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COMFORT*. Communication ( narrative) Orientation and opportunity Mindful presence Family Openings Relating Team. * Wittenberg-Lyles, E., Goldsmith, J., Ferrell, B., & Ragan, S. (2012). Communication and palliative nursing . New York: Oxford. Objectives.

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  • Communication (narrative)

  • Orientation and opportunity

  • Mindful presence

  • Family

  • Openings

  • Relating

  • Team

* Wittenberg-Lyles, E., Goldsmith, J., Ferrell, B., & Ragan, S. (2012). Communication and palliative nursing. New York: Oxford.



  • Describe a typology of family caregivers from a communication perspective

  • Identify two communication skills that could be used with family caregivers

Foundations family as system

Foundations: Family as System

  • Family system

    • Bounded, interrelated, identifiable communication

  • Interdependent

    • Influence one another

  • Environment

    • Interaction, adaption/resistance

  • Boundaries

    • Define system, communication between/with other systems

Family communication climates

Family Communication Climates

  • Over time, families establish a communication climate (McLeod and Chaffee, 1972)

  • Two fundamental communication orientations contribute to this environment

    • Conformity

    • Conversation (Ritchie and Fitzpatrick, 1990; 1991; 1994)

Conversation orientation

Conversation Orientation

  • Degree to which all family:

    • Are encouraged to participate freely

    • Are encouraged to participate frequently

    • Are encouraged to participate without time limits

    • Are encouraged to participate without topic limits

Conformity orientation

Conformity Orientation

  • Degree to which all family

    • Stresses homogeneity of attitudes

    • Stresses homogeneity of beliefs

    • Stresses homogeneity of values

    • Stresses fixed family roles

Caregiver type manager

Caregiver Type: Manager

High family conformity/High family conversation

  • Caregiver dominates care planning

  • Caregiver as self-appointed Family Spokesperson

  • Caregiver controls decision-making

  • Context of illness exaggerates:

    • Limited communication within/by family

    • Lack of diversity in perspectives about illness

    • Obligation to conform in family

Things to look for

Things to look for*

  • Direct blocked communication

    • Hang up phone

    • Refuse to answer

    • Agree not to talk about illness

  • Indirect blocked communication

    • Not responsive

    • Appear uncomfortable

    • Self-censored speech

      *Kenen, R., Ardern-Jones, A., & Eeles, 2004

Caregiver type carrier

Caregiver Type: Carrier

Low family conversation/High family conformity

  • Limited patient-caregiver discussions

  • Caregiver coping takes place outside of family

  • Illness perceived as private

  • Context of illness creates:

    • Dynamic of caregiver as a proxy for patient authority

    • Family conflict due to low conversation

    • Self imposed pressure to over-perform caregiving

Understand family coping style

Understand family coping style

  • Could you give an example of a difficulty your family has faced when you were growing up?

  • What helped your family get through this?

  • What was tried that did not help?

Caregiver type partner

Caregiver Type: Partner

High family conversation/Low family conformity

  • This caregiver partners with family and healthcare team

  • Ability to engage all quality of life dimensions

  • Family-prompted internal family meetings

  • Context of illness creates:

    • Open discussions about solutions and increased quality of life

    • An opportunity for this caregiver to be part of the care process

    • A place for family members to realize their caregiving strength

Assess family stressors

Assess family stressors

  • What else is going on in your family’s life?

  • What has helped you in dealing with these stressors?

  • What has not been helpful?

Caregiver type loner

Caregiver Type: Loner

Low family conversation/Low family conformity

  • A focus on one dimension of quality of life

  • Experiences caregiving as one acute crisis after the next

  • Can feel like a constant outsider to team and family

  • Context of illness creates:

    • Further isolation for patient, caregiver, and family

    • Unrelenting caregiver burden

    • Conflicts for healthcare team and system

Assessing family relationships

Assessing family relationships

  • Tell me about your family.

  • Who is close to whom?

Team based family care

Team-based Family Care

  • Managers

    • Moderate family communication

  • Carriers

    • Encourage self-care

    • Mediate patient-caregiver communication

  • Partners

    • Establish clear routine

    • Educate about home care/pain meds

  • Loners

    • Provide assistance in information seeking

    • Spiritual care/counseling

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