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Caregiving
On Becoming an Expert Caregiver
When moral ambiguity within difficult cases forces growth.
Posted May 3, 2022 Reviewed by Vanessa Lancaster
Key points
- Difficult moral dilemmas in caregiving can lead to self-reflection and improved communication with your client.
- Reflection on moral dilemmas allows for enhanced tolerance and acceptance of varied perspectives.
- A conflict that arises during caregiving may offer an opportunity for self-improvement and new skillset integration.
Imagine you are taking care of a person who has quadriplegia and cannot extricate himself from his bed. He is dependent on his care in every way.
Given his infirmity and frailty, he has developed skin ulcers throughout his parts that depress into the mattress.
He has a sister that brings him food a few times a week, but that’s the extent of what he allows. Despite your compassion and yearning to make his life better by attempting to organize more help with food delivery, wound care, a better bed, mattress, more caregiver support with bathing, hygiene, and feeding, he reminds you that he wants none of that. He counters your good intentions by shrugging you off with disinterest. He motions to you that he wants none of what you came to bring him. In essence, he communicates that he wants none of your expertise.
Kelley Neufeld, LCSW, explained, “I wanted better for him. It struck me as a terribly lonely life; he could not change the channels on TV, he could not pet the cat he loved, and he could not even call for help. He just did not care. He was just waiting to die. Despite advocating for better care, it did not matter. He resisted all attempts to improve his living condition”.
Alternatively, take, for example, a person you are taking care of who wants to suffer and be in agony, for she believes that the suffering will bring her closer to God. Suffering allows her to strengthen her bond/her relationship with Jesus in a way that being healthy cannot.
In her view, suffering allows for deeper communion with God and will enable her to overcome her human nature and accept God’s grace. So, she chooses not to accept your offering of pain medicine despite her having severe cancer-related pain.
Perhaps we can call it the tyranny of the good caregiver. It’s a real phenomenon observed when caregivers believe they know better than their clients. For what is expertise if not knowledge gained through learning and lived experience at the expense of sweat and, at times, tears. Our expertise was acquired via sacrifice.
We have earned our expertise, and we want to put it to use. We want to be of service to another; we want to palliate suffering, and that’s what makes it at times so frustrating that we have to put aside our expertise to learn its finer points. To learn what not to do by way of getting caregiving all wrong. And it takes humility to do that.
The first time, it may feel like a slap in the face, a liver punch, when someone does not want what we have to give. It may feel insulting, humiliating, or even a rejection of oneself. But that is farthest from the truth. Expertise has carried you so far, but now you must learn something else.
You must learn not to be an expert in that relationship. You must learn to let go of your competency and sit back, listen and learn. What is the lesson? The lesson is what the person you are caring for is teaching you. Listen to it. You cannot hear if you are still the expert, and therefore you must abandon that role for a moment.
Lay it down gently, don’t be rough with it as that expertise is valuable, but for that moment, lay it gently down aside and allow yourself to grow in the fertile field fed by the rich nutrients within the soil you’ve helped to plant. Receive your lesson in humility and go on. You’ll be better for it.
So why should one be on guard for expertise, especially when being in service to others? We use our abilities as caregivers to provide what we think of as exemplary care. But, what happens when what we think we know gets in the way of effective caregiving?
Those times when we want to provide care as to how we think it should be provided but run counter to how the person you are caring for wants it. In essence, it is in those moments when caregiving runs counter to the preservation of the relationship based on agency, autonomy, and the right to self-determination.
Caregiving is a collaboration. At times, expertise is needed, and at other times, listening, just authentic listening and not the doing, is what matters most. Learn more about the person you are caring for. There is no standardized person. If it were that easy, caregiving would be effortless but as you know, being a caregiver is one of the most challenging professions.
Becoming proficient in a skill involves being perpetually vigilant to an ever-changing landscape of knowledge gained through experience and adjusting to that landscape in a way that changes your perceived skill level. The spiral of continuing growth allows one to keep improving with regard to constantly having to reformulate what one previously thought they knew to be correct.
Thus, becoming an expert is a constant paradox of having to be skilled in your craft contemporaneously and at the same time not cling to the validity of the current skill set as its final version. Put another way; one has to carry one’s thoughts of what they know lightly. One has to have the courage to renounce expertise for the budding new competence of new skill integration.
It’s extremely gratifying given the connection with another human being to give of oneself to the one who needs our care, especially at times of great need. To become a great caregiver, we must allow an interplay, a dance between our perceived expertise and our apprentice role, to carry us forward. Only in that contradiction does a caregiver blossom into his true calling, an expert caregiver.
