Five Ways to Prevent Caregiver Miscommunication

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Sue Collins, RN, Hospice Nurse

 

Human beings retain about 25% of what they hear, but after three days, that drops to somewhere between 10-20%. So it’s no wonder that what a non-professional caregiver hears about home visits, covered medication, equipment, treatment plans etc. and what professionals think they are conveying can be worlds apart. It’s a recipe for frustration and stress on both sides.

Over and over I have seen families frustrated by the difference between what they thought they read or heard and the information the professional thought he or she was giving. This can be distressing for an already overwhelmed family when they feel they are right about their interpretation of what was said and yet have only their already overburdened memories to buttress that conviction.

To add to the problem, medical professionals are figuring out how to navigate through the Medicare reimbursement cuts that are resulting in shorter length of stay or visit. As a result, attention to customer satisfaction can fall through the cracks. Hospice workers in particular are aware that they meet families at a very vulnerable and often overwhelming time in life. While intending to provide compassionate care and comfort, doctors, nurses, aides and administrators can all inadvertently add to the anxiety and stress by failing to effectively communicate facts about specifics of care. Navigating this divide well can instill confidence in the caregiver and offer reassurance to the medical professionals that communication is clear.

What can those caring for a loved one do?

  1. Repeat back what you are told (if having an actual conversation) so any misunderstanding can be corrected immediately.
  2. Either highlight or take notes on documents or written instructions, and make an appointment to discuss your questions. Avoid communicating through an email, which can be misinterpreted by the reader. Emails do not necessarily reflect emotions, so the recipient may not ‘hear’ one’s frustration or uncertainty, which factors into the equation.
  3. Keep a log with times, dates and information on medications given, treatments received or wound care administered to accurately discuss with medical professionals as needed.
  4. Ask questions. Anytime someone says something you don’t understand, or that doesn’t feel right ask for clarification and jot down the answer.
  5. Always call if there is a question or problem. Never assume.

 

At times we are afraid to ask questions because we are not sure we want to know the answers. One of the most difficult tasks I ever did as a nurse was to have a friend sign the consent forms for the hospice benefit, which meant I had to explain and make sure there was a clear understanding of what he was signing. I tried my best to soften the blow while being honest about the content of the documents. When I got to the part of the document about agreeing to seek comfort not aggressive medical care, my friend turned and looked me straight in the eye for what felt like eternity and said nothing. But I got it. I felt it. The stare made me feel very uncomfortable and I interpreted the stare to mean: Don’t try to sugar coat the information. I was too nervous to actually ask what he was thinking and clarify his look. With a stranger that would have been no problem, but this was a friend. It made me very aware how carefully to choose my words moving forward; a straightforward approach became my technique.

On the flip side I became aware as a patient and family advocate, of how we are often treated in medicine. I realize, sometimes, depending on the situation, being vague and not forthcoming with information is NOT unusual. For example, some medical professionals tend to be vague particularly when dealing with end of life issues or a diagnosis they are not completely sure of. For instance you could be told the blood work is normal without a suggestion for other tests, a kind of ‘Let’s wait and see’, while you are wondering why you cannot get any relief. So it’s no surprise there’s a great deal of confusion on the part of both caregiver and the one being cared for when interacting with the medical professionals.

No one expects caregivers to know any of this walking in, especially as medicine and its policies seem to change frequently, so ask, ask, ask until you do understand. It will spare you frustration, anxiety and anger, which can all add up to a big load of stress. All the best!

Sue Collins, RN and longtime hospice nurse is a co-author of Ok Now What? A Caregivers Guide to What Matters (Head to Wind Publishing, 2014

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     5 Ways to a Better Beginning

 

by Sue Collins

We are very predictably inundated this time of year with the latest diet trends, list of good and bad foods to eat, tips on losing 10 pounds in a week (yeah –right) and all the new 30 day challenges — push ups, abs, squats, butt lifts (!). And this year, to add one more wrinkle, we’ve also got the latest US Department of Agriculture’s (USDA) new food pyramid to considerUnknown

As a caregiver the LAST thing you need or want is another challenge. Sometimes at the end of a long day of caregiving you are ready to sit and put your feet up or simply go to sleep. Sometimes the thought of doing it all over again the next day can bring about feelings of anxiety, apprehension, worry and fear. It can all feel overwhelming at times. But just as in the life of a parent, a little planning and preparation goes a long way in the life of a caregiver. For example, some parents, especially those of young children, prepare the night before their children go to school or daycare by setting out clothes, packing lunches, arranging for after school activities. Yes, not everyone is that well organized – but it doesn’t take much. Spending a few extra minutes before you prop up your feet or go to sleep can start your day a little easier.

Here are five ways to reset you routine:

  1. Set out all the medicines in a multiple pillbox or an empty egg carton that you’ve labeled with the times: morning; noon; evening; and bedtime. Note any medicines that are low and need refilling.

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    Egg carton with medication times labeled on lid
  2. Throw some food in a crock pot and set the temp on low for a nutritious meal the next day. A stew of any kind – beans with a ham bone, beef and vegetables, a chicken and veg – all are quickly prepared and are also a good way to clean out the fridge.
  3. Be sure items used for personal care — bathing, shaving, hair and mouth are in the location in which they are used for thing in the morning.
  1. Prepare for any scheduled outings, doctors office, treatment center or just a drive in the car
  2. Give family members updates via email or facebook
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Beans in a slow cooker with a meaty bone, water, onions and a handful of whatever herbs make a great and easy winter meal.

It sounds like a long list, but it takes longer to read than to do for the most part. Even if you only do a few of the evening preps for the morning, you will be able to relax more completely without having to think about the tasks of tomorrow. Most importantly, do something nice for yourself, snuggle in your favorite chair and read or watch a TV show, call a friend, listen to music, knit or color in the new adult coloring books. Make this your New Year 30-Day Retool. Getting into a new routing can take a little time (usually figure two weeks to make it into a habit). But once it is, it will make things easier. OK Now What? A caregiver’s Guide to What Matters, which promotes a proactive approach to caregiving – with special focus on the caregiver and his or her healthy and wellbeing – offers other simple tips. For more ideas see The Fifteen Minute Ritual.