Submitted by Jamie Funk, Therapy Recruiting Resource

Kiran Sahota is Director of Nursing Services at Park View Post-Acute Care Center in Santa Rosa, California. Kiran exudes a warmth and friendliness that makes a person want to know her. She joined Parkview in 2006 as a certified nursing assistant, working full time while earning her RN and MSN. She quickly assumed the DON role where she has been successfully leading and inspiring those around her ever since.

As a clinical leader, Kiran loves the many opportunities she has to work as a team and collaborate with her colleagues on a multitude of levels. As a clinician, she finds great joy in taking care of her staff and her patients. She conducts regular meetings with her staff not only to address issues that come up, but also to celebrate with them in their successes. She is on the floor in the facility daily, doing rounds and stepping in to help her team with anything at any time. Kiran’s office door is always open, and it is a welcome place for everyone in the facility.

When asked what makes her team special, Kiran says, “My team at Park View is exceptional. Everyone at Park View works very well together and we are all here for each other. The entire Park View team is selfless and truly takes ownership. Our therapy team is amazing and their passion to collaborate with the nursing team is special.”

Balancing work and a personal life is not an easy task as a DON, but Kiran feels fortunate to work with a team who respects each other’s boundaries. “The trick is to have the right people on the bus. If you have the right people on the bus in the right seats, work and life balance will fall into place automatically — and that is the beauty of Park View,” she explains.

Kiran’s favorite recreation is playing with her two small children in her favorite place — her home. “I am a homebody and not very fond of traveling and adventuring. I love to stay home and spend quality time with my family and kids — this is the most beautiful place for me,” Kiran says.

Kiran recharges her battery by reflecting on each day and journaling about the day’s events. “I look at what went right and what went wrong and look in the mirror to see what I could have done differently in these situations,” she explains. “I look for ways to have fun in my work and make it fun for those around me — to smile and make everyone around me smile through the hard times.”

Kiran’s favorite Disney character is Mufasa, who says, “We are all connected in the circle of life.” This is meaningful to Kiran, who believes that there is a bigger reason that we meet our work colleagues and patients — we all meet because we are connected in the circle of life. I feel fortunate to have this connection with such an amazing leader.

 

Submitted by Kelly Schwarz, Therapy Resource

Gordon Murray, Rehab Tech, has worked at North Mountain Medical and Rehab Center for over 14 years. Gordon has built many friendships with residents over the years due to his calm, gentle approach with residents. Gordon has a gift for motivating therapy patients, builds special bonds with them and has been referred to as “The Patient Whisperer” by his peers!

Gordon discovered that one of the therapy patients, Leigh Gholston, was very apprehensive about getting his hair cut in the facility. Upon hearing this, Gordon spoke with his own barber to see if he would come in with Gordon to cut Leigh’s hair. Gordon’s barber was anxious about going to a “nursing home;” his barber pictured a dark, impersonal building and did not want to come in to do the haircut. Gordon was able to convince him that our facility is not at all what he was imagining, and finally he agreed to come cut Leigh’s hair.

Gordon drove his barber here on his day off for the haircut. He was amazed at how North Mountain is such a bright, cheery, welcoming facility, and he really enjoyed his time with Gordon and Leigh! Further, Leigh was thrilled with his new haircut and enjoyed his “guys’ day” as well!

Thank you, Gordon, for making a difference in Leigh’s life and improving all our residents’ lives with your special “gift!” And thank you for providing our guest with a great North Mountain experience, which impressed and awed him!

Through Moments of Truth, we will dignify post-acute care in the eyes of the world.

Miriam Janove, PT, is an August 2019 graduate of the University of Puget Sound, Washington.

Read her winning Essay below:

Jack (name changed for confidentiality) was admitted to inpatient rehab with a left pontine stroke, presenting with dense right hemiparesis and neglect. Three weeks later, he discharged from inpatient rehab with all his goals met, including transferring and walking with no physical assistance and hemi-propelling a wheelchair up and down ramps. The glow and satisfaction of a physical therapist is palpable when discharging a patient who has met all their goals and returned to all their prior activities. So often, however, we discharge patients who have plateaued below what we deemed as within their capacity at initial evaluation. There may be some structural differences between the bodies of the patients in these scenarios, but more concerning are the disparities in their attitudes and perspectives required for healing, such as an internal locus of control, therapeutic alliance and body awareness. Though physical therapy treatment should be based on therapeutic exercise, including strength, endurance, flexibility and coordination, to most effectively treat our patients, we must empower them to believe in the gains made through their own hard work and to engage fully in therapy.

We spend much of our Doctor of Physical Therapy (DPT) program learning about the structures and functions of the body in order to use evidence-based practice to treat our patients. Recently, we have shifted focus towards examining the impact of illness by discussing the patients’ participation goals using the International Classification of Functioning, Disability and Health (ICF) model. No longer is it appropriate to treat impairments in patients without accounting for the fact that we are working with human beings who have rich and demanding lives. I envision using my current and future studies to support the integration of patients’ humanity into medical treatment.

In Jack’s case, it was essential to account for the privacy that he and his wife value, as well as his wife’s inability to assist physically due to her own medical conditions. Due to their private natures, they were unwilling to ask neighbors or extended family for support. Additionally, he was obese and had a very sedentary lifestyle prior to his stroke, which left his intact side too weak to compensate for his hemiparesis.

Putting patients’ concerns and connections first lays a foundation for success in therapy, but there are several other relevant mental components to fruitful therapy. Locus of control is a concept that elucidates the perception of what impacts the outcomes in one’s life. Someone with an external locus of control believes that they have no direct influence over their own life. This person is likely to have significant difficulty with motivation to engage in therapeutic exercise because their perception is that their own actions will not impact their outcomes. However, someone with an internal locus of control believes that their actions directly influence their life.

Jack arrived at inpatient rehab with an external locus of control. He did not take responsibility for his own healing and did not prioritize exercise outside of therapy time. He had a defeated attitude and was resigned to his new immobility. As we know, therapeutic exercise during physical therapy sessions is insufficient for substantial progress, but despite reminders, he spent his evenings resting instead of exercising.

Though every individual has an innate tendency towards either an internal or external locus of control based on their personality, medical professionals can cultivate an increased internal locus of control in their patients through motivational interviewing and encouragement. Communicating to a patient that measurable improvements in strength, flexibility, endurance or coordination are due to the effort they put into their home exercise program helps foster a greater sense of internal locus of control. This internal locus of control is an asset that serves patients beyond one episode of care as they take ownership of their own health and healing overall.

Gentle encouragement for Jack to participate in the variety of therapeutic opportunities offered on inpatient rehab initially went nowhere. His external locus of control was apparent and he made excuses. As he slowly began to recognize strength gains within his own body, drawing the connection between those improvements and his effort helped him see the control he had over his own healing. After planting the seed, this internal locus of control took on a life of its own, growing exponentially each day as his functional mobility improved, first with independence in bed mobility, then transfers, and finally gait.

Motivational interviewing is a technique I used to build Jack’s internal locus of control. This technique allows medical professionals, including physical therapists, to help guide lifestyle changes by allowing patients to come to conclusions for themselves about their own priorities. By using open-ended questions, active listening and reflective statements, we can draw out our patients’ own reasons to make the changes we have already assessed to be beneficial. Many people resist demands and suggestions from medical professionals, but with motivational interviewing, the patient realizes through their own words that there is dissonance between their goals and their actions. People are more likely to commit to change if they are the ones to come up with the idea.

In talking with Jack, we discovered that his dogs were one of the most important things in his life. When thinking about caring for his dogs, he could see the real-life implications of working to increase his independence in mobility. He realized that his wife would become solely responsible for dog care if he didn’t work hard and improve his function. He wants to be a contributing member of society, and to Jack that means being a contributing member of his household.

Another elusive contributor to good outcomes in physical therapy is therapeutic alliance. This is a quality of the relationship built between therapist and patient, including trust, communication and collaboration. In a systematic review, Hall, et al. conclude that positive therapeutic alliance correlates with physical therapy outcomes including decreased pain, improved function, increased home exercise program compliance and increased satisfaction.1 Soft skills, such as listening and motivational interviewing are integral to building therapeutic alliance with patients who have clear benefits.

People can tell when someone is genuinely excited to spend time with them. It was enjoyable to work with Jack because he was pleasant, though he was not always cooperative. Motivational interviewing not only helps us understand the driving factors in our patients’ lives; it also helps us see their humanity. This connection builds compassion which supports therapeutic alliance by boosting each therapist to show up with true caring for each and every patient.

By bringing locus of control, motivational interviewing and therapeutic alliance to the forefront of physical therapy treatment, we will improve the care provided to one of the most challenging populations to treat, people with chronic pain. As the United States population ages, chronic pain has become an epidemic, which is beginning to get the attention it deserves. Chronic pain patients are a difficult population to treat because there is no protocol or quick fix. This group is also one of the biggest beneficiaries of cognitively based therapeutic interventions as a major part of their treatment program. We know that thoughts and breathing can impact patients’ blood pressures and heart rates, so it follows that thoughts and breathing also impact patients’ experience of pain.

Interdisciplinary collaboration is an important aspect of treating patients with chronic pain, since cognitive behavioral therapy is outside of our scope of practice as physical therapists. As with any other interdisciplinary work, physical therapists can support the goals and strategies of other therapists. We can use cognitively based techniques, such as mindfulness and visualization, learned from these other professionals, to enhance their practice and our own. Due to a flaccid arm and shoulder subluxation, Jack had shoulder pain. With diaphragmatic breathing and progressive muscle relaxation, his shoulder pain decreased. Another benefit of these activities is that they can be prescribed for times when a patient is too tired to do physical exercise.

As physical therapists, decreasing pain is a daily goal with many patients. Body awareness contributes to increasing patients’ locus of control and decreasing pain. Body awareness can be cultivated with widely accepted therapeutic interventions, such as diaphragmatic breathing and attention to exercise form, which is a form of mindfulness. Though some would argue that mindfulness training and meditation are outside of the physical therapy scope of practice, researchers have found that with proper training, these are effective and important tools within a physical therapy context.2, 3

People throughout the United States are frequently disgusted by the medical system. As physical therapists, we are players in their medical care with an opportunity to build connection and provide patients with caring and compassionate medical treatment. Building faith and trust between patients and the medical establishment improves patient outcomes, but more importantly improves people’s lives. By continuing to educate myself and others about the psychosocial and cognitive components of successful therapeutic relationships, I will help build a physical therapy community which treats the whole person instead of simply treating their body.

References

1. Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The Influence of the Therapist-Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review. Physical Therapy. 2010;90(8):1099-1110. doi:10.2522/ptj.20090245.
2. Pike AJ. Body-mindfulness in physiotherapy for the management of long-term chronic pain. Physical Therapy Reviews. 2008;13(1):45-56,doi:10.1179/174328808X251957
3. Rundell SD, Davenport TE. Patient Education Based on Principles of Cognitive Behavioral Therapy for a Patient With Persistent Low Back Pain: A Case Report. Journal of Orthopaedic & Sports Physical Therapy. 2010;40(8):494-501

By Jamie Funk, Therapy Recruiting Resource

Scott Langdale is a stand-out leader in our Washington operations. He is one of those dedicated clinicians who quietly goes about doing whatever needs to be done — in his own facility as well as his partner facilities — no matter what it takes and without any expectation of recognition. “We are so lucky to have him on our team,” says Mira Waszak, his therapy resource.

Scott joined our organization when his facility, Beacon Hill, was acquired in 2014. He was a staff therapist at the time but quickly became a Director of Rehabilitation when the position opened up in 2016. He is passionate about developing others and believes that developing others is what great leaders do — they give the people they lead the tools and culture to grow and then get out of their way!

This therapy veteran has been part of many different teams over the years. What sets his current team apart from all the others is their closeness and genuine love for each other. Beacon Hill therapy is extremely supportive of all of the facility departments and has developed outstanding relationships with each one. Because of this close partnership, patient outcomes and satisfaction are excellent.

Scott is quick to praise the nursing team at Beacon Hill: “The thing I appreciate most about our nursing team is how much they appreciate our therapy team. What I mean is that our opinions matter and are taken seriously. We work very well together and there is no us and them.”

When not working, Scott loves to spend time with his family. His favorite Disney character is Goofy, because he puts his heart and soul into everything he does, doesn’t take himself too seriously, and he truly wills the good of others — sounds a little like Scott!

It is no surprise that serving as a director of rehabilitation is a demanding job, and with all the noise, chaos and drama that comes his way each day, Scott mindfully decompresses and reflects on his day during his drive home with no radio on in the car. Each evening after dinner, he takes the time to journal about his day and think about what he did right, what he could improve, or any work issues that are on his mind. This keeps him focused and keeps work at work, allowing him to enjoy his time at home with his family.

To help build morale and culture with his team, Scott has some great tricks. He makes sure he has a small gift for each employee when he does their annual performance review. He also makes sure they have facility T-shirts and hoodies, knowing how much our therapists love shirts. The team also has an off- site rehab team lunch at least once a quarter.

Scott keeps his passion for his field alive by mentoring student therapists as often as possible. He also maintains a willingness to try new things. “There is always something to learn,” he says. “The one thing I know is that I don’t know everything. Everyone I meet or interact with has a story to tell. If I treat them as a person instead of a thing, I am always amazed at how much they will teach me.”