PSWs: Navigating Difficult Conversations
Personal Support Workers (PSWs) play a crucial role in providing care and comfort to people, especially during their times of decline and as death nears. They often struggle with responding to difficult questions from the dying person and from the family/friends/caregivers. As a nurse educator/leader/mentor, you play a vital role in supporting the PSWs through these challenging interactions.
Appreciating the challenge
PSWs are often on the front lines, building strong relationships with patients and their families. When faced with questions about complex medical issues, symptoms, physical changes as death nears, or psychosocial issues, they may feel ill-equipped or overwhelmed. In addition, they may be worried about how to respond within their role as a PSW, and be worried about being criticized for saying “too much” or “too little”. Being a PSW, and striving to provide the best care can be emotionally taxing and can impact their overall well-being.
Here are a few ideas and a tool that might inspire you as you support/educate/mentor PSW students.
Strive to create a supportive environment
- Encourage open and honest dialogue with the PSWs (and the rest of the team).
- Treat PSWs as full members of the team, introduce them to the larger team, the social workers, chaplains, dietary staff, recreation teams, leadership!
- Create a space for PSWs to share the challenges as well as the “good stuff” with you, with other PSWs, and with the larger team.
- Share education resources and courses with PSWs and help them develop competencies. Provide support to attend continuing education activities.
- PLAY – Participate in role-playing. Take a RISK, show that you can “play” the role of the PSW, share how you also feel uncomfortable in responding to difficult questions. Play with different scenarios, and help the PSW (and yourself) become more comfortable.
- ROLE PLAY using the VERS Framework. Scenario:
Wife, “Is my husband dying?”
- Validate the question, “That is a really big question….”
- Explore, “Can you tell me more,… why are you asking that question right now? Is there something that you are seeing,… or that concerns you?”
Wife, “He is not eating, he is hardly swallowing, I think he is dying. I need to know if I should bring my daughter home from back east.”
- Respond, “I hear you… and I can see how important this is, for you and for your daughter.”
- Share, “Can I please share your question with the nurse and have the nurse talk with you in the next few hours? Would that be ok? Would that be soon enough?”
- Debrief the scenario, discuss other possible responses, stress the importance of the PSW responding – and that the PSW did NOT have to give an answer to the question in order to be very compassionate, helpful, thoughtful.
These are a few of the ideas that come to my mind as I consider your role as leader, mentor, supervisor, educator. What ideas come to your mind? How do you support PSWs when they struggle with difficult questions?
