Communicating with Patients

Communicating with Patients

When you talk to a patient, you share information with them, and they share information with you. Communication can happen in many ways, such as:

  • Talking
  • Writing
  • Pictures
  • Drawing
  • Actions

Understanding the Patient’s Emotions

  • Empathy: Try to understand how the patient feels. Showing that you care can help build trust and make the patient feel calmer.
  • Non-Verbal Communication: Pay attention to the patient’s body language, facial expressions, and actions, especially if they can’t talk.

Encouraging Communication

  • Ask Simple Questions: Use simple yes/no questions or short sentences to help the patient express themselves.
  • Repeat Back: To make sure you understood, repeat what the patient said in your own words.

Handling Difficult Behavior

Sometimes, patients might act in a way that seems angry or upset. They might hit, bite, push, yell, scream, or kick. Patients might do this because:

  • They feel frustrated.
  • They don’t feel well.
  • It’s just part of their personality.

Remember, it’s not usually about you. The patient is likely reacting to how they feel. But it’s important to write down what happened and tell your supervisor. The care team needs to know about this behavior because it might show that the patient’s health is changing.

How to Respond When a Patient is Upset

  1. Protect Yourself: If the patient tries to hit or kick, block the blows or move out of the way. Never hit back.
  2. Give Them Time: Let the patient calm down before you try to talk to them again.
  3. Keep Them Safe: Make sure the patient is in a safe place.
  4. Give Them Space: Let the patient have some room and don’t crowd them.
  5. Stay Calm: Speak in a calm, quiet voice.
  6. Be Patient: Take your time and be flexible with the patient.
  7. Stay Neutral: Don’t argue or get into a fight with the patient. Stay calm, even if they say something mean.
  8. Use Gentle Movements: Don’t make sudden gestures or movements that might scare the patient.
  9. Be Supportive: Reassure the patient that you are there to help.
  10. Think About the Cause: Try to figure out what might have made the patient upset.
  11. Report the Behavior: Always tell your supervisor about any bad behavior so they can help.

Dealing with Non-Responsive Patients

  • Gentle Encouragement: Some patients might not respond at all. Keep talking gently and offering encouragement. Even if they don’t answer, they might still hear you and feel comforted by your presence.
  • Use of Familiar Items: Show the patient familiar objects like photos or favorite items. This can help them feel more at ease and might help them open up.

Involving the Family

  • Family Support: Encourage family members to be part of the communication process when possible. They can often help calm the patient or provide important information about what might upset or comfort them.

Where Can You Find More Information

Steps to Follow Before Hospice Patient Care

Steps to Follow Before Hospice Patient Care

Before you start taking care of a patient, follow these important steps. Doing them each time helps you remember and makes them a habit, ensuring both you and your patient are safe and comfortable.

1. Wash Your Hands:

Washing your hands helps stop the spread of germs and keeps everyone healthy. Many illnesses spread if hands are not washed properly. Always wash your hands before you start taking care of a patient.

How to Wash Your Hands:

  • Soap and Water: If you have soap and water, scrub your hands with soap for at least 20 seconds. Make sure to wash all parts of your hands, including between your fingers and under your nails.
  • Rinse: Rinse your hands with clean, running water.
  • Hand Sanitizer: If soap and water are not available, use hand sanitizer with at least 60% alcohol. Rub it all over your hands until they are dry.

Tip: You might need to wash your hands more than once during patient care. Always wash before starting any new task.

2. Explain the Procedure to the Patient and Family

Tell the patient and their family what you are going to do. This helps them feel less worried and more willing to help.

How to Communicate:

  • Speak Slowly: Use simple words that are easy to understand.
  • Speak Clearly: Make sure your words are clear and easy to hear.
  • Eye Contact: Look at the person you are talking to. This helps build trust and ensures they are listening.

Tip: Talking calmly and clearly can help reduce anxiety and make the procedure go more smoothly.

3. Give the Patient Privacy

Make sure the patient feels comfortable and respected by giving them privacy during care.

How to Provide Privacy:

  • Close Curtains or Doors: Use curtains or doors to create a private space.
  • Cover the Patient: Use sheets or blankets to cover the patient as needed.

Tip: Privacy helps the patient feel more at ease and respected during care.

4. Keep the Patient Safe

Ensure the patient is safe throughout the care process.

Safety Measures for Patients

  • Adjustable Bed: If the patient is in a bed that can move, lower the bed to the lowest position and lock the wheels to prevent movement.
  • Wheelchair: If the patient is in a wheelchair, lock the wheels to keep the chair stable.

Tip: Regularly check that the bed and wheelchair are in the correct position and locked properly.

5. Think About Your Safety

Your safety is also important. Proper positioning and adjustments help prevent injury.

Safety Tips for Caregivers:

  • Adjustable Bed: Adjust the bed to a height that is comfortable for you to avoid bending or reaching awkwardly.
  • Proper positioning: Make sure you are in a good position to avoid straining your back or hurting yourself. Use proper lifting techniques.

Tip: If the bed or chair needs to be adjusted, do so before starting the procedure to make it easier and safer for you.

Additional Tips

  • Routine Checks: Regularly review these steps to ensure you are following them correctly.
  • Ask for Help: If you are unsure about any procedure or need assistance, ask a supervisor or colleague.

Where Can You Get More Information

CDC Hand washing protocol

Steps to Follow After Hospice Patient Care

Steps to Follow After Hospice Patient Care

It’s important to follow these steps after you finish taking care of a patient. Doing these steps every time helps you remember them and makes them a habit. This helps keep both you and your patients safe and healthy.

1. Lower the Patient’s Bed

If you raised the bed to take care of the patient, be sure to lower it back down to its lowest position. This helps prevent falls and keeps the patient safe.

Tip: Always check that the bed is locked in place after lowering it.

2. Wash Your Hands

Washing your hands stops the spread of germs and helps keep everyone healthy. Always wash your hands after finishing any patient care.

How to Wash Your Hands:

  • Soap and Water: Scrub your hands with soap for at least 20 seconds. Make sure to wash all parts of your hands, including between your fingers and under your nails.
  • Rinse: Rinse your hands with clean, running water.
  • Hand Sanitizer: If soap and water aren’t available, use hand sanitizer with at least 60% alcohol. Rub it all over your hands until they are dry.

3. Write Down What You Did

Take notes about the care you provided, how the patient is doing, and any important information about the family or caregiver. Writing down what you did helps ensure the patient gets the best care.

Why It’s Important:

  • Communication: Your notes help the healthcare team understand the patient’s condition and decide if any changes are needed in their care.
  • Quality of Care: Detailed notes ensure the patient receives consistent and high-quality care.
  • Legal Requirement: Accurate documentation is required by law. If you don’t record what you did, it’s as if the care never happened.

How to Document:

  • Be Detailed: Write clearly about the care provided and any changes in the patient’s condition.
  • Include Quotes: If the patient or family member says something important, use quotation marks to note their exact words.

Additional Tips:

  • Double-Check: Before leaving, make sure the bed is in the correct position and locked, and confirm that all documentation is complete.
  • Consistency: Make these steps a routine part of your care process to ensure nothing is missed.
Caregivers: Understanding Burnout and Promoting Resilience

Caregivers: Understanding Burnout and Promoting Resilience

Caregivers play a critical role in hospice care, where the focus is on providing comfort and support to individuals nearing the end of life. These unsung heroes, often family members or close friends, offer physical, emotional, and spiritual support to their loved ones during one of life’s most challenging transitions. However, the demands of caregiving can take a toll, leading to burnout and reduced well-being. Recognizing and addressing caregiver burnout is essential for ensuring ongoing support for patients and their families.

Understanding Caregiver Burnout:

Caregiver burnout is a multifaceted phenomenon that is characterized by physical, emotional, and mental exhaustion. It can manifest as feelings of overwhelming stress, compassion fatigue, depression, and a sense of hopelessness. According to the Mayo Clinic, symptoms of burnout may include fatigue, irritability, withdrawal from social activities, and a lack of motivation or interest in caregiving tasks. If caregiver burnout is not addressed, it can have a negative impact on the quality of care provided to patients and negatively impact caregivers’ own health and well-being.

Research conducted by the Ann & Robert Lurie Children’s Hospital of Chicago and the University of Pittsburgh sheds light on the prevalence and impact of caregiver burnout in hospice settings. Dr. Michael Certo, assistant professor of pediatrics at Lurie, emphasizes the high risk of emotional, social, and financial consequences for caregivers. The study found that caregiver burnout is alarmingly common among those providing end-of-life care, underscoring the need for targeted interventions and support mechanisms.

Assessing Caregiver Distress:

To effectively address caregiver burnout, healthcare providers must first identify individuals at risk. The research team implemented a standardized method for assessing caregiver distress, recognizing the importance of early intervention in mitigating burnout. The caregiver self-assessment questionnaire, developed by the American Geriatric Society, emerged as a valuable tool for screening caregivers’ well-being. This brief yet comprehensive metric enables clinicians to identify signs of burnout and tailor support interventions accordingly.

Supporting Caregivers:

Once caregiver distress is identified, healthcare providers can offer a range of supportive measures to promote resilience and well-being. These may include encouraging caregivers to prioritize self-care, providing access to respite care services, facilitating peer support groups, and connecting caregivers with community resources. Additionally, caregivers may benefit from educational programs aimed at enhancing coping skills, stress management techniques, and communication strategies.

The Impact of Caregiver Burnout on Hospice Care:

Caregiver burnout not only affects individual caregivers but also has broader implications for hospice care delivery. Research has shown that patients who do not have adequate caregiver support may be less likely to choose hospice care, leading to delayed referrals and suboptimal end-of-life experiences. Moreover, caregiver burnout can strain healthcare resources and contribute to caregiver turnover, compromising the continuity and quality of care provided to patients and families.

Addressing the Financial Burden:

In addition to the emotional and physical toll, caregiving often imposes a significant financial burden on families. According to AARP, unpaid family caregivers in the United States collectively spend billions of dollars annually on caregiving-related expenses. These costs may include medical bills, prescription medications, home modifications, and lost wages due to missed workdays. Recognizing the financial challenges faced by caregivers is essential for implementing policies and programs aimed at alleviating economic strain and promoting financial security.

In conclusion, caregiver burnout poses a significant challenge in hospice care, impacting both caregivers and the patients they serve. By implementing comprehensive assessment tools, providing targeted support interventions, and addressing the financial burdens associated with caregiving, healthcare providers can foster resilience and well-being among caregivers. Nurturing caregivers not only enhances the quality of care provided but also ensures that patients and families receive the compassionate support they need during life’s final journey.

Where Can you Get Additional Information:

  1. Mayo Clinic. (n.d.). Job burnout: How to spot it and take action. Retrieved from Mayo Clinic
  2. National Institute on Aging. (n.d.). Taking Care of Yourself as a Caregiver. Retrieved from National Institute on Aging
  3. AARP Public Policy Institute. (2021). Family Caregiving and Out-of-Pocket Costs: 2016 Report. Retrieved from AARP Public Policy Institute
  4. American Geriatrics Society. (n.d.). Caregiver Self-Assessment Questionnaire. Retrieved from American Geriatrics Society
  5. Hospice Foundation of America. (n.d.). Caregiving at the End of Life: Finding Resilience. Retrieved from Hospice Foundation of America
  6. Morrison, R.S. et al. (2009). Palliative Care Consultation Teams Cut Hospital Costs for Medicaid Beneficiaries. Health Affairs, 28(3), w450-w460. Retrieved from Health Affairs
Anticipatory Grief: Coping with Loss Before It Happens

Anticipatory Grief: Coping with Loss Before It Happens

Anticipatory grief, also referred to as anticipatory loss or preparatory loss, is a unique form of mourning that occurs before the actual loss takes place. It is the feeling of loss that is felt before the loss happens. While traditional grief typically follows a loss, anticipatory grief begins before the loss and can be triggered by the anticipation of impending death or significant life changes. In our minds it is the “beginning of the end.” Typically, in grief, one is focused on a loss in the past. But in anticipatory grief one is focused on the loss ahead.

What is anticipatory grief?

Anticipatory grief is the emotional response to an anticipated loss. It involves mourning the impending death of a loved one or preparing for other significant life changes, such as the end of a relationship, a terminal diagnosis, or a major life transition. Anticipatory grief allows individuals to begin processing their emotions before the loss occurs, which can help facilitate the grieving process later on.

What is the difference between conventional grief and anticipatory grief?

Conventional grief involves mourning a loss that has already occurred. Anticipatory grief is forward looking. It is grieving a loss that has not yet occurred but that one believes will occur. Anticipation of loss still leaves room for hope that the loss will not happen. This hope, however unrealistic it may be, often leaves anticipatory grievers “hanging on to possibilities” in unrealistic and non-helpful ways.

Who experiences anticipatory grief?

Anticipatory grief can be experienced by anyone who is facing an impending loss or significant life change. This may include family members and friends of terminally ill individuals, individuals facing their own terminal illness, caregivers, and those experiencing major life transitions such as divorce or retirement. Anticipatory grief is not limited by age, gender, or background, and can affect people from all walks of life.  Younger caregivers and patients often experience more severe anticipatory grief.

When is anticipatory grief experienced?

Anticipatory grief can occur at any time when an individual is faced with the prospect of impending loss or significant life changes. It may begin as soon as a terminal diagnosis is received or when a major life transition is anticipated. The duration of anticipatory grief can vary widely, lasting anywhere from weeks to months or even years depending on the circumstances. Anticipatory grief may also continue after the loss has occurred, as individuals navigate the ongoing impact of their loss.

What are signs of anticipatory grief?

People experiencing anticipatory grief may show some of the following signs:

  • Feelings of sadness, anxiety, or depression
  • Preoccupation with thoughts of loss
  • Changes in appetite or sleep patterns
  • Withdrawal from social activities or relationships
  • Difficulty concentrating or making decisions
  • Increased irritability or anger
  • Physical symptoms such as fatigue, headaches, or stomach problems

What are the stages of anticipatory grief?

There are four phases that one may feel while experiencing anticipatory grief. These may come in any order or simultaneously.

  • Accepting that death is inevitable. This phase often brings sadness and depression
  • Feelings of concern for the dying person. For family and friends, this phase often brings feelings of regret – regret over past actions, prior unresolved arguments, and the like. For the dying person this may be regret over missed opportunities or fear of dying.
  • Rehearsing the death. A person may become focused on planning for death including funeral arrangements, saying goodbyes, and what needs to be done in preparation for death.
  • Imagining the future. Family and friends may envision the future without the loved one. This may include imagining holidays and other special occasions with the loved one missing. The patient may imagine how the family and friends will experience life without him. The patient may also begin to imagine the afterlife.

How can anticipatory grief be treated?

While anticipatory grief can be challenging, there are strategies that can help individuals cope with their emotions and navigate the grieving process:

1. Seek support: Reach out to friends, family members, or a therapist for emotional support and guidance.

2. Practice self-care: Take care of your physical and emotional well-being by eating well, exercising regularly, and engaging in activities that bring joy and relaxation.

3. Communicate openly: Share your feelings and concerns with loved ones and healthcare providers. Talking about your emotions can help validate your experiences and provide comfort.

4. Create meaningful moments: Make time to create lasting memories with your loved one and engage in activities that bring you closer together.

5. Seek professional help: If you’re struggling to cope with anticipatory grief, consider seeking help from a mental health professional. Therapy or counseling can provide valuable support and coping strategies.

Is anticipatory grief beneficial?

Anticipatory grief is a natural response to impending loss or significant life changes. By understanding what anticipatory grief is, who experiences it, when it occurs, signs of anticipatory grief, and strategies for coping, individuals can better navigate this challenging emotional journey.  The research is contradictory as to whether anticipatory grief is beneficial in helping cope after the loss has occurred. Some research suggests that anticipatory grief may help with coping with the loss.  Other research suggests that it has no effect on post-death bereavement.

Seeking support from loved ones and mental health professionals, practicing self-care, and communicating openly about feelings are essential steps in coping with anticipatory grief.

What is grief?

What is grief?

Grief is the emotional, psychological, and physical response to loss. It is a natural process that helps individuals come to terms with the reality of their loss and adjust to life without the person or thing they’ve lost. Whether it’s the death of a loved one, the end of a relationship, or a major life change, grief can affect individuals of all ages and backgrounds. Grief can manifest in various ways, including sadness, anger, guilt, confusion, and physical symptoms such as fatigue or changes in appetite.

Who experiences grief?

Anyone can experience grief, regardless of age, gender, or background. Grief is a universal human experience that affects people of all cultures and walks of life. Common triggers for grief include the death of a loved one, divorce or separation, the loss of a job, a serious illness or injury, or a significant life transition such as moving to a new city or retiring.

When is grief experienced?

Grief can be experienced at any time following a loss, and there is no set timeline for the grieving process. While some individuals may begin to experience grief immediately after a loss, others may not fully process their emotions until weeks, months, or even years later. Grief can also be triggered by anniversaries, holidays, or other significant reminders of the loss.

What are signs of grief?

Signs of grief can vary widely from person to person, but common symptoms may include:

  • Intense sadness or depression
  • Feelings of numbness or disbelief
  • Anger or irritability
  • Guilt or self-blame
  • Difficulty concentrating or making decisions
  • Changes in appetite or sleep patterns
  • Physical symptoms such as fatigue, headaches, or stomach problems

How can grief be treated?

While grief is a natural and unavoidable part of life, there are strategies that can help individuals cope with their loss and navigate the grieving process:

1. Allow yourself to feel:  It’s important to acknowledge and express emotions, even if they are painful or difficult to bear. A person who is grieving should give himself permission to grieve in his own way and at his own pace.

2. Seek support: : It is important that people who are grieving reach out to friends, family members, or a therapist for support. Talking about feelings with others who understand can provide comfort and validation. 

3. Take care of yourself:  Practicing self-care by eating well, exercising regularly, getting plenty of rest, and engaging in activities that bring joy and relaxation are important aspects to treating grief.

4. Honor the loved one:  Find ways to remember and honor the person who was lost. This could involve creating a memorial, participating in rituals or traditions, or finding meaningful ways to keep their memory alive. 

5.  Seek professional help:  A grieving person who is struggling to cope with the grief or who is experiencing prolonged or severe symptoms should consider seeking help from a mental health professional. Therapy or counseling can provide valuable support and guidance during the grieving process.

Grief is a natural and universal response to loss that affects individuals in different ways. By understanding what grief is, who experiences it, when it occurs, signs of grief, and strategies for coping, individuals can navigate the grieving process with greater resilience and self-compassion. Seeking support is often beneficial to many who are grieving – whether through bereavement groups, friends, or professional help. And it is important to remember that patience is required during the grieving process as it may take time to heal and find peace after loss.