EDUCATING ~ CONNECTING ~ ENGAGING ~ NURTURING ~ REVITALIZING ~ COLLABORATING ~ INSPIRING
By Lesley Fleming, HTR
It is inevitable that issues arise when horticultural therapy programs are being delivered. The flow of a session is important for effectively delivering programs. This is most often recognized when there are disruptions that can compromise the effectiveness of the therapeutic process. With experience, horticultural therapists can learn to respond better to interruptions, develop skills in resuming activities or shift the focus if required.
Q: What are some tips for reducing interruptions from clients and staff during sessions?
A: Good planning prior to the delivery of any program can greatly reduce delivery site challenges. Working with facility staff to identify appropriate program space where there will be an expected level of privacy (this is a therapeutic service and some degree of privacy is expected), access to necessary materials (water source, table), no loud noises (or time of day for cleaning with motorized equipment), will reduce these types of interruptions. But do be prepared for staff, interested in your plants or activities to stop and possibly interrupt. Practice a polite but effective response—I would be happy to chat with you after my therapeutic horticulture session is concluded—and let administrator know that such disruptions affect clients’ abilities to listen, concentrate and enjoy. If delivery site continues to present challenges, consideration for a different location if possible should be discussed (for example an informal gathering area in the main hallway is probably not the ideal location).
Interruptions from clients are a different matter. Identifying those with hearing loss, cognitive deficits or propensity for chatter can prepare the horticultural therapist for dealing with verbal or other disruptions. Making groups smaller, providing buddy activities for socialization, structuring the flow of activity to allow for reminiscing or other sharing can embrace verbal disruptions that may optimize therapeutic goals related to client interaction or inclusion. Outbursts can be managed by speaking directly to clients before and after sessions, explaining the process and asking for their cooperation, by working one on one with clients with more expansive needs than a group session can accommodate or asking volunteers or staff to intercede when necessary. Loud verbal outbursts from some people with dementia can be a form of self-stimulation so understanding the population you are working with is essential to delivering the best possible therapeutic horticulture program possible.
Q: During one of my programs a person tripped and fell down on the ground. I was left with the group upset and staring at the person. How could I have handled this situation better?
A: First off safety is the top priority. Move walkers and canes away from the activity area so no one, client or practitioner will trip. And watch the floor surface for wet or slippery materials. Be aware of safety protocols prior to sessions. Does the nursing staff prefer to help anyone who falls to ensure medical assessment at the time of the accident? Is there trained staff at hand or close by who can manage the aftermath of the fall? Is emergency medical attention required and if so, have they been called?
Attending to the person who has fallen as quickly as possible is essential. Often this will be done by facility staff. Calming the assembled group and re-directing their focus back to the activity lessens everyone’s curiosity and gives the client some semblance of privacy. While not minimizing the fall, comments like “Mary is being taken care of now by staff or Mary will be back on her feet shortly” will help to normalize and reassure demonstrating sympathy and compassion. To bring the attention back to the plant activity, use voice variation, visual cues or other prompts. Delivering the rest of the session with a steady voice and smiles offers another layer of calm.
Reporting to managers, preparing paperwork or following up on the person who fell, can be done after the sessions concludes. Ultimately, the therapist should review what happened and determine if they own any of the responsibility for the tripping incident. Confirmation of liability coverage may also be timely and provide an opportunity to re-evaluate the type and level of such coverage.
About the author
Lesley Fleming is a registered horticultural therapist living in Florida. She delivers therapeutic horticulture programs to multiple populations, conducts HT workshops in both Canada and the U.S., and her articles are featured regularly in HT trade publications including eatbreathegarden.com. Her latest research in 2015, Veteran to Farmer Programs: An Emerging Nature-Based Programming Trend was published in the Journal of Therapeutic Horticulture 25(1) 27-48.