Instructor Manual for

Instructor Manual for

Mobility in Context: Principles of Patient Care Skills

Third Edition Charity Johansson

Crystal Ramsey, Susan A. Chinworth,

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Copyright © 2022 F. A. Davis Company 26

CHAPTER 1: Establishing the Therapeutic Alliance

Chapter Summary

This chapter explores ways in which the clinician can increase the likelihood of successful patient outcomes before the interaction even begins. Increasing awareness of possible biases and practicing effective communication techniques set the stage for positive patient encounters. The clinician has a duty to approach all interactions with professionalism, which includes recognizing and minimizing their own biases as well as not making value judgments toward patients.The patient and clinician work together to meet the patient’s mobility goals; patients are never used to meet the clinician’s needs.

This chapter presents and discusses:

• Professionalism and the implications for patient care • Common healthcare biases and their potential effects on patient care • Signs of critically judging others

• Guides to effective communication

• Nondisabling, person-first language

• Responding to inappropriate patient behaviors

• Patients’ rights

• Typical patient responses to injury loss

• Common cultural differences among patients and care providers

• Forms and modes of patient education

• Stresses and stress management for healthcare providers

In a therapeutic alliance, the world of the clinician meets the world of the patient.

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Awareness of ourselves and our role as clinicians allows us to interact more effectively. Being a professional also carries with it the obligation to “get into the world” of the patient in order to establish an effective therapeutic relationship. Therefore, the chapter is organized in the context of dynamic systems—person, task, and environment—from the perspectives of both the clinician and patient.Learning Outcomes

After completing this chapter, the reader will be able to:

• Understand their professional obligations to the patient.

• Identify common biases that interfere with the therapeutic alliance.

• Understand ways in which their attitudes affect patients’ mobility outcomes.

• Recognize common responses to loss of mobility.

• Identify behaviors that will facilitate effective patient interactions.

• Be able to communicate effectively with patients regarding goals and expectations.

• Develop strategies to manage stressful situations.

Suggested In-Class Activities

• Have students role-play the Try This boxes and discuss the topics in the Thinking It Through

boxes.

Box 1-2 Try This Most of us need help identifying our own biases because they are often based on unconscious assumptions. The Implicit Association Test is one way to become more aware of possible biases within ourselves. If you have students participate in the online Implicit Association Test (IAT) assessments, we recommend that interpretations of the findings be guided by the instructor. The

following website may be helpful for this purpose:

https://implicit.harvard.edu/implicit/ireland/background/understanding.html

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Copyright © 2022 F. A. Davis Company 28

Box 1-3 Try This Imagine the next patient on your caseload has a gender-neutral name. Do you immediately want to know the gender of your patient? If so, what difference is it likely to make in how you approach and work with your patient?Discomfort with not knowing a patient’s gender can indicate underlying gender assumptions that may not serve the patient’s best interests. In some cases, the patient’s sex can be a physiological factor in determining appropriate patient care, but it can be helpful to become more aware of gender-based assumptions.Try This (Box 1-5)

To prevent patients from feeling judged, avoid “Why?” questions because they tend to elicit defensiveness. Instead, replace them with “What?” questions. For example, “Why didn’t you do your exercises?” can be rephrased as, “What happened that kept you from doing your exercises?”

Possible responses:

Change “Why aren’t you using your cane?” to “What’s up with the cane?” Change “Why were you here so early?” to “What brought you here so early today?”

Change “Why don’t you want to get out of bed today?” to “What’s going on today that makes you not want to get out of bed?” Try This (Box 1-6)

This box allows students to practice silence as a part of listening, a skill that can be challenging but that is useful when communicating with patients. You might also ask the person posing the question what they were feeling or thinking while waiting for the answer.Try This (Box 1-7) It can be difficult to imagine how it would feel to have a communication deficit. This box helps students experience communication challenges. When discussing this activity, have students

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