How to communicate

PMHNP10 · Jun 6, 2008

Since it is the summer I decided I needed to pick up more hours so I just got a job as a Home Health Aide. I started a few days ago, and my only client right now is a woman in a nursing home who really only needs us there for companionship...the problem? She doesn't seem to want the companionship. The first night I was with her I called my boss afterwards in tears because I didn't think I could handle it. For some of the time I was there she slept, so I sat in her room and read a book, but during the time she was awake I could not get her to talk to me. If I asked her a question she would respond, but then that was it. A simple answer, then silent again. She did not seem happy to have me there and I felt very uncomfortable and out of place.
The next morning I was scheduled to go to her again, so reluctantly I did. Once again, she slept a majority of the time I was there. While she was awake I was able to convince her to play a game of scrabble with me, but she did not speak to me the entire time we played. After that, we sat and I decided to tell her stories and talk to see if it would help. I talked about my nephews and niece, stories about my previous waitressing job, jobs in general...I tried to ask about her family, grandkids etc but she wouldn't say much. I figured maybe she just doesn't want to talk about her own family...but she doesn't want to talk to me about ANYTHING.
I have had patients like this during my clinical experience, but it has not made me uncomfortable because I was able to give them space and would go help another student or nurse. But with this lady, I am assigned to spend time with her for 7 hours a day. Any suggestions of how to break this barrier? I really do not want to quit this job because of the flexible hours, and I do not want to come off as a complainer or quitter to my boss if I ask for a different assignment
So please...any suggestions? I'm desperate. I want to be a good companion & not have any more days coming home crying because I cant get through to her...
Thank you so much for reading..

Perhaps your presence alone gives her the sense of companionship she seeks. Maybe you offer her a sense of security, and that's all she wants.

Regardless, remember that this lady doesn't know you from a hole in the ground. You are a stranger in her home where she has probably isolated herself from all life for many years. Point being...it might be a while before she warms up to you, if ever.

Keep conversations relaxed, don't force anything. Make small talk and be ok with short responses. Observe her surroundings...see if she likes to watch certain tv shows or read or do crossword puzzles and inquire. See if she has pictures hanging on the walls and as you become a more familiar face to her, maybe ask her about the pictures.

Bottom line...just relax. I get a sense you are taking this personally, but I highly doubt her lack of interaction has anything to do with you.

CritterLover, BSN, RN · Jun 6, 2008

why are you there and who is paying you/who hired you?

a couple of thoughts, from someone who did a lot of "companion" work while in nursing school:

there is a good chance that you have been hired by a child/grandchild, and it wasn't her idea. possibly, she wishes you were a relative instead of someone who is paid to be there.
i doubt she has requested your presence, even if she is the one paying you.
are you there for a safety reason (the number one reason i got companion assignments) -- as an alternative to restraints
maybe she just needs some time to warm up to you
she just may be depressed, or just isn't naturally talkative
is there any dementia involved?

i wouldn't force the issue. she may warm up in time, she may not. in the mean time, i'd suggest activites that you can do alone, or she can join -- like a jigsaw puzzle. offer to read to her from the paper. watch interesting old movies (contempery to her). take her for a walk if you can. i had one lady that i would put in my car and drive her all over the city (kept her from wandering). maybe some sort of craft project. upscale coloring-books (like paint by numbers type thing -- i would just bring enough for both of you, and do it yourself. if she seems interested, offer her one). maybe she knows how to knit or crochet and can teach you or join you.

many of those suggestions depend on her mental state. but, if she is sharp and depressed, getting her to teach you something may make her feel better and break the ice. i had another lady that was very alert, and very mean to me in the beginning. she was very upset to be in assisted living. i finally got on her good side when i started asking her animal advice -- she had been a poodle breeder.

if her mind isn't still sharp, then keeping her hands occupied with simpler activities may help.

good luck.

mlisk589 · Jun 6, 2008

I work for a small company that sends caregivers out to clients. I believe it is this lady's son who decided to hire us. I have been told by the staff of the nursing home that she is a very private woman and has always been very independant. They told me not to take it personally & that she can be hard to get along with. I am trying to convince myself that just by being there and making an effort with her I am doing my job, but I can't help feeling that I am failing.

As far as her mental status, she is alert and from what the staff has told me, she only has some minor memory issues...which is to be expected for someone her age. The first night I was there, once I saw that the conversation was not going anywhere, I suggested we watch Wheel of Fortune & Jeopardy and she said that she liked watching them. But while they were on, I just felt very awkward because she did not talk to me the entire time. I have heard sometimes there just needs to be comfortable silence...but for 7 hours?

Maybe it is just because I am new to this and am not used to being with one person for so long..

leslie :-D · Jun 6, 2008

you really need to relax a bit.

good chance she doesn't want the companionship.

it was her son's decision, not hers.

given the fact that she was once independent and private, it seems she has lost both of these valued traits.

i'd be depressed too.

for her sake, respect any bit of autonomy she has left and let her be.

be available and present, but respect her space.

it really shouldn't have to be this difficult.

best of everything.

leslie

locolorenzo22, BSN, RN · Jun 7, 2008

Exactly....

I believe that as our older population starts losing things...it's a difficult adjustment for them....

they were once independent and private, and now start having people help bathe them, get them around, others cook for them, etc.....

I work in a hospital, and I am ALWAYS respectful of the fact that if someone does NOT need me there...I get their vitals 3x a shift, check their breathing q2h, and otherwise fill their water, and get them what they need....otherwise, I let them be.

It sounds like someone else thought "Oh, it'll be nice for mom to have some company for when I CAN'T be there...." but it may be viewed as a intrusion by the resident.

My personal advice would be to get there a little early one day, and perhaps check with the activity staff to see what she has been doing.....or what interests she may have indicated she's enjoyed during her admission interview. A little known fact is that residents must be assessed for EVERYTHING, including lesiure interests, within 21 days of admission.....so this may be your ticket to break the ice...

Otherwise, be respectful, and understand that it is probably not personal....the fact that you are there may be enough....keep the peace and bring lots to do.....

ON a side note, whenever I am assigned to be a patient sitter, I do all their personal care(I'm a CNA in the hospital), but it's some longgggg hours from 8PM to 5AM if the patient goes to sleep at 7PM.......personally, I do NCLEX questions, read, walk around when appropriate, and talk to the patient if they want to....but usually, they're sleeping....

decartes · Jun 7, 2008

Conversing every second does not = excellent companionship. This might be a standard you set for yourself but remember that not all of your patients will like what you like. Enjoy the silence...maybe your patient does. Let her open up at her pace.

mlisk589 · Jun 10, 2008

I apologize if I seem like I am being dramatic and paranoid about this...I guess it is just a totally different experience for me that I am not used to. I am used to having multiple patients/residents to go to and from. At clinical if I have a patient who wants privacy, I respect that. I give them space and obviously perform my duties while checking on them appropriately. But with this job I guess I just feel as though I'm not doing it if I just sit there not doing anything. Maybe with some clients that is just part of being a home health aide...but it is totally new to me, so I can't help feeling as though I'm doing something wrong.

I also understand that constant talking doesn't necessarily mean excellent communication. It is just an awkward situation that, once again, I am not used to being in.

chenoaspirit, ASN, RN · Jun 10, 2008

you really need to relax a bit.
good chance she doesn't want the companionship.
it was her son's decision, not hers.
given the fact that she was once independent and private, it seems she has lost both of these valued traits.
i'd be depressed too.
for her sake, respect any bit of autonomy she has left and let her be.
be available and present, but respect her space.
it really shouldn't have to be this difficult.
best of everything.
leslie

I agree. Just be there, dont expect anything. I bet in time it will get easier for both you and her. Neither of you really know each other, give it time. I wonder if she feels that she is wasting YOUR time and is uncomfortable...feeling like a burden to YOU. Try to let her know that you enjoy being there with her. Just casually say things like "Its so nice to be able to sit and relax with good company" or "I really enjoy being able to ..." During a movie, say "Ive always wanted to watch this, but never had the chance to..." Know what I mean? Try not to be so tense. Maybe you could talk to her son and learn her likes and dislikes.