E L N E C _____ Geriatric Curriculum End-of-Life Nursing Education Consortium

1. E L N E C _____Geriatric CurriculumEnd-of-Life Nursing Education Consortium SESSION 7: Communication at End-of-Life Fairfield University Quinnipiac University School of Nursing ELDER Project

2. Objectives: Upon completion of this session, the learner will be able to … • Explore common communication myths. • Identify basic principles of communication. • Practice therapeutic communication techniques.

3. 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

4. Basic Principles of Communication • Communication is a constant two-way activity • Words and actions are interpreted by the receiver • Much communicationis nonverbal • Listening is the mostimportant part of communication

5. 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

6. 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.

7. Presence • Knowing and being comfortable with oneself • Knowing the other person • Connecting • Affirming and valuing • Acknowledging vulnerability

8. Presence • Using intuition • Being empathetic • Being in the moment • Serenity and silence

9. “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*

10. 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.

11. Factors that Influence Communication at EOL • Culture • Age • Gender • Personal & family experiences

12. Barriers in Communicating with Dying Patients and Their Families • Societal denial of death • Lack of direct experiencewith death • Older adults’ and families’fears and emotions • Dementia and other conditions that make conversations about the future and other abstract ideas difficult

13. 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

14. 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

15. Important Messages to Communicate to Someone at EOL • Listen • Respect • Hopes, values, and goals • Encourage questions

16. 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.”

17. *ACTIVITY* Messages to Give to the Dying

18. I love you I forgive you Please forgive me Thank you Goodbye Messages to Give to the Dying

19. 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.”

20. 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

21. Staff Interventions withGrieving People • Support of grieving as normal • Use of nonverbal communication • Smile • Nod • Touch • Hug • Quiet listening

22. Interventions with Grieving People • Provide physical space for grieving • Give emotional support • Encourage expression of feelings/life review • Spiritual support

23. 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…”

24. When You are Communicating With Someone Who is Upset • 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*

25. 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?

26. Respect, Respect, Respect

27. References City of Hope & the American Association of Colleges of Nursing, 2007; Revised, 2010. TheEnd-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