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Bridging the Gap Between Families and Staff

August 1, 2003
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One facility's program to bring families on board BY SANDRA HOBAN, MANAGING EDITOR

It doesn't matter whether your facility is well operated, deficiency-free, state-of-the-art, and staffed by the most caring professionals-complaints are inevitable. Suddenly, an "ideal day" falls like a house of cards when the Willful Wife, the Haranguing Husband, the Demanding Daughter, or the Sermonizing Son steps through the door. "Why isn't my husband's hair combed?" "Why is my wife still in her pajamas at 8:30 a.m.?" "How did my mother get that scratch on her face?" "Why are her clothes disappearing?" Not pleasant-but one way to look at a complaint is that it's an opportunity for improvement.

To build good relationships with families and residents, you must convey to them that their concerns are taken seriously. After all, sometimes even the chronic complainer has a valid grievance that, when resolved, becomes an important lesson in the value of communication.

Clare L. Horn, ACSW, assistant vice-president of Social Services at Morn-ingside House, a 386-bed facility in the Bronx, New York, is a case in point. Observing the various communication styles of staff, residents, and families, and witnessing their effects on her nursing home operations, she began to search for a way to make the most of these exchanges. Two years ago she met with William T. Smith, president and CEO of Aging in America (Morningside House's parent company) and current AAHSA chair-elect, to discuss the issue. Smith told her about a nursing home that had implemented a program called Partners in Caregiving (PIC), a program designed to give people the tools to understand and refine their communication styles.

Developed by Karl T. Pellemer, PhD, associate professor of human development at Cornell University and codirector of the Cornell Applied Gerontology Institute, PIC is an empowerment tool specifically structured for training nursing staff and family members in communicating with each other. Each group undergoes nearly identical training sessions, but the topics are geared to their partic-ular roles in relating to the resident. Through lectures, exercises, and role-playing, participants learn how to air their opinions and/or grievances respectfully, in an open-minded and constructive manner.

"Because Morningside House strives for such exchanges with families," says Horn, "our PIC facilitator, Rhoda Meador, MS, and I agreed to take a 'train the trainer' approach in disseminating this among staff, asking CNAs and others who participated in the workshops to spread the word among their colleagues. In addition to improving communication among residents, staff, and family members, the main program goals were to improve both care and caring by nursing personnel; to increase family satisfaction with and participation in a loved one's care; to improve the entire facility's sense of community; and to promote participation at every staff level-from administration to nursing staff to ancillary service personnel."

Horn and Joan Trendler, RN, director of Clinical Education, revised and expanded the facility's orientation and analyzed ways to sustain ongoing staff education to incorporate PIC principles.

Recruiting PIC Participants
Before beginning the PIC workshops, families who had shown an active interest in the processes of care at Morningside House received a letter detailing PIC and inviting them to participate in two, two-hour training sessions in a particular week. According to Horn, response was enthusiastic and the workshop well attended.

For the staff side of the program, CNAs were recruited from every unit and floor of the facility and attended three two-hour workshops during the week the training was offered. "Of course, this required some scheduling adjustments to cover for those CNAs who were off the floor during their six hours of training," notes Horn.

Highlights of a PIC Workshop
During the PIC training, each group focused on the same communication principles from their own particular perspectives. For example, family members were taught how to complain or criticize in a positive manner, while staff learned how to receive and adjudicate a complaint or criticism constructively. "The course is not just about complaints," explains Horn. "Sessions cover a range of topics that promote cooperation, teamwork, and shared goals." Through PIC, participants learn how to:

Listen effectively. The PIC program introduces advanced listening skills through interactive skill-building sessions that introduce listening and feedback techniques to focus clearly on what is being said. For example, a family member might want to know why a parent has been sitting so long. If the staff member perceives that the question was asked brusquely or with negative body language, he or she might react defensively rather than responding with a reason and, if necessary, correcting the situation. Or maybe the query was asked casually and the CNA, being busy at the moment, brushed it off, leaving the family member with the impression that the caregiver didn't care. In either case, communication has failed.