REQUEST: Write about the role of a hospice nurse in working within a dysfunctional familial environment that involves the patient.

What is the definition of “dysfunction,” really? The dictionary defines dysfunctional as “not operating normally or properly.” With that definition I’d like to know what is normal and proper and by who’s expectations? For the purpose of this response I’m going to define dysfunctional as an inability to adapt to a current situation. Where it gets tricky is that some people, in their inability to adapt, instead adopt coping mechanisms which are harmful, to greater and lesser degrees, to themselves and/or to those around them.

By my definition human beings are by our very nature dysfunctional. We are always presented with new situations and having to learn how to adapt to them but we are imperfect beings and sometimes unable to effectively readjust. Some of us are just more resilient and adaptable than others. When dealing with a crisis in our lives, and experiencing someone close to us dying is certainly a crisis, our “normal” level of functioning can become impaired.

So how do we work with dysfunction? In the same way we address any other areas of concern with the patient and family. It will depend upon each individual situation so there is no pat answer to the above request.

Here are some ideas to consider when working with people under stress, actually, lets say working with people.

* We need to set our personal expectations and opinions of how life should be lived and died aside to accept the patient and family where they are in their coping and adapting capabilities. Remember, all we can do is suggest. The “you can lead a horse to water” adage applies very much here.
* Our role in hospice is to address end of life issues: To guide, support, and educate patients and families (if we get them early enough). It is not to address ALL of their challenges.
* You can’t fix everything. Families have spent a lifetime getting to the level of dysfunction at which they are operating. We will not be with them long enough to make much of an effect beyond helping them create a meaningful, less fearful, and possibly a treasured experience for the death of someone close to them.
* Protect your own boundaries. I have said to a patient, “If you raise that cane at me one more time I’m leaving.” I have also said to families, “You may not speak to me in that manner.” Our role is to educate, support, and guide, not to be yelled at, threatened, or treated rudely. Sometimes we just can’t help people in their ability to adapt to a challenging situation. It is okay for the hospice team to walk away.