The Nurse/Family Relationship

Developing a good working relationship with the client and the family is the bedrock of home healthcare nursing. This will be a two part blog, with this one covering general points of being in the home, and questions for the families of those who have received or are receiving services. The basics are as follows:

1. You are the healthcare professional, but the family, and they alone, are the experts on their loved one.
2. Ask if there are any particular household rules that the nurses need to observe. Simply showing an interest in their way of doing things is a relationship builder.
   
3. Unless you are on a stat case situation, there should be an orientation from your agency's clinical supervisor, a nurse already on the case, or a family member who has carried out the client's care. This affords the family, client, and you a chance to assess the comfort level of your being there. It also allows you, the nurse, to formulate questions regarding care, equipment use, etc. for your clinical supervisor or agency before reporting to work.
   
4. If the client can verbally interact, get feedback about specific likes or dislikes regarding care and routine.
5. Keep the work area clean and organized. In addition, immediately clean up any mess you make in the kitchen or work area. Ask where they would like you to eat your meals, if you can use the microwave, where to put your food in the refrigerator, which bathroom to use, etc.
6. Let the family offer the use of the TV! If they do not offer, chances are great that they do not intend to allow you to watch it. If the only TV is in the communal living area, never turn the channel or request to see a particular show if they are in the room. Unless they are going to bed or leaving the house, assume they are watching the show even if they leave the room. Ditto the remote. You are a visitor. No matter how comfortable you feel, you are at work!!!
7. Have plenty to entertain yourself during downtime (client is sleeping or with the family). Reading is good but can sometimes put you to sleep, which is a no, no. It is better to have multiple things to keep you stimulated. A Netflix subscription and DVD player are invaluable time fillers. Buying a laptop and a connect card (for an Internet connection) are worth their weight in gold.
   
8. Make the client your only priority. Aside from the physical and medical care, you must attend to mental, social, and emotional needs as well. Some of these needs will be apparent or expressed. Others may not be, so, stay vigilant using yours skills of observation.
9. Sometimes family members or the client will not express displeasure with something you are doing. Always be aware of what you are doing and their reactions (body language, distancing, facial expressions) to what you are doing---or not doing. Look and listen for cues about what distresses the family about nurses' behaviors.
   
10. Never, never, never smoke---not even outside, not even if they do---never. It is unprofessional and not healthy for the patient. The smell will remain in your clothing, and thereby offending others.
11. Bring your own food. You should never eat anything that has not been offered, and even then, use discernment.
    
12. You are sure to ruin the relationship, or worst, never allow it to develop if you are controlling. Again, this is their home, and they are the experts about what goes on there. Learn the art of offering a suggestion, and then letting the matter go.
    
13. Keep noise (TV, computer, DVD player, cell phone, movements around the house, etc.) or any type of disturbance to a minimum. If you must take a call, keep it to, absolutely, no more than 60 seconds. Put you phone on vibrate.
    

These tips will get you in the door and help to develop the relationship; however, once there, the ongoing nuances of developing and maintaining a good relationship is crucial. That will be the basis of next week's blog. In addition to the above pointers, I would like to invite parents, clients, and family members to respond to the following questions:

1. What was your overall experience having nurses in your home?
2. What annoyed you most about their behaviors?
3. What did you want to say but did not?
4. Do you feel your home was respected? If not, in what ways did they not show respect?
5. If you had to have nurses in your home again, what would you do to make it a different/better experience?
6. What pleases you most about your nurses?
7. What was the hardest adjustment for you and your family while having nurses in the home?
8. Were you pleased with the interactions between the nurses and other family members, including children?
9. What do you think every nurse should know (from the standpoint of the family) before coming into some one's home to work?
10. Are there any other comments you would like to share?

In the near future, I hope to turn this information into a guide for nurses and publish it, so, this is a chance for clients and families to have a significant impact in the future of home healthcare nursing.