Daily Editors' Notes

People don't 'get' me: Tips for the misunderstood long-term care provider

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Staff Writer Tim Mullaney
Staff Writer Tim Mullaney

Here's a question for long-term care providers: Do you ever feel that people don't really “get” what you do?

I'm guessing the answer is yes. If so, you might take heart from the fact that professionals in other fields also feel this way, according to a recent study. And you might be disturbed at how this lack of understanding affects job performance. 

A research team from a number of institutions, including Boston College and Rice University, looked at nurse practitioners, architects, litigation attorneys and accountants. All these professionals encounter problems working with people who don't “get” what they do, the researchers found. And based on its findings, the team came up with a three-point plan to help professionals avoid these problems. 

In some cases, people just don't understand the basics, according to the researchers. For example, they're not familiar with what a nurse practitioner is, exactly. Consequently, these people don't share health information or allow themselves to be examined, and demand to see a doctor. This misunderstanding cuts the other way, too, with people devaluing high-level professionals in favor of people who “actually” do the work: For example, some people think that an architect is basically just a glorified sketch artist, and that a contractor should be able to “actually build” a structure without any fancy blueprints. People also have misunderstandings due to the way these professionals are depicted in the media and popular culture, according to the researchers.

It seems to me that all these issues are at play in long-term care. If people don't understand the difference between a doctor and a nurse practitioner, how many understand the difference between a registered nurse, a licensed practical nurse and a certified nursing assistant? Add in all the other types of professionals in a facility, from therapists to psychologists to medical directors, and it's easy to see why people might be confused about caregiver roles.

And then there's the person who thinks he doesn't need an architect, just a contractor. Isn't this akin to the person who thinks, “My mom doesn't need that much skilled care”?  Who thinks, “These nurses just help her in and out of bed, get her meds, help her with toilet needs. I don't understand why it's so expensive to have mom in this place.”

As for media and popular culture, I'd venture to say that shows like “Derek,” which portray nursing home workers as heroes, are few and far between. There's no SNF equivalent of “ER.” But there are plenty of news stories about substandard care and criminal administrators, and “nursing home” is synonymous with “bad place” in many shows and movies.

In other words, it's fairly obvious why people “don't get it” when it comes to what you do. So what are the effects of this? 

The researchers found that people's misunderstandings led to “impaired collaborations” as they attempted to work with clients who had “impracticable” and “skeptical” expectations. Surely you've never encountered a resident or family member who is skeptical or has impracticable expectations?

Okay, I expect that you all have encountered such people in your line of work, and have your own strategies for dealing with “impaired collaborations.” The researchers looked at the strategies that have proven effective for the professionals they studied, and came up with a three-part technique.

First, educate the client on “what we do and how we do it.” Notice that there are two parts here, and they are specific: what you do, and how it is accomplished. It's not enough just to make promises about outcomes.

And it's a good idea to start this education early, according to the researchers. They found the greatest success comes from earning trust and managing client expectations from the outset of the relationship.

Second, the researchers advise “demonstrating the skill.” In other words, putting your money where your mouth is, and following through on all the things that you've explained you do. This is straightforward, and an obvious necessity in long-term care, given that the stakes are people's health and wellbeing.

The third may be a little bit less obvious: relationship building. This means “getting to know the personal details about people” to build “rapport.” It's become a given in long-term care that you need to know your residents to provide the best care possible, but this latest research suggests that learning about residents' family members might also be in your best interest — that they're not just a conduit for providing information about who the resident is. If you learn more about these family members themselves, it strengthens the working relationship and could help you find the most effective ways to communicate what it is you do.

In other words, this is a two-way street. The more you “get” where people are coming from, the more they'll “get” what it is you do.

With all the other pressing issues in a facility, taking the time to develop an approach to consumer education may seem like a luxury. But it's far from frivolous, according to researcher Michael Pratt, Ph.D., of Boston College.

"I assumed professionals would actually get over it, that there would be frustration, it would be an interpersonal problem, and that would be the extent of it," Pratt said, referring to clients not understanding professionals. "I didn't think it would have such a big impact on how they did their job … It's not simply annoying – it has real impact."

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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