We who work in end of life situations take care of the patient and the caregiver/ family. As end of life approaches, our attention and interactions revolve around the family/ caregiver as much as the patient. Our work involves creating trust with all involved as quickly as possible.
End of life work is time sensitive. We who serve need to establish a bond and trust by the end of our first visit. Time is the enemy here. Sensitive information, scary information, heart wrenching information will be shared and given.
How do we get beyond the social conventions of strangers meeting and getting to know and trust each other in a very short time? From the time we ring the doorbell for the first time, our bonding efforts begin. I begin with a handshake and introduction. “Hi, my name is Barbara. I’m going to be your hospice nurse” (or admission nurse, or social worker, or home health aide, or chaplain).
Now sit down and get acquainted before actual work begins. This get-acquainted time is as important as all the other work you will do. You’re beginning to build the trust, the comfort that is necessary for each other part of your work.
“Tell me how you’re doing? How is John doing? Tell me a bit about how everything is going for you right now.” While having this conversation, sit next to the person — not across the room, not across a table. You want to be able to touch, to feel close. Without words, you are creating a kinship with which to build trust. No laptops or tablets in sight. No paperwork. This is get-acquainted time, person-to-person time while mentally gathering information.
Then go see John and do your assessment. Much depends upon where John is in the dying process. Is he responsive? If so, maybe he was with you during this get-acquainted time. This would indicate he is probably months from death. Is he in bed, confused, in and out of awareness? Then he is probably weeks from death. Is he non-responsive? Then you assess he is probably days from death.
Where he is in the dying process will determine how you interact with him and the kind of bond you can make with him. It will also be the determining factor in the amount of visits you will be making. (My recommendation: if months, then once a week. If weeks, then two or three times a week, and if imminent, then every day, sometimes twice a day.)
Our assessment visit finished, we can now explain there is paperwork required. “Let’s sit in the kitchen (or wherever) and get the business part and paperwork signed.”
The visit is now complete. When leaving, and with all future visits, ask these questions. “Have you understood everything we’ve talked about today? Do you have any questions you want to ask me? Is there anything else you want us to talk about?” Remind them of the on call 24/7 availability.
As I leave the doorway, I again shake hands. Being the hugger that I am, by the end of most visits the caregiver and I will hug. Sometimes simply saying “I’m a hugger. Can I give you a hug?” brings the visit to a satisfying end. A connection has begun.
Something more… about Establishing a Bond- The Admission Visit
During the first visit I would like to see the “essential bundle” be shared with the family/caregivers: Gone From My Sight (“the hospice blue book”), The Eleventh Hour, and Always offer, Never Force: Food At End of Life. Gone From my Sight tells what is happening. The Eleventh Hour offers ideas of what to do while it is happening. Always Offer, Never Force suggests a way of giving the most nutrition for as long as possible. Families need this guidance after you have left and they can’t remember what you’ve explained due to fear and stress.
