People working in healthcare commonly find themselves providing care to someone they know. In some settings it may be possible to switch assignments. However, when the patient is known to staff, or the community is small, this won’t be an option. Depending on the relationship that former colleagues had with the patient, caring for her may have particular rewards or challenges.
First steps
As soon as it is practical, acknowledge with the patient the new dynamic in your relationship –that while you are a former colleague, you are now her caregiver and she is your patient. Assure her of your commitment to maintaining open, honest and confidential communication. Check in with her regularly: Are staff treating her differently? Are they avoiding her or, conversely, not respecting her space? Rather than making assumptions, take time to discuss her care needs and how well staff are meeting them.
Boundaries and Privacy Issues
Privacy issues take on an added dimension. Your relationship is different now; her comfort in sharing information about herself and her situation, as well as her need for physical privacy, might also have changed.
Information acquired when the patient worked alongside you cannot be freely shared with and among team members. Nor can information that she now shares in a personal conversation. The difficulty comes when issues that may be relevant to her care (e.g. worries about family, finances, spiritual questions) come to light in the context of a personal discussion. Such information should be shared with members of the health care team only with her permission. If possible, clarify with her at the start of any conversation whether she is speaking with you as your patient or confiding in you as a friend.
Each province in Canada has its own regulations to protect Personal Health Information. Consult your regional websites regarding the privacy laws in your area. Your former colleague must be afforded the same protection of privacy as other patients.
Boundaries and Self-Care
At the professional level, care for a colleague at end of life should be similar to care provided to any patient. At the personal level, you need to find ways to acknowledge and work through your own feelings about your colleagues's illness and approaching death while continuing to offer care and support. You will also need to figure out what, if anything, you want to do to bring closure to your relationship. This might mean conversations about how you have appreciated her in the past and how you can be supportive in the present. It might mean reminiscing about shared experiences or even working through past misunderstandings.
To help the healthcare team work together and sustain each other, consider regular, voluntary de-briefs or team support meetings facilitated by a sensitive and skilled spiritual care provider or social worker. Such meetings can ensure a safe, supportive atmosphere to share feelings, identify difficulties, and work together in planning an approach to provide quality care.
A more informal approach is simply to check in with each other at regular reports, rounds or ‘huddles’. Huddles bring all staff members together in the middle of a shift for a brief check-in with each other. More serious specific concerns can be followed up by spiritual care, social work or the team manager. The reference list below includes two articles on how to approach a huddle. You may wish to create a binder of reading materials for the staffroom including these articles or any others from the reading list below.
See also:
References
Goldenhaer, L.M. et al. (2013). Huddling for high reliability and situation awareness. British Medical Journal, 22, p. 899-906.
Fogarty, C. T. and Schultz, S. (2010), Team huddles: the role of the primary care educator. The Clinical Teacher, 7: 157–160.
Salladay SA. When your patient is a coworker. Nursing. 2011 02; 41(2):12-12.
Clarke AI. Caring for colleagues. British Columbia Medical Journal. 2013;55(6):269.
Consalvo KE, Piscitelli LD, Williamson L, Policarpo GD, Englander M, Lyons K, et al. Treating one of our own. Clin.J.Oncol.Nurs. 2007 Apr;11(2):227-231.
Constantino J, Smart CJ. Death among us: grieving the loss of a coworker is a group process. Am.J.Nurs. 2004 06;104(6):64C.
Horn MO. The other side of the bed rail. Ann.Intern.Med. 1999;130(11):940-941.
Kanzler K, E., Goodie J, L., Hunter C, L., Glotfelter M, Ann, Bodart J, J. From colleague to patient: Ethical challenges in integrated primary care. Fam Syst Health. 2013 03;31(1):41-48.
Penson RT, Seiden MV, Chabner BA, Lynch Jr. TJ. Caring for colleagues. Oncologist. 2001;6(2):197-204. http://theoncologist.alphamedpress.org/content/6/2/197.full
Ufema J. Insights on death & dying. Professional friendship: losing a cherished colleague. Nursing. 2008 10;38(10):61-61