Part 7

The transcription discusses the importance of creating psychologically safe environments for patients, including addressing intimate topics and involving family members in therapy. It emphasizes the necessity of open communication, advocacy, and utilizing individual strengths to enhance patient care and outcomes. It stresses the potential dangers of remaining silent in uncomfortable situations and highlights the impact on patient trust and overall treatment effectiveness. The conversation also touches on using unique strengths to promote psychological safety and celebrate small victories in therapy. So, when I was on fieldwork, I was in outpatient neuro, so most of my patients that I was seeing had had strokes or had Parkinson's or other neurological conditions, and one of our patients was super sweet, and she felt very safe with me and my CI, because my CI had laid the foundation for a psychologically safe environment with her and with all the patients, and one day this patient came in and she was not nervous at all to ask us about this, and I could tell from her facial expressions just how easily she asked the question of, like, she wanted to know how she could have intimacy with her partner, while also managing her tone and spasticity, because they had tried, but they could run into some problems with her spasticity kicking in, and so my CI was great and just led by example of how to just dive in and answer the questions without making anything awkward, and she demonstrated some different positions and just made her feel, made the patient feel so comfortable and not awkward at all by asking these questions, and I was so glad that I was able to be there to observe this and see how creating an environment that is psychologically safe leads to patients asking the difficult questions and not being nervous or scared that they're going to be judged for asking those questions. Well, and I think that is such, like, a taboo topic that is finally now coming more to the front lines that sexual intimacy is an occupation, and, you know, if you lose the ability to do something, you want to be able to have the tools to participate in that again, and so I love that she was demonstrating and showing positions because that really speaks to the type of therapist that she is for being willing to be in an uncomfortable person, well, an uncomfortable position to make someone else feel comfortable. Yeah, absolutely. I'm gonna kind of turn it here because just listening to that story, one thing I, you know, don't think we've talked about, which I kind of want to touch on as well, is, you know, we've talked about teens, and we've talked about fellowship, and we've talked about the importance of creating these psychologically safe environments for our patients and within a team, but I think one thing we've kind of left out at this point is considering those families as well, those families of patients, especially in, like, a pediatric world or in those much older individuals, that geriatric world, when they have, you know, children and things, that is a big part of our practice, is being able to make those connections with not only our patients, but with our family members as well, of those patients, and creating an environment that's safe for them as well, and that may look completely different than what you're doing for, you know, the patient, so I just want to kind of talk about that and mention that, because again, that is really important, and we haven't touched on it as much, but don't forget about, you know, those families as well. They play a big part in our patient outcomes as well, especially when they're very involved, so make sure they also feel safe, you know, to question and disagree and do all that, just as much as your clients do. Yeah, kind of going off that, Ashley, you know, in inpatient rehab, a lot of the families were staying with the patients up in the hospital rooms, and so, you know, it may not be the patient necessarily asking you uncomfortable or awkward questions, it may be their family members, and just keep in mind, you know, not only are you building that safe ground for you and your patient's relationship, but they also, them and their families may carry that on to, you know, other providers later down the road, doctors, therapists, whoever that may be, so keep in mind that, you know, you're not just benefiting you and your patient's relationship through occupational therapy, you're influencing their whole healthcare world and their whole perspective of that. Yeah, I actually had an experience on fieldwork with someone who was very prominent in the faith community, and he had to take a shower in order to be able to return home after a TBI, and he really did not want to do that in front of me, obviously, because he had never been naked in front of anyone else except his wife, and so what I did in that scenario was I had his wife come in, and I made sure that she knew, like, hey, I'm just looking in peripheral, and I told him, you know, I said, look, I'm going to treat you with the same respect and the same level of care that I would want someone to do with my dad after he had his back surgery, and so, if I wouldn't have done that for him and been there, you know, that just goes to show, like, what type of care you're willing to provide, and I wanted to make sure that his wife felt safe, too, because I easily could have said, no, you can't come in the room, but for the patient and for the wife, that was the most efficient and beneficial for them to both feel safe as well. Yeah, and I think it's really important to remember, too, that really in any setting you're in, if you're in the hospital, if you're in inpatient rehab or outpatient, or, like, needs-wise, if you're in an outpatient pediatric clinic or a developmental preschool, a lot of these family members are walking through this experience for the very first time. They don't know what's coming. They don't know, like, what their family member's life is going to look like, and I think it's so important to be able to create an environment where they feel safe to ask those questions, and they feel like they can depend on you to provide the best care possible for their loved one. I kind of want to pose the question, what do you guys think would be consequences or the fallback if we were silent in those moments of uncomfortability? I think that our patients would not be getting the care that they deserve, and that we would not, as practitioners, we would not be doing our job completely, because our patients deserve those, and those answers, and if we're staying silent, then we're basically telling them that their question is wrong or that it's not important. I agree, and I think that that also ties into a lot of, like, health literacy and how people view, you know, like, coming to therapy and going to the doctors and things like that. I think it's so important for us to be able to create a safe environment so that they feel safe to reach out when they don't know the answers and when they don't know the next steps. Yeah, I would definitely agree, and I mean, I feel like the most obvious answer, and we've kind of touched on it in the beginning with our health care scenario, and we've touched on it other times, but, you know, it can be dangerous, like, truly, especially speaking on a client level, you know, on your patient level. That can be so dangerous to be silent and not be an advocate. You know, that is what OT is, like, we are supposed to be advocates not only for ourselves and our profession but also for our patients, and so if you're not able to speak up in those uncomfortable, you know, situations, then you're not performing your client-centered care and the advocacy that you should that, you know, is within our standards and our ethics and everything like that, and so it can be a danger. You know, we've heard some scenarios from people within this room that, you know, have had experiences on field work or whatever it may be that it was, like, a potentially dangerous situation to discharge a client or to, you know, perform a certain intervention or whatever that may look like, and so first and foremost, like, it can harm you. It can harm your client, and at the end of the day, you know, when you sign your name on the bottom of that paper, that discharge paper or whatever, and then a patient goes home and say, you know, they injure themselves or something, then that's on you at the end of the day. Like, you had the opportunity to speak up and didn't, and yes, it can be uncomfortable, and it does stink, and those are hard conversations to have. They are, but that is part of what we are as clinicians and what we need to be as clinicians. We need to be able to sit in the uncomfortability and speak up when we feel there's something that needs to be said. Yeah, I really agree with that, and going off that, just the trust factor of not, you know, it can be you and your patient or you and your co-workers, your team. You know, if you don't speak up, you could potentially be impacting the trusting relationship that you've got with your team. You know, they may not, or they may see you in a different way if there's a dangerous situation and you don't speak up about it. They may say, oh, you know, what's she thinking over there? Kind of thinking of you negatively instead of, you know, speaking up, speaking for the better of the patient and improving their outcomes overall. Pause for Keith. Obviously, we have fun in here. Also, so I know we all took the strength test, the, I forget the name of it. Ashley, do you remember? The Clifton StrengthsFinder? Yes, and so we all, that is right, yes. So, we all come with unique strengths. I wonder, too, like how we would use those strengths to provide psychological safety. I think all of us have developer as one of our strengths, and so what does that look like in day-to-day interactions that you have with clients, with patients, families, and just interprofessionally? Yeah, I think for me personally, like I'll be honest, like that was a strength I didn't really see in myself, but when I kind of reflect, like I do kind of see it, I feel like I am pretty good about, you know, lifting other people up and celebrating the small wins of people, which I feel like is a really big part of OT, especially because, you know, you're not always going to have drastic changes, but you have to be able to celebrate those small things, and I think that's really important for creating that, you know, safe environment and building that rapport with a client and making them feel comfortable because, you know, if they know you're 100% on their team and you're going to celebrate, you know, even the smallest things with them, like that's absolutely going to create that environment, and same within, you know, a greater, a bigger team environment, interdisciplinary team or with a family or anything like that, like knowing that you can support and lift up the other people helps, I think, for me at least, really helps me, you know, feel comfortable in an environment when people acknowledge my small wins, and so same thing on a team or with your client or whatever that may look like. So that's kind of, I feel like for me, that's how I view it in daily life, and that's how I would kind of use that specific strength to my advantage in practice. Yeah, Bella, I also want to kind of touch back on that scenario that you talked about because you stood up for someone that, you know, didn't really have a voice and, you know, just the impact that that had on that client as well. Yeah, so kind of relating that to strengths, I was in all blue for mine, so just kind of thinking about that relationship building-wise, I feel like in that scenario specifically, I kind of used that because I think that that patient did feel safe to tell me, like, when I go home, like, this is what my environment looks like, and I'm worried that I'm not going to be able to get up the stairs, and I don't live with anyone, and I think that if I didn't have those specific strengths, he may have not felt comfortable enough to tell me that information, and that could have, you know, greatly impacted what his outcomes looked like, depending on what recommendation I left for discharge, so. Well, and you just advocating for him to also just really show your character as a person, and that's something that I really think no matter what happens, like, he will remember that, is that you listened, and you didn't just listen, like, you acted, and that matters so much. Yes, definitely, and I'm not sure how much this relates, but it made me think of it, and I think that no matter what our strengths are, like, on that, I think that all of us as future therapists can kind of take something away from this, but I remember before I started my rotation at, in the hospital, I was so nervous, I was so scared, and I was telling my mom about how, like, I didn't think, I had really bad imposter syndrome, I was like, I don't think that I'm going to be able to do this, like, I don't think I'm going to be able to be successful, and she has been a nurse my whole life, like, that's been her career, and she's worked in a variety of settings, and she was like, I just want you to remember this, in my experience, therapy gives people hope, and so I think that that, as another healthcare, like, from one health profession to another, you can really kind of tell, like, how psychological safety and our strengths all kind of tie into that, so. I feel like we need charts with that quote, just specifically. Absolutely, and that, too, like, obviously, Taylor, you brought up, you know, our group specifically, as far as strengths, but it doesn't matter what strengths you have, everyone has them, and they absolutely help foster that safe environment, you just have to know how to use them to do so, and that takes, you know, sometimes that takes practice, sometimes you have strengths you don't even realize that you have, I mean, obviously, I didn't recognize in myself, and I'm sure everyone has that, too, and so it's just a matter of figuring out how to use your strengths to your advantage, and to the advantage of your patients, and to promote this profession, and to promote, you know, safe environments for everyone that you come in contact with. Yeah, and I also think, too, like, just with that developer mindset, sometimes that means stepping back and letting someone fail so that they can grow. Absolutely. And you get to help be a part of that, because if you continue to do everything, you know, what are they learning, and so I think that that's also really hard in therapy. I think I really struggled with the sock aid, and watching people struggle, because it's hard, and you want to help them, but stepping in would have caused more time for that individual to need to be in therapy in order to achieve their goals, and so really just stepping back and limiting sometimes your strengths to allow other people's strengths to shine, I think, is important, too. And kind of going back to that psychological safety, you know, again, like, promoting that struggle and that challenge is not a bad thing at all for clients and teams, whatever that may look like. Yeah, and going off of that, I think if you've created a psychologically safe environment for your patients, when you're in that scenario where you're having to let them fail so that they will learn, they are going to trust that you're doing it for a reason, and you're not just sitting there watching them struggle just to watch them struggle. You're doing it so that they can learn, and they're going to know that there's a purpose in the struggle, and not just that you just decided not to help them that day. Yeah, celebrating a small win, for sure.