The interest in person-centered care (PCC) is booming. Increasingly, health care organizations of all types and sizes are integrating PCC in their practice, and the approach is now recognized and formalized by establishments like the International Organization for Standardization and the World Health Organization. Likewise, in audiology, professional and patient associations show a growing commitment to PCC, and practitioners strive to apply it. However, in many contexts, there is still a gap between intention and behavior—between theory and practice.
In a study by Greenness, et al., on verbal communication between audiologists and people with hearing loss, there was a clear tendency that appointments were biomedical and that the agenda was controlled by the audiologist (doi: 10.1097/AUD.0000000000000100). The study, which was based on 63 audiology appointments, revealed that the audiologists initiated consultations with close-ended questions 62% of the time, interrupted patients after 21.3 seconds on average, and asked 97% of the questions during history taking. In summary, not very person centered at all. So why these dismal numbers when the interest in PCC is clearly on the rise?
For many hearing care professionals, helping patients is what motivates them and why they decided to pursue a career in audiology in the first place. But although it is rewarding to help others, the profession can also bring stressful work environments, big caseloads, and overwhelming scenarios of dealing with strong emotion. One challenge is the lack of vocabulary around professional fatigue and how client exposure may impact clinician well-being. Many professionals do not acknowledge that part of being person centered is to allow themselves, as people, to thrive in their profession. When they struggle and feel weary, they lack the knowledge and vocabulary to articulate their own needs and the self-awareness and mental resources to be person centered with their patients.
To break this troublesome cycle and help bridge the gap between intention and behavior, reflective practice can make a tremendous difference. This approach can help clinicians to acquire new perspectives on the challenges they encounter, gain insight into their own assumptions, and ultimately allow them to thrive as professionals (Hearing Rev. Feb. 3, 2010).
Reflective practice is also crucial in an educational context. Deborah Ferrari, PhD, from the University of São Paulo, Bauru Campus, explains why: “For someone who is at the beginning of his or her learning curve, things are not obvious. Even small issues can have a deep impact on the students’ sense of competence and trust in their own skills.” One of Ferrari’s former students, Giulia Ito Santos, says, “Reflective practice was a relevant part of my learning process in clinical practice. I remember coming home after eight hours of service provision and having to write in my reflective journal. This was an individual, private, and safe moment where I could analyze each step of the care I had provided, and what I could do differently next time.”
YOU CAN’T POUR FROM AN EMPTY CUP
The topic of reflection and well-being in audiology is also covered in a university course module titled “Clinician Wellbeing: Self-Care in the Hearing Clinic” developed by Dunay Schmulian, PhD, in collaboration with the Ida Institute. It aims to help transform clinical practice through education, training, and support. Schmulian says, “In order to be excellent at communication, which is our core business, clinicians must be excellent at listening. At the heart of listening and communicating is the ability to self-regulate; to know and separate your business from the patient’s business. The now trite statement that you cannot pour from an empty cup holds water (or tea). But I want to extend that to say that person-centered care requires us to show up for every appointment as a full cup. The point is never to empty your cup at work.” Fundamentally, reflective practice allows clinicians to learn from experience, improve decision-making skills, and enhance hearing care.
EDITOR’S NOTE: Learn more about Ida Institute university course module Clinician Wellbeing: Self-Care in the Hearing Clinic athttps://idainstitute.com/tools/university_course/module_9/and download the Reflective Journal athttps://idainstitute.com/tools/-reflective_journal.