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It's Not Just You


Adapted from OT Theory of the Person, Environment + Occupation Model

When my youngest was in grade one, he spent a lot of time in the principal's office. I remember the shame of being called to pick him up, my head hung low as I walked into the office to see what he had done wrong now. One day, I distinctly recall getting angry at little six year old him, asking him in the car, "Why can't you behave yourself?"


That was my rock bottom of parenting. The next day, I contacted our Occupational Therapist (OT) who had been working with Aaron. I was close to tears, felling awful for having lost my temper with my son with Down syndrome and who was clearly struggling to be included in his classroom.


This OT also happened to be trained in behaviour coaching. Bronwen came over to our house, sat me down and drew three circles on a piece of paper. The overlapping circles said Person, Environment, Task. When my boy had troubles at school, it was never purely his fault. It was a combination of him, the environment and the task that led to his trip to the principal's office. I needed to be curious to find out what was going on to lead him there, not just blame him for being 'bad.'


Bronwen also reminded me that I was losing sight of Aaron's awesome. I felt shame about that too, but Bronwen was totally right. This was the adjustment I needed to get back on track to being a better mom.


This was an epiphany moment for me. I asked more questions about what was going on in the classroom (the environment) and what Aaron was doing when there was trouble (the tasks). Sure enough, there was a group of boys who were encouraging Aaron to do things that were naughty or silly, just so he could get caught by the teacher. Aaron had a role, of course, but it was not just him - the environment and task came into play too. Soon we ended up pulling him from that school because the teacher and parents of the boys wouldn't acknowledge this problem. And voila, Aaron was still Aaron, but he was much more successful in a new environment.


These three circles don't just apply to the behaviour of kids with Down syndrome. I recently read a press release about a study about how nurses' stress and burnout contributes to lower quality patient care and safety.


Of course, anybody who is a patient or nurse knows this to be true. Staff well-being and patient well-being are tightly intertwined. It strikes me that calling stress and burnout 'mental health issues' is a form of person-blaming. For, as my diagram indicates, success does not only hinge on the person. The environment and what folks are asked to do are also significant factors.


In health care, adjustments like better staffing levels would help with the task circle. Creating nurturing spaces for reflective practice for nurses might adjust the environment circle. Yes, there is individual responsibility to manage stress, BUT when the environment and tasks are overwhelming, then it is up to managers to tinker with these factors to create spaces where nurses can be successful. A person cannot do this alone.


It is not as binary as blaming the person OR the system. As with my son, the combination of him, his environment and the task he was doing led him to his troubles. Once we tackled them by changing things up, his behaviour improved considerably.


This applies to health care environments too. I've heard a lot from the upper echelon about health care professionals 'needing' to be resilient. Well, maybe if administrators hadn't stripped back staffing to bare minimum and created miserable environments for everybody in health care, people wouldn't be stressed and burning out. Everybody has a role here, not just the person and not just the system.


Consider what each of us can do to create a more healing environment for everybody - nurses, other health professionals, patients and caregivers. It could start with a hello in the hallway.


Back when Aaron was six, Bronwen reminded me that I had also forgotten my son's awesome. In the darkness of the pandemic, I fear we have taken for granted the awesome of individual health professionals too. As a patient, I pledge to write more thank you notes for the health professionals in my life. If you work within a team, how do you show that you care about each other? Goodness knows we all need to remind each other of our awesomeness right now.

 

Become part of the groundswell.


You can buy a copy of my second book Ducks in a Row: Health Care Reimagined here.


It is a book of encouragement for those who reject the status quo and who pine for change in health care. Packed with ideas, and importantly, practical ways to overcome barriers so we can imagine a new health care world.


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