I am a nurse, and I coordinate the care team of a hospital in the city of São Paulo, Brazil. Last year we had wonderful experiences when you provided the Therapeutic Relationship workshop at our organization. After that we started to hold organized meetings with the families of the patients who were hospitalized in the Intensive Care Unit and clinical/ surgical units. The purpose of these meetings has been to bring these families together with the caregivers in order to take care not only of their health but also to meet their needs and build better relationships. Although it’s not a common practice in our hospitals in Brazil, the results have been excellent, bringing many opportunities, but it is not always so easy to make the families understand our purpose or to get at the point we want. Sometimes the conversations are more superficial.
What could we do to help these families feel safe enough to engage therapeutically?
We’re very excited about the work you’re doing, and we look forward to hearing more about how your meetings with families are impacting care and the overall patient and family experience. Partnering with the family during the rush of daily care can be challenging (though very rewarding). Finding a way to intentionally partner with families in a planned meeting for the purpose of engaging them in a dialogue about what matters most is a brilliant and proactive intervention. We offer the following thoughts and tips in the hopes that they will be useful. Let’s begin by remembering that every therapeutic encounter has a beginning, middle, and end.
The Beginning: Meeting
Paying attention to the beginning is important to set the stage, clarify the purpose, and establish a sense of safety. Some beginning tips include the obvious such as having every member of the team and the family members introduce themselves. You may also want to establish “agreements” that may be helpful to assure safety and freedom of expression. Some examples of agreements are: begin and end on time; protect privacy; honor confidentiality; and prevent unnecessary interruptions. Prepare yourselves to be fully present and attuned. Prepare to listen, see, and give your undivided attention. Remember that for many people, the hospital setting is foreign and even intimidating. Tending to their safety and comfort will facilitate trust and more open expression.
Clarifying your purpose is important to engage the family and to ease any anxiety. If the goal of the interaction is to better meet their needs, you might state it as, “We’re here to learn more from you about how we can support you during this difficult time.” Then express your sincere interest in what they’re going through.
The Middle: Connecting
The conversation with the family is facilitated by wondering through open-ended questions:
• What has your experience here been like so far?
• What worries you most about your loved one’s condition?
• What is on your mind right now about your loved one’s care?
• In what way has your loved one’s illness affected your life?
You want to convey the message: “We want to understand your experience better so that together we can partner to be as proactive as possible.” However, this message is best conveyed by demonstrating genuine interest rather than stating it as an objective.
Once the answers start flowing (even if the flow is more like a trickle) your job is to follow what you are being told. Following is the act of hooking into the last thing the person says (or sometimes doesn’t say) and making your next question or comment follow what the family member is teaching you about his or her experience. When following, you find yourself interested in learning all you can about the other’s experience. Your focus is on the person, and your curiosity and openness encourage the family to let you know honestly what is on their minds. In this way, we honor and respect what the family is teaching us by making it quite literally the most important information that anyone in the room is able to provide. This therapeutic focus empowers the family to truly make a difference in the patient’s experience and in their own. It is a contrast to the very normal feelings of helplessness that are a common human response for the family members of people facing illness and injury.
Following can be verbal or non-verbal. Sometimes the best following is the act of letting the emotion expressed by the other register on your own face, or uttering an empathetic sound, or simply offering your quiet, attuned presence as you wait and listen for the person to continue. Here is some language that may help you follow:
• Tell me more about…
• When you said…, I wondered…
• What else will help us understand how your loved one cope’s with …
• Is there more about…that you’d like us to know?
• OR simply convey nonverbally and by quiet waiting that you are here to listen further
The End: Transitioning
The ending provides a structured way to clarify understanding, receive feedback, identify any next steps, and determine if there is anything further required before ending the encounter. An effective way to close the time is to ask everyone present, “What one or two things have you learned or are you taking away as a result of our time together?” “Checking out” in this way assures that every voice is heard, and in particular, that the family members know they have been heard and that any necessary actions are clearly articulated and implemented.
If you create a structure (beginning, middle, and end), stay attuned and present, and consciously practice wondering and following, the family members will feel respected, safe, and held in your care. When your deepest intention is to build relationships with family members and to learn from them so that you can provide better care for their loved one, your deep intention creates the space for true partnership. This kind of relationship, one built on respect and proactive engagement, will assure that the patient and the family receive extraordinary and compassionate care.
~ Mary Koloroutis