Role of the Volunteer

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 you have been selected to serve as a hospice team member because people experienced in the field have confidence in you. Have 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. 

  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 their illness has not set them apart any more than in the obvious ways. Relate to the patient, not the illness. This holds true for family members as well. The volunteer role is that of friend and supporter, not expert or authority. You are not expected to know all the answers. It does not take long to clarify for the family that the nurse and physician can best answer medical and technical questions; and that you are there to facilitate this communication and to provide other, less technical support. This role definition comes about most easily when the volunteer feels comfortable from the beginning just being himself.

  2. Communications with the nurse: The importance of clear communication between nurses and volunteers cannot be overemphasized. 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. Don’t be afraid to take the initiative in establishing this relationship. It is important to break the ice early so a strong bond can be established before the patient/family situation comes to a crisis. Exchange schedules and appropriate phone numbers and clarify mutual expectations with one another at the start. A working relationship is essential to maintaining continuity and stability, as well as to providing quality care.

  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 these may change as the patient’s condition changes), and to indicate how you can help fill these needs, given your own life pattern.

  4. Dependability: To people in crisis, whose lives are subject to so much unpredictability, it is essential to know they can count on someone or something. Never offer more than you know or 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 eagerly awaited for days. It may also be an opportunity for the primary caregiver to have some private time away from the responsibilities of patient care.

  5. Listening: Always remember 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 over and over again, stories that for whatever reason, satisfy 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 serves 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.

  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 patient or family members should not be shared in a group session unless it bears directly upon the designing care of the plan. Such information may be shared with the individual team members, however, if needed for the peace of mind of the volunteer.

  7. Physical contact: Some people like to touch and be touched. Others don’t. It is helpful if you can be flexible with this issue yourself, so you can cue in on the needs of those you serve. In most instances, patients welcome hand holding and other appropriate physical gestures as means of communicating, caring and connection without necessity for tiring conversation. Family members, too, often respond to a hand on the arm or across the shoulders as a gesture of “I’m here,;I care.” It goes without saying 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:” Over and over again in your training, the concept of turning in to the family and meeting them in terms of their own values and life patterns was stressed. 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 to 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 gong are usually appreciated and serve to break the ice. Don’t assume someone doesn’t need to talk just because they haven’t called you. On the other hand, be sensitive to the possibility 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 after-shave can be unpleasant to people on medication. A positive attitude and pleasant expression mean 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 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.

  11. Frustrations: Becoming involved as a Hospice volunteer may present unexpected frustrations for some. The team approach between nurse and volunteer is delicately balanced, and it depends more on the needs of the patient/family than it does on the relationship of the nurse and volunteer. In some cases, the nurse assumes the primary support role from the Hospice team. This may be because the patient sees no need for a volunteer, or does not wish to share their personal life except in a professional way. In other cases, the patient might need a friend more than professional nursing. Bear in mind the nurse’s role is more defined and often more easily accepted, particularly in the beginning of a case. Volunteers in the past have been frustrated by this and have wondered what their role should be. From those who have experienced this problem, the advice is “tread lightly, but hang in there.”

  12. Conflicts: Another area that may cause frustrations is personality and conflict. There might be a conflict between the patient and the nurse, or between the nurse and the volunteer. Thant's okay; we're human. If the conflict is between the volunteer and the patient or family, remember it might be temporary, as the family or patient might resent needing anybody. In time, this initial rejection can turn into deep friendship. In truth, you will become very involved with some patients and remain relatively untouched by others.

  13. Personal reactions: The relationship a volunteer has with a patient/family is sometimes a deeply personal one. Often the volunteer is involved in helping to support the family members immediately following the patient’s death. The volunteer may also feel grief reactions as would be expected in the death of a friend or any other important person in his/her life. Sometimes these reactions are immediate and easily identified. Others may be delayed for some time, perhaps making it more difficult to identify the source. It is important to understand these reactions are normal and to realize the hospice team stands ready to support you through the grieving process.