Hospice Trends: Storytelling rewards both sides of conversation

Teller and listener reap its benefits
By Eric Resultan
Editor, Hospice Management Advisor

The older I get, the more sentimental I become. I look at my own children and wonder if they will value my life-defining stories, or whether they’ll simply suffer through them, as I have done with some of my parents’ own stories.

One of my earliest recollections includes my mom’s Coming to America tale. She told the story to my brother and me as if Emma Lazarus had penned "Give me your tired, your poor, your huddled masses…" right after seeing a certain young Filipino nurse arrive in Philadelphia in 1960. "I had only $20 in my pocket, and I didn’t speak the language very well," she told her impressionable sons.

As the years went by, Mom dragged the story out time and again to remind us of her humble beginnings in order to shame two ungrateful children into accepting the things they had, or to prod an underachiever ("Surely a boy who has been given everything can do better than someone who started from nothing") into better work habits. It seemed, though, that with each re-telling, she had less money in her pocket when she stepped off the airplane. By the time I packed off for college, the embellishments bordered on the ridiculous: "All I had was the lint in my pockets, and I used it to knit myself a sweater that kept me warm during my first winter there."

OK, maybe I’m guilty of a little hyperbole.

In truth, I have come to realize the value of those stories, both to the storyteller and the listener. And while my mother is alive and well, I imagine the benefit she receives from telling these stories is similar to that received by terminally ill patients when they are asked to tell their life stories: It reminds them that their life has value. For this reason, storytelling should be a part of the care that hospice patients receive. It helps dying patients move past the debilitating emotions that hinder a high-quality death. Storytelling helps the hospice patient see his or her life in a positive light and brings families closer.

When people reminisce and tell stories, they find common ground with others and engage in a social process that promotes a sense of well-being. In the hospice setting, storytelling can help the dying patient feel empowered by focusing on positive life experiences.

The value of storytelling lies in the way it creates an opportunity for social support from family and friends. As people get older, they have fewer opportunities to feel supported by family and friends. The same can be said for the dying, who often feel isolated and angry.

As a result, self-esteem is diminished because of the lack of support. Self-esteem is even more dramatically affected in dying elderly patients. For example, men of retirement age often have lower self-esteem because they feel their life has lost meaning. If a terminal illness is thrown into the mix, the patient’s ability to achieve a meaningful death can be hampered by the perception that his or her life has lost meaning and that friends and family are providing less support.

The goal of hospice workers is to help patients wade out of the sea of negative emotions and get to a place where they can begin addressing their social and spiritual needs. In the book I Remember When, authors Howard Thorsheim and Bruce Roberts list five ways that storytelling promotes life affirmation and helps patients along the road to a positive accounting of their lives:

1. Provides a sense of belonging. Telling stories helps people feel closer to their families and community.

2. Makes the patient’s name known to others and others’ names known to the patient. Storytelling promotes an emotional connection between people who otherwise would be strangers. It can help hospice workers break through walls and nurture a familiarity that precedes trust.

3. Establishes a sense of caring. Sharing stories promotes a closeness among individuals through sharing details of one’s life and perceiving that others are listening and interested.

4. Sets up care. Story listening is a skill that sets the stage for giving care, while storytelling fosters trust that allows one to be cared for.

5. Provides an opportunity to ask for help. A story can often give the listener clues as to which emotions a person is struggling with and how to help the person handle them.

But convincing a patient to reveal intimate details of their life is not a simple task. The patient must place trust in the caregiver — trust not only that the caregiver will keep confidence, but that the patient’s efforts to share will be received favorably by the listener. If the patient believes the story is of little significance to the listener, the listener can cause the patient to retreat and make future storytelling more difficult.

Listening is a skill that few people master. Fortunately, most people possess the skills to become good listeners. According to Thorsheim and Roberts’ book, aspects of good listening include the following skills:

  • Develop good eye contact. Look at the speaker when he or she is sharing a life experience.
  • Ask open questions. Ask for more details through simple open-ended questions. For example, "Can you tell me more about that?" Asking for more details adds weight to the importance of the speaker’s story.
  • Paraphrase what the speaker is saying. In your own words, offer a quick summary of what the speaker just told you. This shows the speaker you are interested in his or her story and promotes sharing of additional details.
  • Reflect the speaker’s feelings. Saying something like, "That must have made you happy," shows the speaker you understand the emotions he or she experienced.
  • Know when to keep quiet. Allow the speaker to tell his or her story without interruption. For example, don’t start in with a story of your own until the speaker has finished.
  • Respect the speaker’s experience. Don’t belittle what the speaker did just because you would have done it differently.
  • Concentrate on what the speaker is saying. If you are going to find common ground with the speaker, you will need to think about what is being said. If necessary, ask questions that would make the story more interesting.

Practice listening skills

Listening exercises can take place during team meetings or inservice programs. Bring an object that has a story behind it — pocket lint, for example.

Break up into pairs and take turns telling the story behind the objects that each has brought. The exercise begins with the listener asking the speaker about the object. The speaker then responds with a short answer that does not offer much detail, simulating reluctance to open up. People have two minutes to tell their story.

The listener not only learns to asks more questions, paraphrasing when appropriate, but also to concentrate on what the speaker is saying so as to keep the conversation going. The exercise should last about 20 minutes, with the two participants switching roles afterward.

It has been a while since my mother last recounted her immigration experience. In fact, I have probably told the story more often than she has. But if I know her as well as I think I do, it’s only a matter of time before my children will get to hear it, or some version of it. "Hey Dad, did you know that lola [Filipino for grandmother’] came to this country in a raft she paddled all by herself?"

No, son, I didn’t. I can’t wait for her to tell me that one.