Transcript Communicating with Cancer Patients

Communicating with Patients with
Cancer
Ayman Mansour RN, PhD
Faculty of Nursing
University of Jordan
Outline
 Communication
and
therapeutic skills
 Psychosocial aspect of illness
 Communicating with cancer
patient
Definition

“all modes of behavior that one individual
employs, conscious or unconscious, to affect
another not only the spoken and written
word, but also gestures, body movements,
somatic signs and symbolism in arts”
Ruesch 1972
Types of Communication
Verbal - written & spoken messages exchanged
in the form of words as the element of language
Nonverbal - messages that do not involve
spoken/written word and are conveyed by
behavior or through any of the five senses
 90% of communication is thought to be
nonverbal
 Nonverbal cues should have congruence with
the verbal message
Assessment of Communication

Includes analysis of how verbal and
nonverbal modes are used to structure
communication

What are the messages conveyed by each?
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Are the messages congruent?
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To what extent are stereotypes about
the self/others conveyed by the
structure of the client’s communication?

How does the structure of the client’s
communication contribute to the
problem (s) for which help is sought?
How can I become a good
communicator?
Feedback:
e.g., the patient is telling the nurse about his
pain, the nurse replied
“if I understand you correctly, you have pain in
your lower abdomen every time you move
you left leg”
* Then the patient can agree or correct the
patient.

How can I become a good
communicator?
Appropriateness:
The message fit the circumstances
A; how are you?
B: fine.

How can I become a good
communicator?
Efficiency:
Simple clear words
Nurse to patient “tomorrow you will have a
procedure where a balloon is threaded into
an artery and inflated to open up the vessels
so more blood can flow through”

How can I become a good
communicator?
Flexibility:
Making communication based on immediate
situation rather than perceived expectations
The nurse enter the patient’s room to give him a
medication and teach him about the side effect.
The nurse found the patient crying.
“ the nurse to be flexible to deal with the patient
feeling rather than what she came for”

Therapeutic Communication

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Occurs between the nurse and the client but
it is client focused
It is a learned skill involving both verbal and
nonverbal communication
The purpose is to promote client growth
Involves the disclosure of personal
information by the client
Therapeutic Techniques


Introducing self
– Enables client to meet nurse
Offering self
– The nurse offers his or her presence, interest,
and desire to understand without making any
demands on the patient.
 “We can sit here quietly; there’s no need to
talk unless you want to.”
Therapeutic Techniques

Active Listening
– Utilizing both verbal and nonverbal skills
that show the client that the nurse is
attentive to what is being said
Facing client; maintaining eye contact;
“Go on, I hear what you are saying.”
Therapeutic Techniques

Stating Observations
– Nurse offers a view of what is seen or
heard to increase verbalization
“I see you are quite anxious.”
“You keep rubbing you forehead;
are you in discomfort?”
Therapeutic Techniques

Summarizing
– A concise review of the main ideas
that have been discussed
– Allows clients to sense whether the
nurse understood their message
“From what you describe, your
family seems….”
Therapeutic Techniques

Focusing
– Focuses on a subject until the important
points come into clear view for both the
client and the nurse
 “You touched on his drinking. Tell me
more about that.”
Therapeutic Techniques

Role Playing
–
The nurse plays the part of a person the client needs to say
something to


“Let’s go over what you want to say to her.”
Confronting
–
The nurse supports the client but directly challenges
inaction on the part of the client

“You keep telling me that you want to quit drinking, but what
actions have you taken thus far to aid with your sobriety?”
Non-therapeutic techniques
Reassuring
 Giving approval
 Rejecting
 Disapproving
 Advising
 Challenging
 Defending
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Dysfunctional Communication
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Acting on assumptions without validation
Assuming that…..
others share your perception
your perceptions won’t change
your perceptions are complete
others know how you think or feel
Decision-making by power
Stereotyped phrases
Sending mixed messages
What is special about CANCER


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life threatening situation
Clients diagnosed with cancer experience
distress
Nurses are there 24/7
Communication is The Most important
aspect of nursing care
Two types of communication
1.

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Instrumental behavior: informing patient
about the disease and treatment and
providing care such as:
Orientation and instruction about the unit,
hospital
asking for clarification, understanding and
opinions
nursing and medical topics
Expressions about lifestyles
Two types of communication
2. Affective behaviors: showing respect,
giving comfort and trust, showing
understanding such as:
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Personal and social conversation (jokes,
laughs, approval, compliments)
Showing concern and empathy
Reassurance/ encouragement
Showing agreement and understanding
 important
for building trust
relationship
 help patient to disclose information
and concerns related to their
confrontation with a life threatening
disease. )
Negatives
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Overwhelming patient with information about the
disease and medications.
Not establishing what patient understands about his
illness.
Overwhelming patient with physical care and
treatment problems
Using close questions not being able to assess
problems of concern to patient
Not being able to get patient disclose feelings

Negatives leads to imbalance in nurse
communication ------leading to ----- patient
dissatisfaction and view nurse as
unsupportive especially if no attention paid to
emotional problems
What studies found about nurse
cancer patient relationship
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Nurse exhibit more negative features than positive
The cancer patient is willing to explore concerns if
the nurse is willing to listen and explore these
concerns
The more the nurse show empathy the more the
patient disclose concerns
Patient discloser is strongly inhibited by nurse’s
avoidance behaviors (abrupt and change subjects,
ignoring the patient)
Why?
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Because discussing emotional issues is
difficult
Unease experience especially with cancer
patient in terminal stages
Nurse tend to use distancing tactics (afraid of
loosing control over the situation if they
became close to patient).