A friend approached me about caring for her elderly, increasingly disabled, parent. She told me about how her mom had become forgetful, slightly confused, and had a tendency to fall. Her worried eyes told me volumes about how overwhelmed she was and about her own confusion as to how to proceed. "So what do I do?" she asked with a sigh, "Mom refuses to move. She says she wants to die in her own home. I feel lost."
As nurses, we are often faced with these types of questions. Sometimes they come from family, other times from friends and even neighbors. Whether it is a caregiving question or a treatment question or a need for a referral, our contacts look to us as professionals that can help.
Most of us really do want to help. People often go into nursing because they long for an opportunity to make a hands-on difference to others-to really help their family, friends, and neighbors. In fact, the ANA's official definition of nursing includes many of these aspects, "Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations." (What is Nursing?)
When faced with a question like the one my friend posed to me, the temptation is strong to simply provide the answer, as we see it. After all, many of our experiences in most nursing settings provide at least limited exposure to potential solutions for caregiving quandaries. My own years of work as a parish nurse, hospice nurse, and even home health nurse immediately prompted a quick list to come to the tip of my tongue. The list would include my "Most Helpful Hints for People in Your Position." However, even longer experience of helping people reach their own solutions to problems led me to almost literally hold my tongue to avoid offering my own solutions.
So how do we really help people that come to us with questions?
Hold the answers
As I pointed out above, serving up a tray with our version of the best way to proceed will most likely meet with rejection, dismissal, defensiveness and even anger. People know, instinctively, that we cannot possibly understand what they are really going through. We cannot know all things. Therefore, our particular solutions offer only a pale light to a murky puddle of problems.
If we allow people to talk through their dilemma, they often circle back around to their own way forward. What we provide here is honest attention, encouragement, and maybe a prompting or two to help them focus. As nurses, we can be great listeners. We are trained to use our body language to show attention; we know how to reflect and rephrase comments; we have the background and scientific knowledge that makes us qualified as well as comforting.
We can't really know everything. We are not walking in this person's shoes. Many years ago, I had a friend whose husband was diagnosed with pancreatic cancer. She knew that I worked hospice. He had the grim prognosis afforded to people with Stage 4. Her question was whether or not to pursue treatment. I realized immediately that she was not really asking me to offer my opinion. Under the tears, she showed a steely resolve to help him fight-he wanted to die in the fight. When she left, my heart followed her out the door, because I knew the pain that was ahead, but I also felt a lot of respect and love for two people who made a difficult decision, based on information they had been given.
Sometimes people feel jumbled, confused, weary. They have a hard time sorting through all the medical jargon to reach the message. Their difficulty lies in clarifying choices, simplifying and categorizing decisions to be made. After listening with humility, we can often ask a pointed question that will help make the matter less murky. For my friend who was dealing with her mother's care, I asked, "What are your mother's goals for this time in her life? What are your goals?" My hope was that by phrasing it this way, my friend would be able to see more clearly how to proceed.
If you are well-versed on community resources, you may be able to make appropriate referrals. If not, you likely know a case manager or someone else who can help offer direction. Many times, people feel trapped. They can't see a way forward. They suffer from hopelessness. Our job is to try to offer options-with options comes a sense of control, because if people feel that they have a choice, then the sense of being trapped is lessened. The choices may not be great but they are, nevertheless, a way forward.
My friend ended up coming to a compromise with her mother: she installed a lifeline-type phone assistance, hired caregivers daily and worked out a weekend rotation with her siblings and family that provided a family member every weekend. It was a hodge-podge solution, not elegant, certainly not simple, but it worked for them. As nurses, most of us want to serve. Paradoxically, by being careful listeners, and actually refraining from fixing the problem, all the while admitting humbly that we can't see everything about the situation, we may truly be able to help.