Bridging the gap between families and staff; how one facility focused on communication approaches that have made families allies rather than Adversaries - Cover feature

Nursing Homes, August, 2003 by Sandra Hoban

Speak clearly. As important as it is to listen carefully, participants are taught to convey their messages clearly and respectfully to diffuse defensiveness and divisiveness. This facet of PIC uses role-playing to convey the message that problem solving is not "I"-focused, but "we"--focused. In the above scenario, for example, instead of just throwing the question at the CNA, participants learned that a family member who prefaces a question with a polite, "Excuse me but ...," will garner a better response, such as, "May I get back to you in a moment because...." In this way, the family member acknowledges the staff member's busyness but realizes, with the staffer's polite response, that his or her concern is seen as valid and that the staff member wants to give it complete attention when he or she is able.

Understand cultural differences. Recognizing and adapting to the various cultures, ethnicities, and languages of residents and staff are essential to effective partnering. Through the workshops' lectures, exercises, and other training modalities, staff learned, for instance, that what might be considered rude or uncaring in one culture or to one ethnicity might simply be a normal style of behavior or speech in another. Horn explains, for example, that Hispanic people generally move closer to a person when conversing, which can be intimidating or seem rude to others who require more personal space.

Another example Horn cites involves touching. "In some cultures touching can be seen as highly improper. For example, Cambodian and Thai mores do not permit touching or patting people, including children, on the head because the head is recognized as being closest to the spirit," remarks Horn. She adds, "Cultural differences are apparent even in decision making. For example, Taiwanese families abide by the decisions made by elders, while Americans generally decide advanced directives and other issues by consensus. Awareness of these differences can prevent accidental affronts."

Improve communication facility-wide. The final segment of each group's workshop was to identify particular areas of concern in the facility that could be remedied by improving communication After each group developed its talking points on these issues, they met in a joint session to brainstorm, design, and implement tasks that would focus on solving them. "The joint meeting," explains Horn, "included administration (CEO, administrator, and department heads), as well as both groups of trainees. With the help of our facilitator, all recommendations were reviewed. From them, a Cooperative Communication Action Plan was developed to pinpoint tasks and measure outcomes."

The action plan recognizes that successful family-staff partnerships begin on the first day of admission. One of the assigned tasks required of everyone--from administration to housekeeping--is to smile and say hello to one another not just to the resident and his or bet family. "Basic courtesy helps immensely when problems do arise," says Horn, "because it reminds people of their common mission--providing optimum care to the resident."