Communicating with Families
Christine L. Williams DNSc, APRN, BC
Tamika R. Sanchez-Jones PhD, MBA, APRN, BC
OBJECTIVES
To compare communication with individual clients to family-focused communication
To discuss how cultural traditions may influence interactions with families
To describe strategies for communicating with families
▪ INTRODUCTION
Nurses have traditionally conceptualized their care as family centered. In the past most nursing care was delivered in hospital settings where family members’ access to nurses was limited by visiting hours and rigid rules for interaction. In this era of community-based care, effective communication with families is becoming increasingly important. More care is delivered in ambulatory and home settings where nurses have frequent contact with families.
▪ FAMILY COMPOSITION
For purposes of developing relationships that support clients’ recovery, the term “family” is loosely defined. Nontraditional families may include members who are not blood or legal relatives yet they live with and have strong emotional ties to the client. Clients may identify a same sex partner as their closest relative. Not everyone has living relatives who are available to help them during illness.
Mrs. James, age 89, is the last living member of a large family. Her closest “family member” is Hazel, her neighbor and long-time friend of 30 years. When Mrs. James is hospitalized, Hazel is designated as her health care proxy.
Family members may not live with the client but may be very involved in their care. Sometimes caregivers live in a distant state (or even another country) but would like more communication with nurses about their loved one’s care. Caregivers may work full time during regular business hours and would welcome communication with nurses about their loved one’s care.
Many patients and families experience difficulty in communicating with nurses and other health professionals.1 Communication between nurses and family members is often infrequent and fragmented.
Mrs. Jackson works full time as a high school teacher and has little time during working hours to use the telephone. Her mother is a resident in a nearby nursing facility. Mrs. Jackson visits twice a week, once on Wednesday evenings and again on Saturdays. She has no communication with nurses or other health professionals at the facility. She receives written invitations to periodic interdisciplinary meetings regarding her mother’s care, but the meetings are always scheduled during her work hours. She sees the same nurses when she visits her mother but they always seem so busy and never initiate conversation about how her mother is doing.
▪ WHOSE RESPONSIBILITY IS IT TO COMMUNICATE WITH FAMILY MEMBERS?
Nurses have frequently viewed communication with the family as the physician’s or the social worker’s responsibility. Too often, family members are not included in the client’s care, and communication with the family is neglected. Regardless of who the client identifies as family, it is important to maintain communication. Family members can provide vital information about the client. Children, cognitively impaired individuals, and very sick clients may not be able to provide a history, and the family member may be the only source of information. Building an alliance with family members can make the difference between success and failure of the care plan. They can either support or undermine your efforts to positively impact the client’s health.
▪ HOW IS FAMILY-CENTERED COMMUNICATION DIFFERENT FROM COMMUNICATION WITH INDIVIDUALS?
Communicating with families generally implies communicating with more than one person. Interaction with a group requires different skills than communicating with individuals one at a time. Families have customary ways of communicating. There are alliances and rules for interaction between members that will influence decision making and the flow of information. How do families normally exchange information among members? To answer this question, begin by noticing family members’ nonverbal communication. Who contacts you to set up a meeting or to ask for information? In a meeting with the family, who sits next to whom? Who speaks to whom? Who seems to speak for the group?
Confidentiality can become a challenge when several family members want to be involved in the client’s care. You will need to carefully consider who should receive confidential information. If clients are able to decide who should receive information, the nurse can rely on their instructions. When clients have diminished capacity to make decisions, the nurse will rely on state laws regarding who has the legal right to act as a proxy. Although you may not disclose information without appropriate permission, you can still meet with the family to allow them to express their concerns and emotions and provide you with information about the client. Some families may not want the client to receive details of a diagnosis or facts about the severity of their illness. They may be concerned that the truth will result in despair and the client will give up prematurely. Such dilemmas should be discussed with the interdisciplinary team or may have to be resolved by an ethics committee.
When interacting with a family, there is increased risk of misunderstandings and miscommunication. To minimize these problems, try to gather the family in one place and give information once. If you must interact with only one person, be aware that the designated person may not disseminate information to other family members accurately and completely. It is best not to assume that one member will take care of all family communication.
Mrs. Rodriquez (age 85) was hospitalized for repair of a fractured hip. Mrs. Rodriquez’s daughter, Maria (age 55), visited her mother daily. When the nurse tried to initiate discussion of discharge plans for her mother, Maria was vague and noncommittal. On the weekend, Mrs. Rodriguez’s son visited and began asking about discharge plans. It became clear that Maria was not the decision maker and was waiting for her brother to visit.
Respect boundaries between family subgroups. In families of older adults, support the integrity of the spousal relationship. Children (regardless of age) should not be given important information before a spouse. The spouse is the appropriate person with whom to communicate. Special circumstances such as a spouse’s illness or lack of cognitive capacity will necessarily alter your plan for communicating. When a spouse is severely impaired, the health care proxy becomes the person with whom you will communicate. In families with younger children, parents are obviously your point of contact. Even this family structure may present communication challenges. Divorce, custody disputes, and joint custody arrangements may create barriers to communication with family members. Adolescents should be included with the parents in discussions of their care.
The Family Meeting
Successful communication during a family meeting begins with preparation. Whenever possible, ask the client or resident who should be included. Sometimes clients are too young or too ill to provide direction. In the case of older adults and their adult children, they often come into the health care setting together. Find out if this is the client’s next of kin and who else can or should be included.
The need to balance inclusion of family members in communication and protection of the client’s privacy can create dilemmas for the nurse. Questions about who to include can be discussed with the health care team.
The need to balance inclusion of family members in communication and protection of the client’s privacy can create dilemmas for the nurse. Questions about who to include can be discussed with the health care team.
Consideration of the communication environment can convey respect for the family. In a health care facility, it is your responsibility to provide adequate seating with as much privacy as possible. Sit at the same level as the family members to communicate equality. Avoid sitting behind a barrier such as a desk. When client and family members are present in a meeting together, the nurse needs to address the client directly rather than speak about the client as if she or he were not in the room. To convey the message “I value you,” ask for opinions and input from everyone present. If family members seem to want you to take sides in disputes, remain neutral to not alienate one side or the other. Recognize their efforts to be there and to be involved in the care.
Be cautious if a family member asks to confide a secret and asks that you refrain from sharing information with the client or other members of the health team. Never promise to keep information from the health team, especially when you have not heard the content of the secret.
The Role of Setting
The decision about who to communicate with varies according to the situation and setting. Generally long-term settings and life threatening situations require more family interaction. When we establish long-term relationships with clients (such as admission to long-term care, home care, or hospice care), the involvement of supportive others is critical to obtaining a complete assessment and laying the foundation for cooperation and trust. When the setting is a health care environment (such as a rehabilitation unit), subtle nonverbal communication can make the difference in whether or not the nurse establishes a successful relationship. Who does the nurse make eye contact with when speaking? Who is encouraged to be present as care is administered and who is asked to leave the room? Does the nurse extend visiting times for some family members and not for others? How many family members are too many? Who should be included when there is bad news? All of these questions should be considered and discussed with colleagues involved in the care of the client and family. Consistency in communication and in approach to the family will help to ensure cooperation and minimize dissatisfaction with care.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
