You just passed your boards, aced your interview, and landed the OT job of your dreams. You feel amazingly confident as you enter the clinic on your first day of work as an OT practitioner, but those feelings of elation suddenly evaporate as you examine your caseload. Cue the choir of internal doubt: what am I going to do with these patients? I’ve never treated these diagnoses. I am not prepared to handle this.
Thankfully, you’re not alone. You aren’t the first OT to feel overwhelmed, and you won’t be the last. I personally experienced many of these feelings working my first job as an occupational therapist. One case that triggered these concerns occurred when I first began working as a PRN OT in skilled nursing. I was scheduled to evaluate a ninety-year-old woman with an elbow fracture. Sounds straightforward enough, right?
As I browsed the patient’s chart, I noticed it was missing fundamental information, including her upper extremity weight bearing status, her range of motion status, and instructions for her splinting protocol. There are tons of creative ways to treat patients in skilled nursing, but I had no idea what to do or where to start.
Unfortunately, many situations like this one can arise because health care is full of grey areas. While having a broad knowledge base is a crucial part of evaluating and treating patients, raw information can only take you so far when you're working with patients. No clinician, especially a new graduate, knows how to treat every diagnosis. The difference between a new grad and an experienced practitioner, however, is knowledge of the process, or the approach to handling difficult situations.
Experienced practitioners are likely to be well versed in clinical reasoning, professionalism, and coping skills—some of the components necessary to gracefully handle abstract, less-than-ideal situations. Learning these skills takes time and experience but having an idea of where to begin can reduce the learning curve. Below are some strategies that I currently use when I encounter obscure diagnoses or odd situations. Following these tips can help you navigate uncertainties in the clinic and grow as an occupational therapy practitioner.
1. Practice some mindfulness...
While you can’t necessarily change the caseload you’ve been given, you do have control over your response to the situation. Rather than becoming frazzled and stressed, which can set the tone for the rest of your day, admit to yourself that you don’t exactly know how to treat the patient. Allow yourself to feel the anxiety and nervousness that accompany this vulnerability. These feelings are normal, and it’s healthy to acknowledge them.
2. ...and keep your cool
After you accept the situation, use your coping skills! Say a little prayer, take a few deep breaths, or pause for a moment to gather your thoughts. Remember that it’s all going to be okay. The ability to think clearly in times of stress is crucial when problem-solving your way through challenging situations, so be sure to attend to your own mental health before trying to treat others.
3. Stay professional
In my opinion, professionalism is one of the most important items on this list because it’s possible to maintain a respectable demeanor even if you lack experience and knowledge in a certain area. When you keep your composure, handle the situation with dignity, adhere to ethical principles, and clearly communicate your thoughts, you earn the esteem of your co-workers and boss. Perhaps even more importantly, though, you build trust and rapport with your patients.
4. Be honest
As an OT, patients place a lot of trust in you. You don’t simply play a role in their recovery process; you’re the team member who is wholly responsible for ensuring they are able to engage in meaningful, life-enhancing occupations. In other words, patients are trusting you to guide them toward independence in activities that make life worth living.
Because of the significance of this role, white lies, however small, can be incredibly damaging to a therapeutic relationship. On the other hand, honesty is a primary way to build trust in a therapeutic relationship. Generally speaking, patients are receptive when you are transparent with them. If you don’t know how to address a particular aspect of their care, be truthful. They will appreciate your sincerity.
5. Use your resources
There is no shame in looking up information. The almighty Google can probably help you out if you aren’t sure about your patient’s diagnosis or surgical procedure. Rather than tip-toeing around a patient with an unfamiliar diagnosis, gather the facts you need prior to seeing the patient.
Co-workers are an equally important source of information. OTs, OTAs, PTs (check out this guide to what PTs actually do), PTAs, SLPs, and nursing staff can all provide invaluable perspectives and knowledge that will assist you in better understanding the problem so you can effectively treat your patient.
6. Safety first
Remember what you were taught in school: the patient’s safety is the top priority. When in doubt, be cautious. Always ask for help if you are unsure of something safety-related. This may mean using a gait belt, ringing the call bell for extra assistance when transferring with an unfamiliar patient, or double checking a patient’s dietary consistency prior to serving a snack or beverage.
7. Employ therapeutic use of self
Therapeutic use of self employs “narrative and clinical reasoning; empathy; and a client-centered, collaborative approach to service delivery”.1 Therapeutic use of self can go a long way in any patient encounter. While developing a therapeutic relationship takes time, committing yourself to your patient, demonstrating genuine compassion, and treating the patient with unconditional positive regard can accelerate the process. These practices are healing in themselves and will promote trust in the therapeutic relationship.
8. Stay true to OT’s roots
While the diagnosis is important, occupational therapy is ultimately about treating the patient within his or her occupational context. Facilitating participation in meaningful activities is paramount in our profession. Having an open conversation with the patient related to their goals, progress in treatment, and valued occupations can help to stimulate goal development and treatment ideas.
It’s easy to see that there isn’t one clear-cut solution to treating complex patients. Instead, you’ll likely be required to progress through a series of strategies to determine a suitable approach. Developing a repertoire of skills and a game plan for tackling uncertainties will allow you to make the most out of every treatment session and evaluation. As these skills become ingrained, you’ll feel less stressed out and more in control of obscure situations. Be patient with yourself. You can do this!
Do you ever run into these situations? Let us know how you handle treating unfamiliar diagnoses in the comments!
- American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006