Section One:

 

It is essentially universal that an optimal environment is where patients and clients can heal and become their best selves.2 Bridging a positive client relationship and experience begins with the environment that they are will be in with the professional. Varying healthcare and professional facilities share the same need to create a safe and therapeutic environment for the patients and clients that will inhabit the rooms where healing and treatment will be taking place. Many components go into these environmental spaces that will ensure that clients feel completely safe to be vulnerable and address difficult topics for their desired well-being and reach towards their goals.  Specific designs are necessary for all types of healthcare facilities and are often observable. From a design perspective, this is for the main reason of making sure the patients feel embraced by the space, the family and caregivers of the patient feel comfortable, and that the space supports the treatment involved and influences a positive impact on the clinical outcomes that will occur.1 Designers for these types of facilities take many things into consideration. Some of these components include eliminating environmental stressors, noise reduction, social support, appropriate lighting and artwork and aesthetics enhance a calming space.1

An Optimal Healing Environment was create by the Samueli Institute nearly a decade ago with the aim of creating and elevating healing spaces for the health professionals, patients, families, and caregivers.2 Within the structure of the Optimal Healing Environment, there are four defined environments that can elicit healing, and seven constructs were deemed imperative for healing to occur within those environments.2  The four environments or areas where healing can occur are internal, interpersonal, behavioral, and external.2 For individuals to properly feel as though healing can take place, they must understand which environment they are in, and the professionals working with them must properly understand how to elicit healing in these varying areas of one’s life. While the physical environment is incredibly important for mending, whatever that may look like for the patient, there are also emotional environments that are very important to be understood by the professional directing the healing process of the client.

An interesting perspective is from the patient or client view, one that is likely not asked enough even though all effort to create a healing environment is centered around the one receiving the healing, asking more questions and considerable time spent with the perspectives of patients can optimize how well the environment does the job of healing. A research hospital in Canada had this very thought in mind and carried out a research project to receive feedback from the patients and visitors regarding how they felt about their environment at the hospital and then develop higher standards for design and patient centered areas.3 Those that were interviewed reported that they felt most comfortable and safe in their environment when they felt like a priority and were able to receive their basic needs when they asked for it.3 Additionally, being able to move throughout their environment easily and accessibly was a large factor as well as privacy, safety for vulnerability, cultural sensitivity, interaction, and cleanliness.3 Many of the patients that were interviewed did not comment on the design of the hospital, but rather their physical ability to maneuver through their environment such as handrails, large alleys for wheel chairs, and enough space for visitors and care.3 While this report is unique to the research conducted, it could be assumed that many of these indicators are common among all patients and clients entering the varying healing environments.

 

Section Two:

 

The effectiveness of therapeutic work rests on the shoulders of the one stimulating the healing narratives in the many environments that healing occurs.  Compassion is almost always essential for an effective patient care setting.5 If this is not done in a manner where the client does not feel validated and empathized with and no client-provider relationship is formed, the provider risks losing a client and creating a distrust for professional help. Empathy is an easy word with hard work attached to it, and that work is required of providers. Empathy is a skill and within a healthcare setting is defined as the ability to understand personal experience of a patient or client without bonding to them.4 Empathy is an emotional act to care for someone regardless of if you can relate to the situation that they are in, which is very common within healthcare settings and a practice all healthcare workers would benefit from.5

Incorporating empathy among physicians has long been known to be an effective means for patients to have improved health outcomes when they can feel empathy from their providers.5 Connecting with a client during a time of prospective healing can be the key to making the difference that is needed for setting the environment for healing to occur.

In a 2007 study, a research team examined the patient observed differences between sympathy, empathy, and compassion within healthcare settings from their healthcare providers.6 For this study, patients in a critical setting were interviewed and correlations were reported to determine what the patients in this setting feel from the providers that they interacted with in terms of sympathy, empathy, and compassion. For sympathy patients often felt as though it was unwanted pity and unhelpful, compassion felt kind and motivated by love, and empathy felt like emotional resonance where patients felt the providers put themselves in their shoes.6 These are some of the brief highlighted points of a much larger perspective within healthcare settings. It should be the priority of all providers that the clients and patients they serve feel that even though they may have never experienced what they are currently trying to mend or heal, their provider can emotionally and visibly put themselves in the shoes of those they treat.

The role of empathy in a health providers career can lead to greater success for the provider as well as the patient success of adherence to the recommendations given by the provider.4 There is also an important reality of compassion fatigue that should also be considered for the provider-client relationship. Being too empathetic in such a high stress and often negative environment and career has also been shown to be a reality of many healthcare professionals resulting in being exhausted emotionally, especially among physicians.5  This occurrence can create more risk for the provider could be at an increased risk for making medical errors and possibly losing the trust of their patients and clients.6 Emotional regulation in high stress and emotional careers is an important skill to develop in order to maintain a level of stability while on the job, but more importantly, to be able to provide the clients and patients with an optimal amount of empathy.6

Section Three

 

Working with clients on an emotional level requires a lot of patience and skill on the provider’s part. Motivational interviewing is one of the key skills widely used in many different therapeutic environments or in settings where behavior change is being encouraged or recommended. Motivational interview was initially developed to be used for drug and alcohol addictions, but within the last few decades has been used in varying healthcare settings including those involving chronic disease behaviors.7 This communication style can be described as a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence”.8 This approach is for the provider to center interventions and motivated conversations around what the patient is interested in and allows for the provider to be able to resolve the resistance that may be occurring within the client and empathetically find suggestions that will encourage behavior changes to meet the clients realistic goals.8 A systematic review looking at varying motivational interview research studies and their effectiveness among a wide range of healthcare populations. It was determined through this review that motivational interview appeared to be the most effective method that prevents behaviors that are harmful to the client or patient.10

The spirit of motivational interviewing is ensuring that this practice becomes intuitive and means of motivational encouragement for the client and patient. The hope behind motivational interviewing is that is done in a raw, organic manner where the change occurs naturally and avoiding feelings of force or guilt from the provider.8 Motivational interviewing can very quickly become a rigid and structured technique that learners of the method including clinicians and providers will overcomplicate and turn into a memorization skill. Many therapy settings are run by hearing the client and giving advice, whereas motivational interviewing is the patient doing the psychological work on their own.9 Doing so goes against the nature of the skill and is more of a type of therapy designed to rely on listening, going with the resistance, and gently directing towards change.9

Involving interview methods that evoke change within a person include asking questions that meet the patient where they are at, allowing the patient to determine realistic goals, listening and prior to giving advice, summarize and check for understanding with the patient, and always act as an agent of change.11

 

Section Four

 

Within a counseling session that includes a patient with an aim of change, there are theories and models used to assist the one conducting the interview towards success with the clients. Many models have been developed to explain the way human behavior changes. One of these models is called the Transtheoretical Model of Change. This model tends to be among the most common to be used in an explanation of change and how behavior evolves during those changes.12 This model uses stages that are in order: precontemplation, contemplation, preparation, action, and maintenance.12 Using this model of change is not to coerce the individual wanting or hoping to change, it is to support and accept the stage that the individual is in and provide evidenced based treatment that is personalized to the individual.12 A systematic review determined that the Transtheoretical Model of Change is a very effective way for changing health behaviors especially within a healthcare setting.13

The enhancement of motivational interview within this model of change could be a key manner to which an individual is motivated to change for the betterment of their own health and wellness. Motivational interviewing could be used as the clinician performing the discussions appropriately determines which stage the patient or client is in and then as a means of intervention, using motivational interviewing techniques that are only appropriate for the stage that the individual is in. This technique would need to be practiced and well thought through in order to make sure there is a clear understanding of how likely the patient or client is to change their behavior, and at types of discussion would be needed in order to instigate some kind of step towards change. The beauty of the research of change, models involved, and the theories used to determine behavior is that each of these individualistic frameworks can collide in the discussion rooms which will ultimately lead to the most well-rounded practice to support positive behavior change for anyone willing to head in that direction.

 

References

 

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  10. Frost H, Campbell P, Maxwell M, et al. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One. 2018;13(10):e0204890. Published 2018 Oct 18. doi:10.1371/journal.pone.0204890
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