Teaching Presence with Social Distancing

August 23, 2020

At Unity we have been working hard to make adjustments with the covid-19 pandemic. The pandemic has touched just about every aspect of our world including how to train our new hire nurses and CNAs. People are still seeking new opportunities of employment and we continue to assist and support skill development in our new nursing staff every month. The pandemic has even influenced some nurses to seek out Hospice work for the opportunity to make a difference during this time.

We take great pride in our orientation process. Strategic intention was used all the way from the development of the content to the timing of the classes offered. Many new hires have expressed gratitude at the time allotted them to learn their new role and the great detail provided. Then the pandemic hit and we had to scramble to find a way to continue to provide this invaluable orientation experience – at a distance.

We knew it was vital that with the temporary change in our orientation we didn’t compromise the quality of our training. We needed to find a way to energize and engage our learners without our physical presence. We had to ensure we were adaptable and flexible to their needs while still maintaining an evidenced-based framework. We used creativity and collaboration to develop our virtual orientation platform.


We needed to find a way to energize and engage our learners without our physical presence.

Our orientation included not only classroom learning, but also time with an at-elbow preceptor and a dedicated mentor. The preceptor’s role is to teach the role of the Hospice professional at bedside. They are there to demonstrate and reinforce the technical skills needed, communication with patients and families, Hospice documentation, and the day-to-day work. The mentor is there to provide support through the whole process, answer questions, and guide the orientation process.

Many dimensions of the orientation process have been impacted by social distancing, including:

  • Valuable time riding in the car to and from visits with the preceptor has been removed. This was a great opportunity to discuss the visit and why things were done the way they were.
  • Staff are masking all day which can hide reassuring facial expressions provided by a preceptor during a visit the new hire is leading.
  • Time spent together learning in the office with their preceptor, getting to know their peers, and learning other office resources is discouraged.
  • Visits have been decreased to only essential to decrease contacts with our high risk patients.
  • Regulatory waivers are being issued which can cause confusion regarding what the normal hospice regulations are.

The biggest impact is about teaching presence. Hospice care is about presence with our patients and families as they go through their journey. Hospice is one of the only times in their medical journey that they get to direct their course of care. Patients and families do not come onto Hospice knowing how to make these decisions or how to talk about what matters most to them. We teach our staff how to encourage these discussions and a major factor is presence. Letting them know that we are there to support them, provide them with the information they need, and walk with them on their journey.

Contact Unity 24/7 if you have any questions or if you would like to join the Unity Team.

This blog post was shared by Sonja Kuehl, a Registered Nurse who is also a Certified Hospice and Palliative Nurse. Sonja serves as a Clinical Nurse Specialist at Unity Hospice.

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