From Elizabeth Causton, MSW, Counsellor – Palliative Response Team
As a PSW, situations will challenge your ability to maintain your therapeutic boundaries — meaning that it will be difficult to keep your personal baggage from getting in the way of providing compassionate, non-judgmental, empathetic care. Responding to questions about Medical Assistance in Dying (MAID) may be one such situation where it may be difficult to respond from a neutral place, for example, if a person has strong opinions about MAID, and or if discussing MAID challenges their beliefs. Because MAID is legal in Canada, and more people are asking about it so as to make informed decisions, all care providers, including PSWs, need to know how to respond neutrally to questions about MAID.
When teaching PSWs how to respond in difficult situations, e.g., questions about MAID, the focus is often on what you (as a PSW) cannot say, rather than on what you can say, on what you can’t do instead of what you can do, and on the limitations of your role rather than on the value of your role. Unfortunately, this leaves few options, and you may end up saying something like “I don’t know” or “I’m not supposed to talk about that.” Or you may cross a personal or professional boundary by sharing an opinion or information that is outside the role of a PSW.
Fortunately, you can use a unique strategy, called VERS, developed for responding to difficult questions, like those related to MAID. With this strategy, you can:
- Validate the question being asked, rather than dismissing it.
- Support the person asking the question to feel seen and heard.
- Maximize your information-gathering skills and therefore your value on the team.
The VERS strategy stands for Validate, Explore, Respond and Share. It offers a template for responding to difficult questions using your own words. It shifts the focus from figuring out what to say or do when faced with a challenging question, to focusing on,
- What (more) does the team need to know about where this question is coming from?
- What (more) does the team need to understand why this question is being asked now?
- What other information would help the team respond effectively?
With VERS, your focus is on gathering information about what the person is asking and sharing information with the team about the person’s concerns. It is not your role to provide information or an opinion about MAID.
VERS starts with validating — taking time to acknowledge a person’s right to ask a question, even a difficult one. It’s about listening to the question rather than worrying about giving the wrong answer or avoiding answering. When you pause and take the time to validate the importance of the question being asked and the legitimacy of the feelings of the person asking the question, you are saying,
“I hear you, I see you. Let’s start there.”
We start with validating because it takes the focus off of us and our attempt to come up with an answer, and puts the focus where it belongs, on the person asking the question. Responses that validate the question a person asks could be,
“This sounds important to you.”
“That’s a question that many people have about MAID.”
“In our experience, people are often concerned about that.”
“You seem to have put a lot of thought into this.”
The second step in VERS is exploring — seeking to understand what the question is about, and or the reason for the question. It is about gently exploring to clarify and expand our knowledge so that the team does not react based on assumptions about what someone means. Asking for clarification is a way of being fully present to both the question and the person asking the question, allowing the person before us to feel seen and heard.
You explore when you say things like,
“I want to be sure that I understand your question. Can you tell me a bit more about what information you are looking for?”
“Is there a particular reason why you are thinking about this now?”
“Do you already have some of your own ideas about MAID?”
The third step is responding. It is important to understand how a response is different from an answer. An answer is a statement and statements can be true or false, correct or incorrect. However, while a response can be an answer, it can also be another question such as,
“Would it be OK with you if I shared your question about MAID with the nurse?”
Or it can be a validation, such as,
“Thank you for clarifying that for me, that is very helpful.”
The fourth step in VERS is sharing the new information with the team. The underlying premise of VERS is that PSWs do not have to answer every question they are asked – but they do need to respond.
If we feel pressured to come up with an answer, we are more likely to say too much, to say something that is inaccurate or beyond our role, or to share our own beliefs and opinions inappropriately, perhaps in an attempt to influence the person asking the question.
On the other hand, responding by validating the importance of the question, then gathering information to help clarify the question or concern, will help make it easier for the appropriate member of the team to deal with the question(s) more effectively.
Let’s try out VERS
A question that might be asked is,
”How does MAID work?’
Using VERS, the PSW might start with the following statement that validates the person’s question, then explore by asking a question.
“Hmm, that’s a question that the team has heard quite often now.” [Validating]
I’m just wondering if there’s a particular aspect of MAID that you are wondering about?” [Exploring]
The person’s response to your question would come next. You might then respond with something like,
”OK, thanks. That helps me understand the information you are looking for. I want to be sure that you get the most accurate information possible. Can I have your permission to share your question with the nurse?” [Responding]
Finally, with the person’s permission, you can share with the team the question they asked and the information you gathered about their question. [Sharing]
Thank you for joining us and taking time to learn more about communicating in difficult situations. Do you have new information now that will help in your practice? Let us know in a comment below. Best wishes from everyone here at Life and Death Matters in your caregiving journey.
Thank you for clarifying best strategies in a place where our role is limited. As the person our residents see most often, we often are the ones with which they are most comfortable voicing difficult subjects. This gives us a clear and important strategy to allow us to help our residents while staying within our scope of practice.
This is a beautifully concise post that is helpful for any communication we, as HCAs, may have with our clients/residents/patients, MAiD related or otherwise. I’ve shared it with my manager who will use it for future training and education.