A few weeks ago I was helping a Hospice build self-learning modules for nurses. We were filming a video for the nurse visit. It was . . . fine. All the points in the visit structure were there. Technically nothing was missed. But something was missing. Warmth. Touch. Caring. I asked who their best CNA was and could she come in. We gave talked with her a bit and got the following bits of information. Then we asked her to show us how she does a visit. It was quite moving. We filmed it of course, and now all the nurses at this Hospice will learn “touch” from this self-learning module. My notes from our talk which her are below, but the key take-away is two-fold: Touch and stories. She unconsciously touches and just as unconsciously leads the patient into telling her story. The combination of the two affirms and validates the life of the Hospice patient.
Think of these as quotes from the CNA
- All attention is on the patient
- We just do what they want
- Wash hair (we filmed her doing this)
- Doing nails
- Shower, bed bath—must be thorough
- Back massage, hand massage
- Play them music; read to them
- Simple conversation about the patient—trying to get them to tell their story (need question list)
- I just want to take their minds off their sickness and help them forget about it for a while.
- Just ask and listen
- Like to put lotion on them; if you see perfume or makeup about, use it
- Like to blow dry their hair
- Sometimes dress them because it makes them feel good
- I take them out into the sun and just sit with them
- I love my patients (what type of pre-employment test can screen for this sort of personality?)
- Help them exercise their fingers
- Three times a week—call first or the patients worry
- Don’t treat them like a sick person
Based on this we want to make our CNA visits a little longer and teach all our CNAs the questions and phrasing we want them to use to get patients to talk about their lives and to move the patients to DO some of the things our CNAs can do for them—for example suggest don’t just offer (Let’s have spy day!). Then, we’ll have our nurses certify on the CNA visit as well as their own. We want all our clinicians to be more like our CNAs. Keys: Touch and Stories
We decided that if a visit feels like a trip to the doctor, we’ve failed.