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How Can Therapeutic Use of Self Improve the Quality of Patient Care?

Updated: Feb 27

The Stories of Shelly, Amy and Nate

by Chris Ouderkirk O.T.

A photo of a beautiful blonde therapist looking confused.

First, what does Therapeutic Use of Self even mean? Simply put, it’s interpersonal interactions: verbal and non-verbal in a therapeutic setting. A wide range of interactions requires an appropriate and timely response to meet the demands of the situation. We have a lot of those types of situations with our patients, their families, MDs, and medical staff. I’ve always focused my interpersonal interactions on the patient because it helps me to gain the patient/therapist connection. It improves the patient's trust in my treatments, therapy compliance, and hopefully a great outcome. However, sometimes the "use of self" can be something you never expected!

The stories of Shelly, Amy, and Nate are a few of my challenges, read on...

The story of Shelly.

Hand therapy was located in the hospital Outpatient Therapy along with PT, OT, Lymphedema, and Wound Care, and was always very busy. Patient Shelly and I both had reptile pets. She loved telling me about her iguana’s routine (I had a turtle). I removed Shelly’s hot pack and started hands-on treatment when the iguana came crawling out from her shirt! I’m thinking, this will be a disaster (physical location of patients, therapists, and how did she get by security with an iguana?) I gave her a big smile with my finger to my lips and mouthed, “I’ll be right back” (with the therapy supervisor and security). I had lots of situation analysis paperwork to complete that day. I don’t like paperwork.

The story of Amy.

The very first time I worked inpatient, I was assigned patient Amy, a nurse who worked in the hospital. Amy was in her mid-40s with a diagnosis of ovarian cancer. My heart sank, and after speaking to the charge nurse, she told me to teach her how to clean her stoma. You’re kidding, right? I’m a hand therapist (also an OT), so this task would be mine. Keeping control of my body language and facial expression, I said, "Okay, no problem" but honestly, I had never done this. I thought hard about the procedure trying to recollect what we were taught in college. I took a deep breath and entered her room. Amy was sitting in bed and fixated on the 4 wall photos of her 3 children and husband. I introduced myself as her OT for today. Then she turned and stared into my eyes and said, “Am I going to die?” I froze …everything froze, and I don’t know where the words came from, but without taking my eyes away from her stare, I said “Yes, we are all going to die, but not today. Today we are going to learn together how to clean your stoma.” Amy got out of bed, and we went into the bathroom where I had a personal lesson on cleaning a stoma. I was humbled when Amy shared her knowledge and ability ... it was a special moment for both of us.

The story of Nate.

Connecting with Nate was a big challenge. He was a retired DDS with a strong personality (his way or the highway) and had some cognitive deficits post-surgery from 15 years prior. Nate had a supportive significant other who kept me informed about Nate’s "incorrect" responses (fibbing) - he was not a good historian! Nate had a sense of humor and tried to use it as a diversion from doing therapy. One day I returned the humor and said we were going to do a "dry shower" transfer in prep for his goal of showering independently. I demonstrated the steps to transfer in/out of the shower and now it was his turn. Nate had some balance issues, so I placed a gait belt on him and said, “I don’t like to do paperwork, so please don’t go down on me.” Nate stopped and turned toward me with a playful grin and said nothing. I didn’t "get it", then I covered my face and realized the phrase that I had used many times with others was taken out of the intended context by Nate because of his sense of humor! So much for Therapeutic Use of Self…

For more stories like this one, pick up a copy of Off the Chart A Nurse's Journey

of Heart and Humor at

Published by Jennifer Tipton / This post may contain affiliate links.


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