The first visit is always hard. "Will they like me?" "Will I be able to help?" "What will I do?" These questions are natural. Just remember at these times that you have been selected to serve as a Hospice team member because people experienced in the field have confidence in you. Just "plunge in" taking with you an attitude of openness and receptivity to the needs of the patient/family to whom you have been assigned. They will let you know what they need, and you, in turn, will let them know what you can offer. The relationship unfolds step by step in a very natural way.

Here are some guidelines that may help:

1. Genuineness--Be yourself. Aside from modifications in behavior to assure the comfort of the patient, i.e., quietness, less talking and more listening, conscious attentiveness, etc., the volunteer should relate with the same "personality" he displays in any other situation. People who are ill appreciate being treated naturally, and in this way are reassured that their illness has not set them apart any more than in the obvious ways. Relate to the patient, not the illness.

2. Communication with the Nurse. The importance of clear communication between nurse and volunteer cannot be overemphasized. The two of you are a mini-team and can be of great help to one another and to the patient/family by maintaining regular contact and keeping one another current with what is going on. The Volunteer Coordinator is an important liaison in this communication. A working relationship is essential to maintaining continuity and stability, as well as to providing quality care. Always feel free to call your assigned nurse at the office.

3. Communication with the Family. It is your responsibility to state clearly to the family what you can and cannot offer in terms of time and availability. This will prevent awkward and possibly painful misunderstandings at another time. It is helpful to ask the family to outline their needs and expectations at the beginning (with the stated understanding that these may change as the patient's condition changes), and to indicate how you can help fill these needs, given your own life pattern. Regular phone calls to "check in" are appreciated, and sometimes result in meaningful and substantive conversations. Some people find it easier to open up in an unplanned phone contact than during a scheduled visit. Again, in most instances it is up to you to take the initiative in getting things going.

4. Dependability. To people in crisis, whose lives are subject to so much unpredictability, it is essential to know that they can count on someone or something. Never offer more than you know you can deliver. The life of a seriously ill person has little variety and few distractions and therefore each outside contact assumes larger than usual proportions and importance. What may be a minor part of your week may be the single event that the patient has been eagerly awaiting for days. It may also be an opportunity for the primary care-giver to have some private time away from the responsibilities of patient care.

5. Listening. Always remember that your function as a volunteer is to first meet the needs of your patient/family, rather than your own. In most instances this means listening more than talking. It may mean listening to the same stories that, for whatever reason, satisfy a need of the patient or the family member in the telling. It may mean listening non-judgmentally to outbursts of anger, frustration, and resentment which serve to release tension. You may even be the target for some of these negative feelings. Don't take it personally. People under severe stress often act inappropriately. ***Please let the Volunteer Coordinator or Executive Director know if the negative response begins to interfere with your relationship.

6. Confidentiality. References to the patient/family by name should be confined to contacts with the Hospice team, either individually or at meetings. Information of extreme confidentiality divulged by a patent or family member should not be shared in a group session unless it bears directly upon the designing of a care plan. Such information may be shared with the individual team members, if needed, for the peace of mind of the volunteer.

7. Physical Contact. Some people like to touch and be touched. Others do not. It is helpful if you can be flexible with this issue yourself, so that you can cue in on the needs of those you are serving. In most instances, patients welcome hand holding and other appropriate physical gestures as a means of communicating, caring and "connection" without necessity for tiring conversation. Family members often respond to a hand on the arm or across the shoulders also as a gesture of "I'm here and I care." It goes without saying that this dimension of the relationship evolves naturally with the passage of time and the intensity of events. Be open. Do what feels right. Again, your comfort or discomfort will communicate itself clearly, so it is important to be yourself.

8. Meet Them Where They Are. Regardless of how much you may disagree with a family's way of dealing with their situation, it is never appropriate to give unsolicited advice. Patterns of interaction between family members, no matter how counterproductive they may seem to you, have been formed over years of association and are rooted in a history of which you are not a part. Your responsibility is to work as helpfully and harmoniously as possible within the given structure--not to try and change it.

9. Initiative. At the onset of a relationship, the family will usually look to the volunteer to set the pattern of interaction. Regular phone calls and brief visits to see how things are going are usually appreciated and serve to break the ice. Don't assume that someone doesn't need to talk to you just because they haven't called you. On the other hand, be sensitive to the possibility that you may not be needed, and never prolong a conversation in which you are doing most of the talking.

10. Little Things Mean A Lot.

* Your personal grooming and manner of dress can affect a patient's mood. Color and attractiveness can help lift the spirit.

* Perfume or aftershave can be unpleasant to people on medication.

* A positive attitude and pleasant expression means a lot. This does not mean phony cheerfulness or overly bright chattiness, but merely a clear message of caring and attention.

* Cards and flowers brighten a room and remind the patient that people care even when they cannot be present.

* Sometimes not talking, but sitting with a patient and letting him know you care by being there is the greatest gift of all.

***All patient personal care is to be done by the nurse or home health aide.

Examples of this would be bathing, giving medication or changing dressing. If you have any questions as to whether or not there is a task you should not be doing, please call the office.