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FAMILY APPROACH ATTEND-TOs™
Interactions with a grieving family regarding organ, tissue or eye donation are often complex, highly variable, and unpredictable. Since these interactions are improvisational in nature, no “to-do” list of prescribed actions could ever be comprehensive enough or flexible enough to be truly useful.
EffectiveArts has designed a powerful and robust tool to support requesters when they work with families: the Attend-Tos.
The Attend-Tos are eleven elements that should be paid attention to, or “attended to,” in each family approach interaction. Attend-Tos are not
To-Dos. They are not a How-To list either. “How” (i.e. what action to take to fulfill any given Attend-To) is left up to the requester. Each Attend-To can be fulfilled in a myriad of ways -- the most appropriate way will depend on the specific family and the particular moment.
For example, one of the Attend-Tos is Connection. One common action used to create connection with someone is to shake that person’s hand. But what if the person doesn’t want to shake hands? If the requester is attending to Connection (versus fixated on a particular action), she or he will find an alternative way to establish connection.
All eleven Attend-Tos must be paid attention to and addressed continuously during the entire interaction with the family -- from the moment of walking in the door to the moment of exit. It’s like keeping eleven plates spinning: if a plate at any time starts to wobble, that plate must be given extra attention (but all eleven must be watched at all times).
This list is not meant to be the be-all-end-all list, but we think it is a good starting point. Many of the Attend-Tos are supported by the research literature; several are still only educated guesses.
A description of each Attend-To follows. Below the descriptions is the rating grid used to assess a requester’s skill in fulfilling each Attend-To (rated on a 1-5 scale where 1=Not at all fulfilled, 2=Barely fulfilled, 3=Partially fulfilled, 4=Mostly fulfilled, and 5=Completely fulfilled).
ATTEND-TOs DESCRIPTIONS
1. Connection with the family
Does the requester establish an authentic connection with the family? Is relatedness present?
2. Trust
Is the requester trusted by the family? Trust can be gained and/or earned in many ways.
3. Family power dynamic (who’s in charge)
Does the requester figure out who among the family is “in charge” (whether or not that person is the most vocal)? This could be a single person, or the power could be shared among several or all members of the group.
4. Inclusiveness of all (appropriate) family members
Does the requester include all appropriate family members in the conversation, even if they are not Legal Next of Kin (if it is clear that the LNOK wants them there)? Does the requester facilitate the exclusion of people who the family feels should not be a part of the decision-making process?
5. Technical Information / Education
Does the requester understand all aspects of the donation process? Does the requester explain each aspect of the donation process to the family in a clear, concise and accurate way, in a language and at a speed that is appropriate to the family’s current ability to understand? Is the appropriate level of detail given (not too much, not too little)? Does the requester check for understanding?
6. Timing / Pacing
Timing involves bringing up topics at the appropriate time and not sooner. Timing also includes not delaying -- when it is time to address a topic, that topic should be brought up.
Pacing involves the requester’s speed of speaking. Does the requester’s speed match the family’s ability to hear and understand? Speaking at an appropriate pace means not speaking too fast, but it also includes not speaking too slow. Appropriate silence is also part of pacing.
7. Emotional level of the family (includes being OK with family’s emotions)
Does the requester notice and act appropriately to the type and level of emotion displayed by each member of the family? Is the requester OK with any emotion displayed by the family (i.e., the requester is not excessively uncomfortable with that emotion)? For example, some requesters are fully at ease when people are sad but very uncomfortable around people who are angry. Other requesters can be exactly the opposite.
8. Condolences
While the requester doesn’t (and shouldn’t) feel the same pain as the family, does the family experience that the requester fully knows and acknowledges their current condition?
9. Acceptance of death
Does the requester find out if the family is accepting the death of their loved one? Here “accepting” death does not mean liking it or being at peace with it -- it only means that they get that their loved one is dead (this is sometimes especially difficult for brain death cases where the patient’s heart is beating, his/her chest is rising and falling, and he/she is warm to the touch).
10. Directiveness / Guidance
We compare requesters to tugboat captains towing ships through unfamiliar and perilous waters. Is the requester sufficiently focused to skillfully guide the conversation without being pushy or manipulative?
11. Religious, cultural, or other differences (includes being non-judgmental)
Is the requester sensitive to how the family might be different from him- or herself (for example, in terms of religion, politics, culture, ethnicity, or background)? Can the requester avoid imposing his or her values, customs or expectations on the family? Is the requester familiar with the customs and beliefs most often encountered in his or her area, as well as the positions of the major religions on donation?
Click here for a printable page of the EffectiveArts Attend-To list with explanations.
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