I am continuing to shadow practitioners and visiting patients in their homes. This has given me an opportunity to begin interacting with patients some that are close to the end of life. Patients are in different settings: in their home surrounded by family, in someone else’s home, in a skilled nursing facility, or living alone. Each time I visit a different situation, I can feel myself on some level assessing the situation, and judging it, yet also having my world opened wider to the varied ways people live. Ultimately I am struck by how open and inviting people have been with me, when they have so little time left, and they are willing to share stories, feelings, or words of wisdom with me. I am noticing myself observing the patients, who I know are the primary concern, but also what the interactions are between the patient and caregivers, and well as the mood of the caregivers. One situation I found myself feeling judgmental was when I visited a woman who was praying with the Chaplain to live for one more week until her new great grandson came to visit. The patient was not eating or drinking very much, and was quite jaundice. Not knowing the details, I was frustrated that her family could not come sooner. Yet as I observed the Chaplain, she focused on reading to the patient, discussing looking forward to next week, and ensuring her pain was under control so she might be able to eat. One patient I visited was living alone, and she is very close to the end. Her house is immaculate, she is perfectly dressed, and as a stranger I would never know she was ill. Yet as we visited with her, it became apparent that she was experiencing more frequent heart trouble, and was worried that she was going to pass away last week. As she and the Chaplain discussed her recent decline, the Chaplain brought up the possibility of getting a Lifeline service. The patient mentioned several reasons she did not think it was a good idea. The Chaplain allowed that choice, even though the woman had brought up several safety concerns around possibly falling when she had chest pains, and having pain at night when she is alone. These are areas where I understand the NASW Code regarding allowing patient self-determination yet it also feels like it is difficult to determine what is the boundary between self-determination and acceptable risk. Also how do I define ‘acceptable risk’ versus how does someone else define it? This is an area where I will need to remember to not impose my values and ensure I am following the guidelines regarding if a “clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others” (National Association of Social Workers, Code of Ethics, 2008).

February 15, 2013

I am trying to be thoughtful regarding my interactions with both staff and clients at my new internship site.   I can tell this is a true skill to form a tie with someone without inadvertently communicating information about myself, and it depends on my boundaries, as well as the other person’s.  This last week there were times where clients in groups directly asked me multiple personal questions (where are you going to school, where do you work, why did you get into social work, do you have kids, do you have a partner).  My natural tendency is to be open and honest with people, but I am realizing I need to learn the art of deciphering why they are asking these questions and what it is that they are truly asking, and try to get to that root issue more quickly.  In this one instance I was being quizzed by a client, who ended up wanting to talk about their personal interest in a social work career.  The volunteer training was excellent in clarifying the importance of being client centered, always listening for what the client is really trying to convey, and clarifying what that information is, for ourselves and the client. It is refreshing to learn what a truly client centered framework looks like for end of life care and bereavement, and then have the opportunity to practice these skills. 

After attending the orientation sessions, I reflected on the content of the training, my personal experiences, and this new professional journey I am embarking on.  I already knew that death and dying was a taboo topic in our society before attending the trainings.  I am even more keenly aware of the overwhelming need for bereavement support in all segments of society after the training, and after having an opportunity for several client interactions. I wonder also about the role unresolved grief and multiple losses played in how my own life unfolded and the unrecognized strains this put on myself, and former spouse during our relationship.  From going to just two different groups at my internship, I can see how individuals need support in different ways, and the challenges this can present in a group setting for facilitators to meet each group member’s individual needs.  As I continue my orientation and observation process of the different aspects of grief support, I hope I can learn to focus on developing my active listening skills and adapting various therapeutic techniques, which will work with unique individual and group dynamics. 

Blog #1: February 8, 2013

As I begin my field placement, I feel that my initial challenges are around setting aside my personal experiences in order to develop a new understanding of Hospice services from a service provider’s perspective, and being aware of appropriate boundaries in our small rural community which I have called home for almost twenty five years.  On one hand my personal experiences as a consumer of Hospice services, as well as a long time community member I feel are assets, I can relate to clients’ experiences, and in conversation with almost any individual, I usually discover we have similar friends/acquaintances in common, which can assist in establishing a sense of trustworthiness in certain situations.  However, as a professional social worker, I need to set aside my lens of personal experience, and understand what each individual client is going through.  I also think in most cases it will be helpful for clients to feel I am an anonymous neutral person they can talk to, who is outside of their normal community interactions. 

I attended a grief support group on my first orientation day at Hospice, and quickly realized I should have asked more questions about what my role was before the group started.  Initially it was unclear to me what the ‘rules’ were for the group, or the group leaders.  I noticed two individuals with staff identification tags, and so I tried to follow their lead regarding modeling behaviors.  Upon reflection, I think I was confused if the entire group, including the facilitators, were supposed to be participating in sharing or if only the clients were supposed to be sharing.  This was uncomfortable to realize I was in this situation, with new people, and I did not want to appear to be withholding if I was supposed to be sharing, yet I also was trying to determine if I was really supposed to be sharing or not.  I did share that I was an intern, and how my week was going with starting classes, and my internship. After the group ended I was thankful to have some time to debrief with a supervisor about the experience. 

As I analyze why I feel conflicted about what to share and what not to share, I realized that my own experiences in support group or social work environment settings have been with parent groups primarily, where everyone, including the facilitator, shared information from personal experience. As I learn more about Hospice clients and agency expectations, I will feel more comfortable about what the parameters are regarding sharing personal information.