Non-verbal patients deserve our more active intervention as much as they deserve to be heard. Unfortunately, many shy away from providing direct psychosocial interventions with patients whose responses are slower, more subtle or minimal.
It is understandable. Direct social work practice is about 2-way communication, and we know that the patient appreciates the value of our communication when they communicate back. While even non-verbal patients can provide feedback, as the article [chapter]* about hearing patients explains, it can be difficult to know where to start when it comes to using your own presence to try and enrich the experience of a non-verbal patient.
The following ideas are how I recommend you start:
1. Be there with a warm heart
Your patient may be in an extremely receptive state. With few people communicating with her every day, she may be sensitized to your subtle non-verbal communication to an extent that may reveal some of your thoughts and feelings. She also may not be. But if she isn’t speaking, how would you know? Either way, you provide better service if you provide a warm-hearted presence.
As social workers, it’s good to have the awareness to know what kind of emotions we’re emanating, and also the ability to intentionally emanate loving vibes. The basic “getting-to-know-yourself” practices, such as journaling and meditation can support you in taking responsibility for the emotional energy you emit. You can also imagine embracing someone you love unconditionally, such as a baby or grandbaby. Enjoy how it feels, and then allow yourself to feel some of that warmth for your patient.
It will matter.
2. Lend a hand
I offer a handshake to patients unless we’re established that they won’t be able to take my hand.
Typically, I let them set the handshake rules. If their touch is very gentle, I’ll match that. If they apply some strength, I’ll match that. If a patient starts to arm wrestle with me, I’ll carefully provide some resistance, never enough to injure, and sometimes he’ll win. Yesterday, an old Army vet made my day when he said, “Let me see your grip!” Afterwards, he thanked me for not giving the weak fish grip he usually gets from people.
I’m not sure I have to, but I would like to provide a disclaimer: Don’t powerfully squeeze the hands of hospice patients! It might not end well… Instead, carefully match your patients’ energy and enthusiasm when shaking hands.
I also let patients set the rules about how long before I get my hand back. If a patient takes my hand and doesn’t let go for a while, that’s usually ok.
3. Music!
I’ll usually ask non-verbal patients if they’d like to hear a song. If I don’t receive a negative response, I’ll play one that came out around the time the patient was 20. And I observe. Sometimes patients will smile big. Sometimes subtly. Sometimes they’ll leak tears and sometimes, as I mentioned previously [link to article]*, they’ll indicate that the music isn’t making them more comfortable.
Photos!
There are lots of photos out their on the internet that can be pleasing to patients. One always calmed into a blissful reverie when I showed a photo of his hometown in Mexico. I’ve shown veterans photos of myself in my Army uniform, and photos of service members doing amazing things. I’ve shown some patients photos of my children when they were babies. Why not offer such benign sensory experiences to patients who don’t get out much anymore?
Talking at them
I’ll speak to them, even when I don’t know for sure how they’re receiving my words. I’ll tell them about how recently spoke with their child, and how respectable person their child is, and how proud she must be. I’ll tell benign stories about the weather or funny things my children have done. I’ll tell them about how much the members of my team or the facility staff love them. I’ll tell them truthfully that I’m very happy to see them, and I appreciate them letting me have some of their time.
Accept that we’re sometimes flying blind
When there isn’t a lot of feedback, you may feel like you are flying blind. And that’s ok. You can’t go wrong when you are paying attention both to your intention and your patients’ responses. You can (and will) make mistakes, and occasionally say something awkward, but hospice patients, as much as anyone else, have the right to experience authentic interactions with other humans.
Authentic interactions are sometimes awkward. And that’s ok.
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