Transcript Slide 1

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_____Geriatric Curriculum
End-of-Life Nursing Education Consortium
SESSION 7:
Communication at End-of-Life
Fairfield University
Quinnipiac University
School of Nursing ELDER Project
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Objectives: Upon completion of this
session, the learner will be able to …
1.
Explore common communication myths.
2.
Identify basic principles of
communication.
3.
Practice therapeutic communication
techniques.
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Myths of Communication
• Communication is deliberate
• Words mean the same to
sender/receiver
• Verbal communication is primary
• Communication is one way
• Can’t give too much information
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Basic Principles of Communication
• Communication is a constant
two-way activity
• Words and actions are
interpreted by the receiver
• Much communication
is nonverbal
• Listening is the most
important part of
communication
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Verbal and Non-Verbal
Communication
• Includes body language, eye
contact, gestures, tone of voice
• 80% of communication is nonverbal
Boreale & Richardson, 2006;
Buckman, 2001; Dahlin, 2010
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Which statement is true about
communication?
• 1. we can never give someone too much
information.
• 2. We communicate only when we choose to
communicate.
• 3. The majority of messages we send are
unspoken.
• 4. Communication is mostly words and their
messages.
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Presence
• Knowing and being
comfortable with oneself
• Knowing the other
person
• Connecting
• Affirming and valuing
• Acknowledging
vulnerability
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Presence
• Using intuition
• Being
empathetic
• Being in the
moment
• Serenity and
silence
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“Nature gave us
one tongue and two
ears so we could
hear twice as much
as we speak.”
Epictetus, 55 A.D. – 135 A.D.
*LISTENING EXERCISE*
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Which factor is most important
to quality end of life care?
• 1. controlling the cost of pain medication
• 2. limiting care to symptom management
protocols?
• 3. communicating well with clients and
families
• 4. using volunteers to make sure clients are
not alone.
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Factors that Influence
Communication at EOL
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Culture
Age
Gender
Personal & family
experiences
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Barriers in Communicating with Dying
Patients and Their Families
• Societal denial of death
• Lack of direct experience
with death
• Older adults’ and families’
fears and emotions
• Dementia and other conditions that make
conversations about the future and other
abstract ideas difficult
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Barriers in Communicating with Dying
Older Adults and Their Families
• Caregiver fears:
• Not having “the answers”
• Feeling helpless/
inadequate
• Upsetting the patient/family
• Fear of showing emotions
• Caregiver’s personal fear of dying
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Basic Communication Concepts
• Use active listening
• Being present, rather than what you say, is
most important
• Let the patient and the family lead you –
join in their journey; but emphasize that
they are in charge
• Encourage reminiscing; let the older person
and families tell their stories
• Let the patient know that their lives have
meaning
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Important Messages to
Communicate to Someone at EOL
• Listen
• Respect
• Hopes, values,
and goals
• Encourage questions
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A man with advanced cancer is told that his therapy
is not working. He asks “Why is this happening to
me?” What is your best response?
• 1. “I don’t know. I wish I had an answer for you.”
• 2. “Perhaps you are being tested and this will
make you a stronger person.”
• 3. “I’ll ask the doctor to more fully explain the
disease process.”
• 4.”If I were you, I’d explore additional treatment
options.”
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Messages to Give to the Dying
*ACTIVITY*
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Messages to Give to the Dying
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I love you
I forgive you
Please forgive me
Thank you
Goodbye
During morning care a dying man asks the
healthcare worker if he is dying. The best
response is:
• 1. “Yes. I suppose you’ve know this all along. I promise I’ll
be right with you all the way.”
• 2. “Not today. Why don’t we look at some of the things you
would like to accomplish now.”
• 3.”Yes. Tell me about your concerns, fears, or questions
you have about what will happen.”
• 4.”Why do you ask that? You look like you feel so much
better today that you did yesterday.”
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Communication with health care professionals
should NOT:
• 1. be honest and truthful
• 2. involve the health care team
• 3. decide what client issues should be
addressed first
• 4. listen to a client’s concerns
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Staff Interventions with
Grieving People
• Support of grieving as normal
• Use of nonverbal communication
- Smile
- Nod
- Touch
- Hug
- Quiet listening
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Interventions with Grieving
People
• Provide physical
space for grieving
• Give emotional support
• Encourage expression of
feelings/life review
• Spiritual support
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Possible Things TO Say
• “I’m so sorry.”
• “What is this like for
you?”
• “Tell me about [your loved
one].”
• “What I remember most
(or appreciated most)
about [your loved one]
is…”
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When You are Communicating
With Someone Who is Upset
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Treat the person with respect
Answer the person’s questions
Stay calm; don’t argue
Use active listening skills
Let the person talk
*Role play activity*
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Strengthen Your Skills
• Identify your communication
style/your team member’s
• What communication styles are
easy/ difficult for you to deal
with?
• Do you understand your role on the
team and communicate it to the team?
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Respect, Respect, Respect
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References
City of Hope & the American Association of Colleges of Nursing, 2007;
Revised, 2010. The End-of-Life Nursing Education Consortium
(ELNEC)- Geriatric Training Program and Curriculum is a project of
the City of Hope (Betty R. Ferrell, PhD, FAAN, Principal Investigator)
in collaboration with the American Association of Colleges of Nursing
(Pam Malloy, RN, MN, OCN, Co-Investigator).
D.J. Wilkie & TNEEL Investigators, 2001. Toolkit for Nursing Excellence
at End of Life Transition, version 1.0. Cancer Pain & Symptom
Management Nursing Research Group; University of Washington.
Supported by DHHS/HRSA/BHPR/Division of Nursing
Grant # D62HP06858
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