Applause for nurses and care workers, at night on the balcony, during the pandemic. Who doesn’t remember that?
Applause for nurses and care workers, at night on the balcony, during the pandemic. Who doesn’t remember that?
And who in this country isn’t confronted with the – to put it kindly – very difficult situation of people in social professions in Germany in the news, feeds, and sometimes in their own personal everyday life? Whether your elderly aunt is looking for a place in a care home or you yourself end up in the emergency room – what you experience there is frightening. And inspiring at the same time. Frightening, because everyone everywhere screams “overload”. Inspiring because the people there go beyond their limits time and again and do their “job”.
I struggled a bit with this aspect of our topic because, yes, because it seems almost unbelievable to me that anyone still wants to (or can) work under such conditions. Maike Lewerenz from The Rauhe Haus* in Hamburg, Germany, proved me wrong – with a lot of good humor and a very clear attitude.
B: Dear Maike, would you like to briefly tell us about yourself, who you are, what you do and especially why you are doing it?
M: I’m actually a nurse. I got into geriatric care by chance and was involved with people suffering from dementia relatively quickly. I found the field very exciting, so I gradually developed my skills and in 2010 I did my specialized training to become a psychiatric nurse.
B: Where did you get the idea to do something like that?
M: At the time, I was working in a facility that provided typical nursing care for the elderly. And then the position of residential area manager became vacant in the dementia area. That appealed to me and interested me, but it was linked to further training. And that is always part-time. That meant a lot of effort, which is why I ground my teeth at first – but it was the best training I’ve ever done in my professional life. It really helped me personally and paved the way for me to meet these people.
B: What did you like so much about it?
M: I’ve certainly always had very good access to dementia patients, I think I’m just a really empathetic person and can communicate well non-verbally. But thanks to the conversation techniques you learn there – we talk about integrative validation, which focuses on feelings and understanding – I can now communicate with them even better. You have to realize that the mind becomes demented, but not the feelings.
For example, if I really understand and accept the other person’s sadness and signal this to them verbally or non-verbally, it creates a very intimate emotional form of communication – that’s impressive. You can understand why a person with dementia is so disinhibited. Whether they eat, they seem excessive. Whether they drink, they seem excessive. And the choice of words can also be very spicy. Which was certainly not in common usage before, especially among an older generation. But if you practice this form of communication, you get access more quickly. And you can calm them because they simply feel understood.
That’s what it’s all about: Understanding, accepting, and respecting. Regardless of whether they lash out in anger, this is actually always an expression of fear because they no longer understand what is happening to them.
B: That’s the key word: Respect. How do you feel about that? Do you feel that your work is more valued now after COVID? Or has nothing happened apart from the clapping?
M: Yes. And no. So, there is an appreciation, but it hasn’t increased as a result of the pandemic. And the demand from people who bring their relatives to a care facility or hospital is high. And it’s growing constantly. Even though the care situation and the staffing situation are being publicized daily. I think we would all like to give our all, do everything we can, but we just can’t get the jobs filled. I can understand my counterpart having this attitude of entitlement, but I can also understand my colleagues who say that we simply can’t do it.
B: Do you have to be a certain type of person to be a care worker?
M: I think so. On the one hand, you have to have a lot of empathy, a lot of understanding. You also have to – let’s think about personal hygiene – see this as normal, as human and not disgusting. You need a mixture of being sensitive to the other person and taking a step back at the same time.
B: How do you manage to convey that you still respect someone when you physically get so close to them?
M: By being approachable, but also professional. I think it’s very important to communicate this clearly: This is part of it for me. And that takes away the shame. It’s a question of attitude. An attitude towards shame. And, yes, to simply be honest sometimes, to say that I can understand them, because should you find yourself in the same position one day…
B: Can this be learned? Or do you need a kind specific attitude for this, an image of humanity??
M: I think you need an attitude, and, above all, you have to be prepared to grow. You need a lot of self-reflection, all the time. About your daily actions – or when you switch to a different position, like me: What happens to me when I’m a “manager”? I have to provide structure, I have to give employees security, I have to give residents security, I have to leave my actual level of immediate action and go one step further. This also applies if I remain in basic care: Can I still do this? Or can I no longer cope with the conditions that have become so tight and rigid in recent years?
B: How do you manage not to exploit yourself? Or do you not manage it?
M: Hm, exploiting myself… (she smiles). So that’s development, that’s personal development, because you inevitably reach your limits. I’m certainly the type of person who tends to let myself be exploited or give a lot, and who perhaps also finds it hard to let go. You think: “I’m going to stay, I need to make sure that this person is going to be fine”. And then another one comes along and another one and another one… It’s a learning process. At some point you realize that you can only help, you can only be good, if you are good to yourself. If you respect yourself and say, here’s my limit, I’m simply exhausted now and need distance and rest.
B: I imagine it to be very difficult, as you say, you are empathetic and want your protégés to be well. How do you strike a balance between closeness and distance? And how do you not lose respect for someone because their spirit is no longer there? I imagine that’s also incredibly difficult. Is that the case?
M: No, when I look into the faces of these people, these very old people, and into the eyes that shine, or eyes that are dull – you find so much character there. It’s natural and easy to maintain respect, it’s inevitable. It doesn’t matter whether this person says something I don’t understand or just mumbles to themselves in a stooped posture, but once you catch a glance like that, you can still recognize – not character, but what kind of charisma is still there. What facial features, how strong they are. And then respect and esteem just comes naturally. And that’s not exhausting at all, by the way.
It becomes exhausting when someone is afraid and expresses this fear with an outburst of anger or dejection. Then it’s time to let go and say, I’m leaving now. Because I’ve just realized that I’m exhausted. And that is actually very interesting: People with dementia in particular notice your exhaustion, they are very sensitive. They realize that you don’t really want to be there anymore, so they don’t want to be close to you. That’s actually good communication. Someone clearly communicates to me: The way you are, you don’t want to be here with me, so please leave. A very clear signal. And that makes it easy for me again.
Many people think it’s best to be around these people 24 hours a day. No, nobody can endure it if you’re constantly in physical contact. That would make us break out as well. The “aggression” that is so often associated with dementia patients is often simply a message: Something is not right here.
B: Do you think one can learn to understand that?
M: Yes, I learned that too. But of course, you also have to be interested in people. You have to be curious.
B: And respect? Can that also be “learned”?
M: I think it’s important that respect is exemplified – a form of imprinting. Hm, but, yes, I think you can learn that.
B: What does respect mean to you?
M: Respect means that I accept a person with all their ideas about life, with all their understanding, even with a view that is completely different from mine. That I nevertheless accept or can accept this, that I do not judge and do not pass judgment. Of course, there are limits, but…
B: Where are the limits for you?
M: In any form of discrimination. Disrespect is to cross boundaries. The other day, someone I didn’t know at all came so close to my face that I could just fit two flat hands between them. That’s going too far. Or anything that goes in the direction of “deriding someone”, that violates my personality, that is disrespectful to me.
B: What I see at the moment is that people are stuck in dogmas, that only this or that opinion counts and that there is no exchange of arguments. What do you think from your experience? How do you manage to talk to someone who doesn’t actually want to talk?
M: By accepting him as a person. I think you can also convey that non-verbally. And that you make it clear that there are points that you don’t agree with. I can say: “I see things differently, but maybe we can come together somehow. Maybe we can discuss this.” But there are certainly limits, as I have just said. There are also people you can’t get through to.
I think we always try to understand a lot through logic. We try a form of missionizing – to say: “Be reasonable, look at this”. That doesn’t work. Then you have to accept it. Nevertheless, this person may also have many other likeable views and qualities. And is good for me on another level. For me, it’s not about understanding everything, accepting everything – and that 70s feeling that everyone loves everyone else… No, it’s about taking a very differentiated view and distancing yourself if necessary.
I can’t cope with people who don’t understand my world view per se. But on a small scale, for example, if I’ve been friends with someone for many years and there’s a discrepancy on a topic, whether it’s the pandemic or a political view, then I ask myself: What do we have? What is more important, do we have more fun and enjoy each other? Can we somehow support each other in certain times? Or is someone simply no longer good for me? Then I withdraw so that I can maintain my own stance and say to myself that this has gone too far for me.
B: Does respect depend on the function – whether you are a manager or an active care worker?
M: No, I wouldn’t see it like that. The respect I pay is the same at every level. Of course, responsibility is always increasing, and each person needs something different. If I treat one person very casually, it can be too lax for another person. You have to see who reacts to what or how different people like to be approached.
B: And how do you get respect? Are you a person of respect?
M: That is difficult. Yes, I think so, because I make it relatively clear what I expect. There are high expectations from my colleagues, whether that’s in dealing with dementia or in other areas that this profession simply entails. But I think because I can set an example, I would describe myself as a person of respect.
B: And how do you gain respect? – I don’t think you’ve been working at The Rauhe Haus for that long…?
M: I think this balancing act of closeness and distance is very important. You have to be confident and clearly say: Even in such an interpersonal profession, we need structure and transparency in how we deal with things. You also have to set an example. If you also lend a hand and say: “OK, then I’ll help out again, even though that was not the plan. But when you see that your colleagues are in need…” I think that’s how you gain respect. And by setting clear guidelines that you consistently adhere to. You need a lot of staying power – that’s another way of gaining respect. But it’s also a question of being accommodating. Listening to what is needed. Sometimes it’s quite trivial things like materials that make the work easier. Then you get it and bring it to them. Yes, I think it’s the listening and acting that makes the difference.
B: And the relatives, how do you deal with them?
M: Here, it is also about listening: I can understand every family member who is in such distress and wants to achieve the best possible outcome for their father, mother, or grandparents. Understanding this and taking away this distress – a lot can be regulated by listening. Relatives are also in exceptional situations during such times because they are so powerless. They would like to do something but can’t.
B: And if you could wish for something right now to make things better for care workers: What would have to change?
M: Of course, I would like to see a different political arrangement. That this shortage of skilled workers simply stops. So, if I could wish for anything, I would wish for a large gate through which many people come who have a desire to do good for other people, to care for them – and who also see this as a profession. I would like people to see that: Nursing is also a professional profession. I would like to get away from the belief that “anyone can do nursing”, because it’s not true.
B: But how do you get people to show up on your doorstep and say, “I would like to do this”? One girl, a nursing student, whose conversation I overheard on the train, said, after she had ranted a lot about her situation in the hospital: “But you know what, when I sit next to a terribly sick woman and she basically tells me her whole life in half an hour and you realize what a relief it is for her that I’m listening to her or that I’m there…. You know how the eyes light up then? That’s why I do this.” Is it like that? With you? With your colleagues?
M: Yes, this incredible curiosity about people, about biographies. As I said earlier, when you look into the face of a person with dementia and see how much that face has lived – and lives, in all its expressions – there is so much in it, you can read it like that. That’s exactly the reason why this is still the best job for me. Despite all the adversities, I wouldn’t want to do anything else.
B: Dear Maike, thank you very much – for that. And for the conversation.
* The Rauhe Haus is a foundation established by the theologian Johann Hinrich Wichern in September 1833 to care for neglected and orphaned children from the poor neighborhoods of Hamburg. Today, it is a diaconal institution that deals with child and youth welfare, inclusion of handicapped people, social psychiatry, care, and education (school, kindergarten).