The role of the
caregiver has many facets. An effective caregiver,
whether a professional or family member, is interested
in providing educated, nurturing and loving care to
allow patients or loved ones to become as
self-sufficient as they might be and to heal with
An effective caregiver must be an
effective communicator. Communication is critical on
several levels. The caregiver is the “eyes and ears” of
the medical team, observing the patient daily, and must
be able to develop a rapport with nurses, therapists and
physicians. Secondly, the caregiver must be able to
discuss with the loved one daily needs, both emotional
and physical. It is evident, therefore, that the
caregiver must be skilled in the art of communication.
Communication—talking, listening and exchanging
information—is at the heart of caregiving. Effective
exchanges will allow you to understand your loved one’s
needs, express your concerns to the doctor and ask for
help you need from others.
Communication becomes more
difficult when people are tired, in pain, frustrated or
depressed. It is easy to become distracted, confused or
intimidated in a doctor’s office or on the phone with an
insurance representative. When communication breaks
down, the misunderstandings that arise can range from
inconvenience to disastrous. By keeping a few basic
communication principles in mind, you can keep the flow
of information open with your family and with the care
special needs that your loved one has that might affect
communication. Does he have hearing, vision or speech
impairments? Is there dementia or confusion? Talk with
any former caregivers to get an idea of what kind of
communication has been effective for them. Also talk
with healthcare professionals in the field relating to
your loved one’s impairment for communication
strategies. Be prepared to adjust communication
strategies as his condition changes.
Talk to your
loved one about the care she is receiving
Find out how she feels about the members of the care
team, the care plan, and how it is being implemented.
Ask how she has responded to treatments and how they
have affected the quality of her life. Find out if there
are any needs that she has that are not being met to her
Make consultation appointments with
all of your loved one’s doctors to find out the details
of the care plan. Get as much information about
treatment and expected outcomes as you can. It is
helpful to ask for written information or even take a
tape recorder with you to the consultation.
Communication is the process that
we use to send and receive messages and exchange
information with other people. We communicate using
signs and symbols, including words, drawings and
pictures, and also by behavior and gestures. The
simplest form of communication takes place between two
people…a sender and a receiver. These two constantly
switch roles as communication takes place. The next
step, providing feedback, occurs when the receiver
repeats or responds to the sender’s message, letting the
sender know that the message was received and
understood. During a conversation, this three-step
process is usually repeated over and over.
Communication can be either verbal
or nonverbal; that is, with or without words. Nodding
your head instead of saying “yes” is nonverbal
communication. The tone or emphasis we have to words is
also nonverbal communication.
Body language is a form of
nonverbal communication. Movements, facial expressions
and postures can express different attitudes or
emotions, including sadness, happiness, anger and
pain. Just as when speaking, we send messages with our
body language that other people receive and interpret.
people send one message verbally and a very different
one nonverbally. Nonverbal communication often tells us
how someone is feeling, despite what he or she is
saying. Your loved one may tell you, “I’m feeling a
little better,” but stay in bed and stare blankly at the
wall. Such nonverbal clues can tell you he may be
depressed. You may need to say something like, “Dad, you
don’t seem to be feeling better. You seem to be feeling
down today.” This could open the door for verbal
communication and allow him to express his feelings, or
at least allow you to acknowledge what he is feeling.
Barriers to Communication
can be blocked or disrupted in many ways. The following
are some barriers to communication and ways to avoid
a. Your loved
one does not hear or understand what you say…speak
clearly and check that any hearing aid is working.
b. You do not
hear or understand what she is telling you. Ask her to
repeat what she has said.
c. The meaning
of words or terms is not clear. Use simple words and
avoid medical terminology.
d. Using clichés
makes your message meaningless.
e. Asking “why”
makes your loved one defensive. The word “why” often
does not allow you to open up a conversation that is
helpful in resolving the question.
answers end a conversation. Unless you are seeking
direct information, ask open-ended questions that need
more than a “yes” or “no” answer.
and Complete Communication
In addition to
avoiding barriers to communication, these positive
techniques will help you send and receive clear,
a. Be a good
listener. Allow the other person to express her ideas
feedback as you listen. Active listening involves
focusing on message and providing feedback. Offering
general but leading responses such as “on?” or “go on”
or “hmmm” provide feedback and encourage the sender to
expand the message.
c. Bring up
topics of concern. If you know a topic may be of
concern, raise it in a general, non-threatening way.
d. Let some
pauses happen. Use silence to allow the other person to
gather her thoughts or decide to convey another message.
e. Ask for more.
When your loved one reports feelings, events, or
symptoms, restate what you have heard to clarify. Ask if
there is more he or she can tell you.
Communication with Medical Professionals
with a care team is equally as important as
communication with your loved one and within your
family. Do not hesitate to take an active role in the
care of your loved one. You, as caregiver, must
understand what plan of care has been established. You
must be able to send clear and accurate messages about
the state of your loved one’s health. As a family
caregiver, you are often in the best position to observe
changes in symptoms, abilities and general health. The
more clearly these are conveyed to the doctor, nurse or
other professional caregivers, the better the care that
will be provided. Planning your communication in advance
and writing notes will help you get all necessary
information across and ensure that all of your questions
are answered. Be polite and focus on the information
that you need to send and receive, rather than any
frustrations you may have. While the experience of
visiting a doctor’s office may be frustrating, it is
more important to get the information you need than to
express your aggravation.
Observing and Reporting
family caregiver, you probably spend more hours with you
loved one than anyone else does. You are in an excellent
position to observe and report on his condition,
including any changes, occurrences or new symptoms.
Any of the
following should be reported immediately to the doctor
or agency. You may also need to call 9ll or go to an
emergency room for assistance for falls, chest pain,
severe headache, difficulty breathing, changes in mental
status such as confusion, sudden weakness, high fever,
loss of consciousness or bleeding.
conditions should also be reported--loss of appetite,
rash, difficulty sleeping, pain, weakness or fatigue,
nausea, depression or withdrawal.
You should not
try to diagnose the problem nor should you try to decide
if a complaint is important or trivial. When in doubt,
Always gather your information and
write notes before calling the doctor or nurse. Plan
what you will say in advance; writing notes is a good
way to help you remember. If you have to leave a
message, make it brief, complete and clear. If someone
will call you back, keep the notes by the phone or in
your pocket so you can easily find them. Write your
observations, when you first noticed them, and any
supporting details such as the presence of fever. Always
be prepared to give the patient’s name, date of birth,
Social Security number and insurance information.
strategies for phone calls may also be used for visits
to the office of professionals.
at all levels is essential for the continued physical
and emotional well-being of a loved one, and serves as a
key bridge between the patient and the healthcare team.
All caregivers should consider the importance of
communication and reflect upon strategies to develop the
art and science of communication.
Washington, DC neurologist
William Leahy, MD, is the author of Caregiving at Home,
and Providing Home Care: A Textbook for Home Care Aides.
An Assistant Professor of Neurology at the Johns Hopkins
Medical Institution, he has devoted his book royalties
to a project teaching high school students heath care
careers. He has been honored as "Washingtonian of the
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