the privacy of individuals health information

What is culture?

the sum of beliefs, customs, and norms that are characteristics of a particular group

How can culture affect healthcare?

cultural differences can affect a patient's outcome if the therapist doesn't adapt to the patient's needs and abilities

What is degree of acculturation?

the degree to which a person from a cultural group functions and interacts competently within the majority culture.

How do you determine a person's degree of acculturation?

-determine language spoken at home

-determine the preferred language for media

-determine family roles

-determine the the types of social interactions with people outside the culture

How do most people respond to loss?

-fear

-anger

-guilt

-anxiety

-withdrawl

-depression

How do most people respond to loss in the acute stage?

-anxious/state of crisis

-need for survival and safety

-possible denial

-limited social interaction and obligations

-information seeking

How do most people respond to loss in the subacute/posttraumatic stage?

-stabilization of medical condition

-awareness of the long-term effects

-emphasis on rehab efforts

How do most people respond to loss during long-term adjustment?

ongoing adjustments to condition

What is palliative care?

specialized care for patients with serious illness

What is hospice?

end-of-life care, focusing on the patient's quality of life

What can help identify spiritual distress and open a conversation between patient and therapist?

spiritual screening questions

What are some spiritual screening questions?

-is spirituality or religion important for you?

-are your spiritual or religious beliefs helping you right now?

-do you have any spiritual beliefs, practices, or values that you want integrated into your care?

What offers guidelines for a clinically relevant spiritual assessment?

the FICA Tool for Spiritual Assessment

Why should the therapist collaborate with the patient to set goals and find out what tasks are most important to the your patient?

the patients many have very different view of what tasks are most important and meaningful to their life

What do collaborative relationships require?

-know the patients' and families' community

-willingness to work with other agencies

-determination for a positive outcome

-mobilization of support/resources

-awareness of economic impacts

-awareness of culture

What can be a clinician's best friend or worst enemy?

the internet

What are some patient education techniques?

-match instruction method to patient's age

-find out the patient's preferred way of learning

-provide important information in multiple formats (spoken, visual, active, and written)

-pace the information

-engage cognitively and physically

-provide feedback

-practice recall

What must education methods take into account?

the possibility that the patient has difficulty reading

What term is starting to replace "compliance"?

adherence

What does adherence suggest?

a proactive approach from the patient

What is an effective way to to gain insight into a patients future adherence to a treatment?

ask the patient "can you imagine yourself doing this?"

What kind of encounters should the therapist try to avoid?

challenging patient encounters

It is the healthcare provider's responsibility to facilitate what kind of encounter?

a positive encounter

How can a healthcare provider create a better encounter?

-self reflect on personal biases

-collaborate

-good communication

-active, nonjudgemental listening

-patient-centered focus

-expression of empathy

-involvement of family

What should you do instead of labeling a patient as uncooperative?

reframe to look beyond the surface situation and assume the patient has a reason for this response

What can improve patient performance?

strategic choices in auditory input