How to Work with Families Who Challenge Us

As healthcare providers, our goal is to support patients and their families through what can be a very difficult ordeal.

We are meeting families sometimes at their worst, sometimes at their best, and everything in between. It can be very difficult to know how to approach families when they are struggling through grief, hardship, comorbidities, poverty, and even substance use/abuse and mental illness. How can we help the patients and families we work with when there significant challenges in our attempts to provide support? Sometimes even our own patience may be wearing thin - so what's next? Here are a few skills to add to your toolbox in caring for families who challenge us. 

Approach without Judgement

When we understand our biases, we can approach families without judgement. This will support building trust in you as a care provider and open the door to meaningful conversations about patient/family needs. In social work practice, we call this adopting a “position of not knowing” which allows us to be ready to learn, with an open mind and an open heart. This also creates a safe space for everyone to care plan TOGETHER with the patient and family at the center of our care.

Setting Boundaries and Contracting

One of the best tools we have in working with challenging families is setting clear and consistent expectations and boundaries. Often, family systems or individuals escalate because of poor communication of goals and expectations. How can we work together if we are not on the same team, working towards the same goal? Setting clear expectations and boundaries around the professional relationship protects both the clinician and the patient/family from missteps. When a safety issue or barrier to care is assessed by a clinician it is crucial that communication of that assessment is transparent and behavioral agreements put in place if indicated. We cannot hold people accountable (including our teammates) if we don’t set clear expectations upfront. This is a two-way street which requires teammates to be transparent, consistent and reliable care partners.

Check your Biases

We all have inherent biases rooted in our life experiences. Our family of origin, our socioeconomic status, culture and religious beliefs all influence our biases. Take some time to think about what biases you inherently have (we ALL have them) before approaching care for families. Checking our biases is crucial in providing compassionate and supportive care. Understanding your own biases will lead to stronger rapport with patients and families.

De-escalation Techniques

Some situations are escalated before you even walk in the door. Sometimes, you are the trigger. Having skills in de-escalating a difficult situation are key in keeping staff and patients safe. A few great tips are to:

• Check your surroundings and ensure you are SAFE. Never let anyone or anything come between you and your exit. Be cognizant of where you are in the room and where you need to be to stay safe. Immediately remove yourself from any unsafe situation.
• Calm yourself before engaging with the person. Two escalated and upset people will not help the situation. Breath and use a low, calm voice.
• Listen and restate what you heard with an honest, helpful approach.
• Validate and/or get them to say “yes.” When there is agreement between the parties, it de-arms the fight and creates more of a team working on a solution together.
• Understand that it is not about YOU. Personalizing the aggression or escalation makes it difficult to calm yourself or be helpful in problem solving.
• Mind your body language. Maintain neutral posture and facial expressions and make an effort to minimize any threatening or dismissive body language.

Self Care

Working with challenging families and situations can be very stressful. Focusing on your self care and “filling up your cup” will protect you and your loved ones from compassion fatigue and burnout. Self care looks different for everyone and can include any and all of the following:

• Physical Self Care – take care of your body through good nutrition and physical exercise. Ensure your workspace is ergonomically supportive. Enjoy the outdoors.
• Emotional Self Care – prayer, medication, self affirmations and therapy are all tools that support emotional self care.
• Social Self Care – spending time with friends and family, volunteering or participating in organizations or groups can be methods of social self care.
• Workplace Self Care – finding a safe and supportive work peer group as well as a strong mentorship are great ways to care for your self and maintain balance at work.

It’s not always easy, but it’s a critical part of providing care.

Supporting patients and families is a calling and a honor but comes with its challenges. Every family system and patient circumstance is different. As clinicians and care providers, it is our job to be equipped with the tools to help in a wide variety of circumstances. Sharpening our tools in working through challenging situations will allow us to continue to serve from a full cup.

References:
Behavioral Health News

Conflict De-Escalation Techniques