How Listening to the Family Can Make or Break a Therapeutic Encounter

This week I witnessed an interaction between a hospice nurse and a family who is coping with their loved one being newly admitted to hospice.

The nurse is devoted to her work and to the care of the patient and family.  Of that, I have no doubt. 

She is knowledgeable about the medications and the way to coordinate resources.  I know she will excel at holding the patient and family in her care through being highly responsive and highly proactive.  She went to extraordinary trouble to dress a wound that the patient had sustained from a fall.  She needed to go to her car, adapt the bandages to fit the area, cleanse, and teach.  She was careful with the patient’s fragile skin and gentle in her touch and care.

I could not help but notice, however, that when it came to her interaction with the patient’s wife, she seemed most comfortable when teaching, guiding, informing, and advising.  The wife of the patient has been caring for him for over two years and yet a conversation about what those two years have been like—what the wife is confident about, knowledgeable about, and struggling with—did not happen.

I witnessed the wife being agitated and responding in clipped words and saying “Yes, I know…” as the nurse instructed her in great detail, never asking any questions to learn more about what the wife already knew.  If the nurse noticed the wife’s tone, she did not indicate so, and continued with teaching about a particular medication that the wife said several times that she did not want to give her husband because of the unwanted side effects and her own assessment (informed by two years as his primary caregiver) of his current status.

The nurse stated her goal for the day’s encounter as getting to know them and building trust. My hunch is the nurse was pleased with the interaction and felt like she had thoroughly done her job.

Some hours after the nurse departed, the wife expressed concern about the nurse and asked my opinion about whether they would be able to work together.  I could honestly answer Yes, as my assessment was that they would find their rhythm together over time.  I guided the wife to simply say to the nurse, “I want you to please pause and listen to what I’m saying to you.”  If she does this in the future, an exchange can take place that makes a relationship possible. As it was, there was a sender of information (the nurse) and a receiver of information (the wife). But that sort of one-way transaction does not create a relationship; in order for trust to be built between the nurse and the patients wife, the wife must feel seen and heard.

The problem here may come partly from how this nurse’s role was defined for her. Her title—Case Manager—suggests to her that she is to be a “manager” of care, and that’s what she did. But people know the difference between being managed and being cared for. Is it possible that her perception of her the role as manager interfered with her ability to simply quiet down and be interested in learning about the wife?

When the stakes are so high, as they are in this sort of high acuity and/or end-of-life setting, the patient and family are exquisitely attuned, but in a very specific way: They are vigilantly looking for the attunement of the people caring for them. The way to make an encounter of this sort go well is to quiet yourself and listen.

*****

Rea GinsbergI happened upon this beautiful blog post by Rea Ginsberg shortly after this experience, and it really stirred my thinking. It speaks to how difficult and somewhat unnatural it is to simply quiet ourselves and listen. It is, however, essential.

To read the post, “Can You Hear Me Now? Listening to Grief, Notes from a Perpetual Student,” click here.

 

~ Mary Koloroutis