Hearing the silent: Why hospice social workers must listen to even non-verbal patients

The first and last lesson of people-helping is to listen. This doesn’t change when the people we serve don’t have anything to say.

What we do when listening to non-verbal patients is similar to what we do when listening to anyone else, but it is a different experience that can require more awareness, patience, and commitment to stay present. We find this listening more challenging because we don’t get the clarification we are so comfortable with that comes with comprehensible statements.  But as with any other patient, our goal in listening is to receive communication about the patient’s needs, well-being, and responses to our approaches.

Being receptive to their responses to us is critical: it’s how we know we are doing any good versus making our patients’ experiences more pleasant.

Listen for feedback

Recently I was interacting with a patient who could make eye contact and some facial expressions, but couldn’t speak or steadily move his arms. I asked him if he’d like me to play some music, but I couldn’t tell from his response if he wanted me to. I put on some easy listening by the Eagles, which seemed a good bet considering his age. His behavior definitely changed after I started the music. He began moving his arms in a way that could have been dancing or air guitar, but also could have been anxiety. I couldn’t tell. “I’m not sure if you’re enjoying this song or if it’s bothering you, so I’m going to turn it off for a minute.”

I called his wife, and she explained that music seemed to stress him out. Good to know! No more music for this guy. I apologized for causing distress and asked if I could still sit with him for a while. He responded with what seemed like a confident nod, which he repeated later when I asked if I could come back and talk to him in a couple weeks.

Listen to respect individual dignity

Dedicating ourselves to understand our individual patients’ experiences allows us to provide individualized care. It helps us to get to know them as unique people. Forming these relationships can seem harder when patients aren’t don’t speak, but that doesn’t let us off the hook. So many of our social structures see people only for their labels. As social workers in direct practice, we are responsible to get to know people as people.

Hearing those who can’t speak can be a struggle. We’ll wonder what things mean or what they’re thinking. We’ll get it wrong like I did with the music that day. But as long as we 1) truly want to know about our patients’ experiences and 2) keep our minds open and in receiving mode, we’re giving our patients something that they might not be receiving much of from many other people.

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Five direct interventions for non-verbal patients

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Interacting with non-verbal patients as a hospice social worker