Transcript Legal and Ethical Situations that Accompany Supervision

"The Respect-Worthy
Supervisor: Receiving and Giving
Respect in Home Health Care
Supervision.“
Rita A. Jablonski, Ph.D., RN, ANP
Anthony J. DeLellis, Ed.D.
Respectful Supervision
• Begins with respectful communication
Give respect to get respect?
?
• Usually get respect if you give respect, but
no guarantee
• Get no respect if you give no respect,
guaranteed
Giving respect - names are
important
• Call people what they want to be called: If
her name is Mary Jones, do you call her
Mary, Ms. Mary, Miss Mary, Mrs. Mary, Ms.
Jones, Miss Jones, Mrs. Jones?
Giving respect - names
Ask people what you should call them, and
then just do it
Respect is listening
• Listen actively
• Look, stop, wait - let them finish
• Don’t interrupt
• Turn off radio, TV - completely off
• Let them know you heard and understood
• Paraphrase
Respectful communication • Respect is something we feel, even if we
don’t show it.
• So show it!
Tone and choice of words
matter
• Use respectful tones.
• Use courteous language, always.
Clothes matter
• How we dress sends a message to the
people around us about how we feel
about them.
Assertive vs Aggressive
Communication
Assertive - say what is on your mind, but
keep in mind the feelings of others.
Aggressive - say what is on your mind, but
don’t care about the feelings of others or
deliberate try to hurt or offend them.
Politeness and Power
• Powerful people can afford to be polite.
• Politeness isn’t weakness.
• Politeness isn’t being somebody you’re
not.
• Politeness to rich and poor alike is powerful.
Addressing Unsatisfactory
Performance
Opportunity to help the NA to concretely
understand workplace obligations
Cultural differences regarding “on time”
Differences in work ethic among members of
various age cohorts, e.g. “entitlement” in
workers under the age of 30 versus “work
until you drop dead” ethic of workers in their
60s
Addressing Unsatisfactory
Performance
May be the first time a worker has had to
problem solve
Instead of telling the worker, “Late
again, you are fired,” try asking the
worker a series of questions to help him or
her figure out options
“Coaching” type of management
Be assertive when coaching
• Speak assertively, not aggressively.
• Stick to the point.
• Describe the behavior, don’t characterize
the employee as a loser.
• Don’t be afraid to praise someone who is
not perfect - when praise is due.
• Don’t use praise to avoid conflict.
Coaching is shared risk
• Coaches rise or fall when their teams rise
or fall.
• Coaches find inner motivation of team
members.
• Team members eventually have to go it
alone.
Disagreement
• Disagreement with an employee is never
an excuse to switch from assertive
communication to aggressive
communication.
• Respect, assertiveness, listening, and
politeness are especially important during
disagreement.
Effective Supervisors
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Compassionate
Creative
Decisive
Empathetic
Fair
Flexible
Humble
Objective
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Problem-solver
Respectful
Self-directed
Self-evaluative
Understanding
Visionary
System-thinker (able
to see big picture)
Hewlett, et al., “Minnesota Frontline Supervisor Competencies
& Performance Indicators,” U. of Minn., 1998.
Some Guiding Principles for
Supervisors
• Internal motivation.
• External motivation.
• Recognition.
• Importance of staff
•
development &
training.
2 important
questions:
• What motivates you?
• How do you want to
be recognized?
•
LaLiberte, Hewitt and Larson, “Staff Motivation and
Recognition.”
Challenging Issues in Home
Care
Legal and Ethical Situations that
Accompany Supervision
Legal Definitions
• Assault (criminal act)
An attempt to inflict physical injury on a person; the
unwanted touching of one individual by another
• Battery (criminal act)
The actual infliction of physical injury on a person.
Includes “every willful, angry, and violent or negligent
touching of another’s person or clothes or anything
attached to his person or held by him” (Creighton,
1986).
Legal Definitions
• Unlawful use of restraint
Could be considered assault and battery
– Care must be taken to use only with a
physician’s order; to monitor the client
frequently (minimum, every hour); to remove
the restraints and exercise the limbs
(minimum, every 2 hours)
Legal Definitions
• Tort
A legal wrong, not a crime (a crime must have
evil intent and involve a criminal act).
– A legal right of a person is somehow violated, and the
violation is called a “tort.”
– A legal case involving torts is heard in civil, not
criminal, court.
– Example: two drivers are involved in an automobile
accident. No criminal charges are filed. One driver
sues the other.
Legal Definitions
• Negligence
“The omission to do something that a
reasonable person, guided by those
considerations that ordinarily regulate
human affairs, would do, or as doing
something that a reasonable and prudent
person would not do” (Creighton, 1986, p.
141)
Legal Definitions
• Malpractice
“any professional misconduct,
unreasonable lack of skill or fidelity in
professional or judiciary duties, evil
practice or illegal or immoral conduct”
(Creighton, 1986, p. 141)
Legal Definitions
• Defamation
The ruining of a person’s reputation by verbal or
printed statements; any verbal or printed
statements that could be considered detrimental
to a person’s personal or professional reputation
– Slander
Oral defamation
– Libel
Written/published defamation
Legal Definitions
• Neither slander nor libel refers to a
conversation or written communication
between 2 persons, unless overheard or
witnessed by a third person.
Legal Definitions
• Defamation is not an issue when there is a legal
duty to speak.
• Confidentiality
– Be aware of potential HIPAA violations, especially
when carrying client records and information in your
car.
– Be aware of your surroundings when using your cell
phone in the field. Password protect laptops, Palm
devices
Types Of Legal Issues
Types Of Legal Issues
• Living Wills
– Also known as Natural Death Acts, Patient
Self-determination Acts
– These documents state which specific
treatments may be rendered if a client is
unable to make medical decisions for him or
herself.
Types Of Legal Issues
• Patient-specific treatment instructions
– Designation of a proxy to make these
decisions
– Do Not Resuscitate Orders
– Medicaid regs do not require that DNR orders
be kept in the client file in the agency, and as
a practice, agencies do not obtain a copy.
– The DNR notice is to be posted in the room or
on the client’s door.
Types Of Legal Issues
– The RN’s responsibility is to discuss this with the
family and instruct the aide as to the family’s wishes
regarding who to call should the client become
unresponsive.
• That may be the rescue squad, hospice, or a family member.
• If the family wants the rescue squad called, it is important
that the nurse instruct the family to have DNR orders posted
in an obvious place.
• The RN would insure that the aide understands what DNR
orders are and what the aide’s responsibilities are as a result.
• Usually, DNRs stipulate that no “heroic” efforts be made in
the event of severe illness or cardiovascular arrest.
• Can be modified, e.g., may not administer CPR and
intubation but may use medications
Ethical Issues
Ethical Issues
•
Ethics
–
–
A body of knowledge concerned with the
rightness or wrongness of an act. In the
professional arena, ethics refers to the
rightness or wrongness of professional
conduct.
Something may be legally “right” but
ethically “wrong,” depending on a person’s
own code of ethics: e.g., abortion
Ethical Issues
•
Types of ethical views
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“Do no wrong”
“The end justifies the means”
“The individual’s choice takes precedence
over society’s views”
“I know what is best for you”
Ethical Issues
•
Clients should be active participants in
decisions about matters that involve
themselves or their lifestyles
Ethical Issues
•
Decision-making is problematic with
cognitively impaired individuals
Ethical Issues
•
Supervisors must be able to help PCAs
realize that individuals with cognitive
impairment may be unable to make
decisions is some areas, but may be
able to make decisions in other areas
•
–
Mental capacity fluctuates, resulting in periods
of lucidity and confusion
Respect for others as one useful guiding
principle in remaining ethical
Violence in the Client’s Home
Violence in the Client’s Home
• National Institute of Occupational Health
and Safety
• “Physical assault, threatening behavior, or verbal
abuse occurring in the workplace”
• Usually client-caregiver; also caregiverclient, , caregiver-caregiver, familycaregiver
Violence in the Client’s Home
• Violence is not often recognized as a
problem in the home.
Violence in the Client’s Home
• Many administrators and licensed nurses
have been acculturated to view violence
as “part of the job”
• Many administrators think that physical
abuse upsets PCAs more than verbal
abuse; actually, PCAs can be just as upset
with verbal assaults such as racial slurs,
cursing, and demeaning remarks
Impact of verbal and physical
abuse on PCAs
• Feelings of hurt, anger, frustration,
resentment, sadness, disrespect, being
violated, shock, and fear
• Less willing to spend time with offending
clients, less willing to care for them
• Absenteeism, negative behavior toward
supervisors, quitting job
Making a difference
• Put a mechanism in place for PCAs to
report violent behavior by clients
• Ask about the existence of physical or
verbal abuse during supervisory visits, and
be prepared for more information than
you expected; make sure you document
interactions and interventions in your
notes
Making a difference
• Recognize that the violent or abusive
behavior may be triggered by a specific
event (e.g., bathing) or may be due to
feelings that cannot be expressed by a
cognitively impaired individual.
Making a difference
• Once PCAs alert the nurse supervisor
about this behavior, the nurse needs to do
the following: speak to the family
regarding what they have done to
successfully handle the abusive and
violent behavior; advise the PCA as to the
best approach.
Making a difference
• If the family is also grappling with the
same issues unsuccessfully, the RN should
urge the family to discuss possible
solutions with the health care provider
(MD, NP).
Making a difference
• The nurse should advise the family that
solutions to violent and aggressive
behavior must be sought if the client is to
remain in the home with the NA. In fact,
this is a common reason for NH
placement.
Making a difference
• Need to stress that UNDER NO
CIRCUMSTANCES IS IT ACCEPTABLE FOR
CAREGIVERS TO “HIT BACK” OR
RESPOND IN KIND TO A CLIENT’S
ABUSIVE BEHAVIOR.
Making a difference
• Virginia has a mandatory reporting statute
and it is the nurse’s obligation to make an
APS referral for all cases of suspected or
actual abuse and neglect.
Making a difference
• Sometimes agencies and individuals are
reluctant to report because it becomes
very uncomfortable and is sometimes
impossible to continue to provide services
for a client when a family member is
angry with the agency for reporting
suspected or actual abuse.
Recognizing abuse towards clients
• Unexplained bruises, cuts
• Pattern to bruises, cuts: fingerprints, cords
• Sometimes the result of violence against the family
•
caregiver—“payback”
Sexual abuse does occur
– May see vaginal/rectal bleeding, spotting, complaints of pain
with urination
• Caregivers who are emotionally and physically exhausted
are at risk for abuse—important for PCAs to recognize
this and report to supervisors, so that the agency may
help avert future problems
Helping Your Staff Care for
Clients with Dementia
Helping Your Staff Care for Clients
with Dementia
• Explanation of Dementia
– Dementia is an all-inclusive term that refers to
global confusion and forgetfulness.
– It is gradual in onset and proceeds at a slow
rate.
– It is irreversible
– Can be aggravated by depression
Helping Your Staff Care for Clients
with Dementia
– Associated with many diseases
• Alzheimer’s Disease
• Cardiovascular disease
• Atherosclerosis
• Cerebrovascular accidents (CVA or stroke)
• AIDS
• Is not a ‘normal’ part of aging
Helping Your Staff Care for Clients
with Dementia
– Common behaviors in dementia
• Non-aggressive
• Moaning, repetitious words or sentences
• Wandering, rocking
• Aggressive
• Yelling, cursing, screaming
• Hitting, spitting, biting
Helping Your Staff Care for Clients
with Dementia
•Paranoia is not uncommon, especially
when the person with dementia is
trying to make sense out of the
environment or situation.
–In early stages of dementia, the person
knows that something is wrong. In later
stages, the person does not know that
something is wrong, and blames other
people for missing items, changes in the
routine, etc.
Helping Your Staff Care for Clients
with Dementia
• Sexual behavior, such as masturbating in
public is also not uncommon.
– Sexuality is present in aging and disabled
persons, and the confused person is often
seeking sexual solace.
– Persons with dementia may confuse another
client for a spouse or may forget they were
ever married.
– Inhibitions are removed, which explains why
sexually inappropriate behavior may occur in
public.
Helping staff work with clients with
dementia
• Several researchers have developed a
model to explain the disruptive behaviors
associated with dementia
Helping staff work with clients with
dementia
• Need-driven, Dementia-compromised Behavior
Model
– All behaviors, no matter how distasteful, are the
result of the clients’ response to some emotion or
fear. Clients with dementia have difficulty interpreting
stimuli and may react with violence if they believe
that they are being harmed.
– It is important to realize that the person with
dementia does not exhibit disruptive behavior
because they choose to, but the behavior is the result
of the dementia—communication patterns are altered
by the disease causing the dementia
Helping staff work with clients with
dementia
– Assessing reasons for disruptive behavior
• Misinterpretation of surroundings
Helping staff work with clients with
dementia
• Persons with dementia have limited capacity for
learning new information. Even though they are
told several times, “this is the bathroom,” they
may still misinterpret the surroundings and may
react with fear
• Vision and hearing impairment may further create
problems with correct interpretation
Helping staff work with clients with
dementia
• Pain and painful procedures
• May be aggravated by clients who are resistant to
taking medication and may not receive their pain
medications
• Stress
• Sensory overload
Helping staff work with clients with
dementia
– Meaningless noise
– Desire for immediate attention
– Loss of control/autonomy
– Fatigue
Helping staff work with clients with
dementia
– Desire for sexual intimacy
– Change in routine
– Psychiatric co-morbidities
– Failure of staff to acknowledge
communication attempts and failure to
anticipate and meet resident’s needs. This can
only happen when they know the resident.
KNOW THY RESIDENT should be the gospel
of disruptive behavior management
Helping staff work with clients with
dementia
• Strategies for helping PCAs to cope with
disruptive behavior
– Determine antecedents to the disruptive behavior
– This may be challenging because the cause may not
be immediately apparent, and the cause may not
always be consistent (i.e., whatever caused the
disruptive behavior yesterday may not cause
disruptive behavior today). A pattern needs to be
determined. Important for staff to discuss what they
believe precipitated the disruptive behavior.
Helping staff work with clients with
dementia
– Bathing is a usual antecedent. If water is near
the face or head of a confused person, he or
she may react in an aggressive manner
– Let the client get into the tub slowly
– Approach client in a relaxed manner
– Less likely to provoke agitation. If one
approaches a confused person in an
authoritarian or “bossy” manner, the client
may react in an unfavorable way.
Helping staff work with clients with
dementia
– Avoid being focused solely on the task:
• “Hello Mrs. Jones, how are you? Here, let me help
you get this dress on. How’s that?”
• “Hello, Mrs. Jones. I’m going to help you get
dressed.”
– The second approach will more likely result in
agitation than the first approach.
Helping staff work with clients with
dementia
– Have the client control the flow of water (e.g.,
using a hand-held shower head to direct the
flow of water)
– Sometimes, the client does not understand
what is expected of him or her with a specific
task, and may become frustrated and act out.
Helping staff work with clients with
dementia
– It is a good idea to talk to the client about
personal things of interest to him or her
during tasks (e.g., grandchildren, previous
occupation, favorite activities)
– Be flexible in approach with client
– The use of gestures and pantomime to show
the client what you want him or her is helpful
Helping staff work with clients with
dementia
– Do not limit your conversation to the client
because of the confusion. “Chatting away”
with the client has been shown to improve
agitated behavior. The client may respond to
the verbal stimulation.
– However, when asking the client to do
something, use short, one-step REQUESTS,
not commands. Do not keep repeating the
same request, otherwise the client may
become agitated
Helping staff work with clients with
dementia
– Show interest in the client, both verbally and
nonverbally
– Avoid interruptions
Helping staff work with clients with
dementia
– Studies have shown that interruptions
resulted in increased agitation and tension on
the part of the client and decreased flexibility
and personal contact on the part of the
nursing assistant.
– Remember not to take aggression personally,
unless you have deliberately done something
to provoke the client, it is not your fault!
– Praise the client in an adult-like manner.
Helping staff work with clients with
dementia
– Have manipulatives in the environment
– In the home environment, encourage families
to have items available that are associated
with activities that the client previously
enjoyed. One family kept jumbo blunt
knitting needles and bits of yarn in a basket
for their grandmother, who was an avid
knitter prior to the dementia. She derived
comfort from sitting and holding the items in
her lap.
Helping staff work with clients with
dementia
– Use touch judiciously
– Some clients respond well to touch; others
may react negatively. Find what works with
your clients.
Helping staff work with clients with
dementia
– If the client is already agitated, touching in a forceful
manner may escalate the agitation
– Remove client from the disruptive area, if possible
– If the client is engaging in sexually inappropriate
behavior (e.g., masturbating in public), will need
redirection. Depending on the severity of the client’s
dementia, you may be able to encourage him or her
to refrain from this behavior in public and to engage
in it in a private area.
Helping staff work with clients with
dementia
– Distraction
– Humor or playful responses may divert the
client’s attention from the discomforting
situation and may stop the aggressive
behavior
Helping staff work with clients with
dementia
– Keep clients busy
– In one study, disruptive behaviors rarely
occurred during organized activity or when
clients were proceeding to an activity.
However, 72% occurred during periods of
inactivity
Supervisory Meetings and Plans of
Care
• Encourage participation from PCAs
– By alerting the agency if disruptive behaviors
become unmanageable
– By identifying triggers to disruptive behavior
– By sharing proven intervention that work in
preventing disruptive behavior
Supervisory Meetings and Plans of
Care
• Communicate these interventions to the
scheduling coordinators, and asking that
those interventions be passed on to any
new aides assigned to the case. May want
to document this information in the
nurse’s notes as well
Supporting Your Staff When a
Client Dies
Supporting Your Staff When a
Client Dies
• Help PCAs recognize that loss is a part of life
• Can be sudden (death of a young person) or
•
expected (death of a terminally ill person)
Can be bittersweet
– Transition of a child from infant, to toddler, to
preschool, to school age
– Loss of a child leaving home, but going to college and
growing up
– Some losses seem bad initially, but then turn out to
be a blessing (a man is laid off from one job, only to
find a better one)
Supporting Your Staff When a
Client Dies
• When losses are ‘bunched’ together, as in
older years, multiple effects can be
devastating
Supporting Your Staff When a
Client Dies
• Reactions to Loss
– Because losses are personal, reactions to loss
are individualized
– What may be a small loss to me may be a
larger loss to someone else
– The process of grieving is called
“bereavement”
Supporting Your Staff When a
Client Dies
– Although the process is individualized, there
are some general components
• Sadness
– The person is unhappy with the loss. He or she
expresses sadness, cries.
• Denial
– “This isn’t happening.” “If I ignore it, I won’t have to
deal with it.”
Supporting Your Staff When a
Client Dies
• Anger
– Can be at self or others
– May belittle others, may become a “difficult” or
“demanding” client
– Sometimes, PCAs are targets because they are “safe;” a
client may be angry at a son or daughter, but can ill
afford to antagonize that person, so he or she takes out
the anger on a PCA May express anger by trying to exert
control over those items that the person still has control
over.
– Example: a quadriplegic client who calls the PCA every
five minutes for a minor, trivial requests, and/or verbally
abuses the PCA
Supporting Your Staff When a
Client Dies
•Blaming
–May seek to make someone else the
culprit for the loss. This is an attempt to
make meaning out of a loss—This bad
thing happened to me because…
–May blame self or others: “If only I had
taken my medicine, I wouldn’t have had
this stroke.”
Supporting Your Staff When a
Client Dies
• Bargaining
– “If I can learn to walk with this walker, you will
let me go back to my apartment, right?”
– Can be with family, health care providers, even
God
• Depression
– The person may lose interest in food, enjoyable
activities
– May sleep all of the time or most of the day
Supporting Your Staff When a
Client Dies
• Acceptance
– Reconciles the loss with overall picture of self
– Adjusts self-concept to “fill up” hole left by loss
– This process may take days to years,
depending on the extent and importance of the
loss
– Some people move out of one stage, only to
return to it later
– Some stay “stuck” in stages
Supporting Your Staff When a
Client Dies
• Role of the Supervisor
– Anticipate the loss and prepare PCAs
Supporting Your Staff When a
Client Dies
– Know the persons most at risk:
• Start of care
• Holidays
• Holidays hold memories of family gatherings and rituals.
Losses may be felt most acutely the day of the holiday or
immediately after, when family members or friends leave.
• May cry easily and all of the time
• Anniversaries
• Birthdays, wedding anniversaries, and death anniversaries
may trigger memories and feelings of loss
Supporting Your Staff When a
Client Dies
• Persons with previous histories of depression
• Persons who are rigid or negative
• Persons who are flexible and resilient cope better with loss
than those who are not. Example: Mrs. S. was a morose
individual who was rigid and negative her entire life. She
was very demanding during each visit when the PCA was
with her. She would also complain during the entire visit
about the care she had received from other caregivers and
agencies. The PCA began to dread her visits and asked to be
reassigned to a different case. How can the aide be helped
to deal with her frustration in order to remain on the case
with Mrs. S.?
Supporting Your Staff When a
Client Dies
– Determine at what stage the individual is in
– Communicate this information to the family
member.
– The person may benefit from psychiatric and
spiritual counseling
– Work with the individual
Supporting Your Staff When a
Client Dies
– Avoid even more losses
• Give the client as much independence as possible
• Give clients choices regarding meal ideas, daily
activities – make choice options realistic.
• Listen to clients’ ideas about the care
• Sometimes care revolves around agency
schedules. Allowing the client to voice his or her
opinion, and listening, empower the client.
– Help the PCA to not take things personally
Supporting Your Staff When a
Client Dies
– The best response of the PCA to the client is to
personalize their actions based on the client’s needs
and history. While this strategy is ideal, the realities
of staffing and workload may make this approach
very challenging.
• This is also extremely difficult
• No one likes to be the scapegoat, but realize that the client is
not striking out at you, the person.
• Tell the client, gently but firmly, “I don’t like it when you (fill
in blank). I understand that you are upset and hurting, and I
would like to help you.”
Supporting Your Staff When a
Client Dies
– Keep yourself aware of the resources of your
agency, and use them
Dying Trajectory
Various Shapes Of Dying Trajectory
• prolonged or rapid
• characterized by uncertainty
Response To Trajectory
• closed awareness
– the client is not told that he or she is dying,
but the family and caregiver know
• mutual pretense
– everybody knows the person is dying, but
everyone pretends it is not happening
• open awareness
– the dying process is openly discussed by all
Physiological Changes
– peripheral circulation decreases
• first in feet, later in hands, ears, and nose
• mottled & cyanotic skin, esp. in extremities
– internal temperature may remain high, so
keep patient's room cool
Physiological Changes
– changes in vital signs
• respirations rapid & shallow, irregular or
abnormally slow
• cheyne stokes or agonal
• decreased and weaker pulse
• decreased blood pressure
Physiological Changes
– loss of sensation, power of motion, & reflexes
in legs and gradually in arms
– diminished touch sensations
– pain and pressure remain intact
– loss of muscle tone
– cool, clammy
Physiological Changes
– relaxation of facial muscles; jaw may sag
– difficulty swallowing; gradual loss of gag
reflex
Physiological Changes
– muscles in back of throat and tongue leading
to snoring sounds or death rattle
– GI system shuts down
• May not require or tolerate food or fluids. Do not
force food. Offer sips of water for comfort only.
• Nausea, flatus, abdominal distention, constipation
• Decreased sphincter control leads to incontinence
Physiological Changes
• Physical Signs of Actual Death
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–
–
–
cessation of heart activity & respiration
pupil dilation & absence of reaction to light
body changes
algor mortis
• gradual decrease of temperature with cessation of circulation
(falls about 1.8F per hour) until reaches room temperature
– livor mortis
• discoloration that appears in dependent areas of the body;
caused by breakdown of RBCs with release of hemoglobin
Physiological Changes
– Psychosocial Signs of Impending Death
• Detachment
• life reflection
• speaks of death with increasing frequency
• puts affairs in order
• speaks of seeing loved ones who have already
died
Physiological Changes
• There is a difference between death and the dying
process
– Most aged persons are at peace with the idea of death
– There may be apprehension about the dying process: fear of
inadequate pain management, heroic measures, life support
machinery, impending transfer to a hospital, etc.
– Important for the PCA to know who is in charge when a client is
actively dying; when to call family member, nursing supervisor,
or 911
– IMPORTANT: cultural differences in attitudes and customs
concerning the dying process, death, and burial
Physiological Changes
• Help the PCA to support of family/significant others
– research has shown most important thing is to know that loved
one receiving compassionate, competent care
– reassure the family that their loved one is comfortable
– “It was important for me how they cared for my husband. They
called him by name and told him what they were going to do
before they did it.” (Wilson & Daley, 1999, p. 24)
– OK to cry with family after relative has died
– In waivered services, after care is not a covered service. The NA
is instructed to leave once a family member ahs arrived in the
home.
Physiological Changes
• Support the PCA with his or her own emotions
and reactions
– Both the family of the deceased, , and staff caring for
the deceased have similar emotions:
– IT IS OK FOR PCAs TO ACKNOWLEDGE THAT THEY
CARED FOR THE PERSON AND WILL MISS THEM
– Some PCAs believe it is better to not get attached.
– These individuals may avoid caring for a dying person
or will be aloof, so as not to become emotionally
involved.
Physiological Changes
– As people come to grips with their own sense
of loss, they may avoid the dying person and
the family. This negatively impacts the care of
the family and the client.
– Let yourself grieve. Give yourself permission
to feel your feelings. Accept sadness as a
consequence of having a rich relationship with
the client.
– Find your own support system through co
workers or your family.
Physiological Changes
– Best for persons who are struggling with their
own emotions and feelings of loss to work
with a chaplain or social worker, so that the
care they give is not affected.
– The role that the PCA may play during a
death can be frightening for some, especially
those new to the role.
Putting It All Together
• What are the things I can do?
• What are the most important principles for
me to follow and instill in others?
• What are the five most important
principles related to this workshop for me
to follow?
• What are the five most important lessons
for me to pass along to others?