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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