COMMUNICATION

Aims of the Session

Identify core communication skills Explore communication issues that

you face in your daily work with patients, and their families/carers

Practice ways of using communication skills to deal with difficult situations

Identify the importance of team working

Definition

Communication is the imparting or exchange of information, ideas or feelings

Not simple – complex interplay of experiences and attitudes affecting what is given and what is received

Communication

Verbal

Non-verbal

Para-verbal

Environment

Communication

Verbal – the words we choose 7%

Para verbal – how we say the words 38% account for what is perceived and understood by others

Non-verbal – our body language 55% account for what is perceived and understood by others

Verbal/Para-Verbal communication

What you say Meaning How you say it (tone, volume, clarity) Jargon Open questions Responding appropriately

Non-verbal Communication

Behaviour Facial expression Gestures Eye contact Touch Listening skills

Environment

PrivacyFind a roomDraw screens

Noise levels Decor

SENDER

INFORMATION

LISTEN

OR

BLOCK?

RECEIVER

Process of Communication

Behaviours which Encourage Communication Demonstration of empathy -warmth and

genuineness Active listening Body language Meaningful silence Acknowledgement of strong emotion Encouragement to continue Picking up cues by use of

Reflection Open questioning Clarification

Examples of Open Questions

“Could you tell me what the most important things are to you at the moment?

Can you tell me about your current illness and how you are feeling?

Who is the most significant person in your life? What fears or worries, if any do you have about the

future? In thinking about the future, have you thought about

where you would prefer to be cared for as your illness gets worse?

What would give you the most comfort when your life draws to a close?”

Horne, G., Seymour J.E. and Shepherd, K. (2006) International Journal of Palliative Nursing.12(4): 172-178.

Listening……

Why bother?To understandTo show compassionTo encourage talkingTo improve symptom managementTherapeutic in itself

Still listening?What inhibits

listening?

Interruptions Distractions Language barriers Blocking tactics

Blocks to effective communication for HCP

your own problems stress/anxiety physical

environment non-verbal skills verbal skills

Blocks to effective communication for patient’s/families

Out of control Don’t understand Afraid Distressed No privacy Poor continuity The unknown Facing loss

As HCP how do we block?

Selective attention to cues

Inappropriate Encouragement or Advice

Premature or False Reassurance

Switching TopicsSwitching Topics

Switching focus to Relatives

Premature Problem Solving

Avoiding the person

Normalising or StereotypedComments

Giving Your Opinion

Closed QuestionsClosed Questions

Passing the buck

Talk about yourself

Having conversations with patients and families at the end of life is challenging

Group Discussions - What aspect of having these conversations do you find challenging?

Difficult Questions

Am I dying?

How long have I got?

Is my mother going to get better?

Difficult Questions

Explore why they are asking this.

For example-Patient: Am I dying?Nurse: What makes you ask that

question just now?

Difficult Questions

Always focus on the patient and their perspective, it doesn’t matter what we think they have been told, the important thing is what they remember!

Use listening skills.

Difficult Questions

Use reflection to check understanding and encourage the person to talk.

examplePatient: I just feel so afraid…Nurse: You said you feel afraid can you

tell me a bit more about those feelings.

Difficult Questions

Use of clarification, don’t assume you understand the use of a word.

ExamplePatient: I just feel so sick and tired all

the time.Nurse: When you say sick and tired,

can you describe how that feels for you.

Anger

Can take many forms

Common reaction to ill-health by patient or family

Sometimes ‘masks’ feelings of guilt, fear, stress

If not addressed can escalate

Anger

Be safe Acknowledge emotion(s) Permission Listen to story to get as

much information as possible

Focus on stress/feelings Apologise Reasons Negotiate a solution

Anger

Talking in a private environment Listening Open body language Reflection, repetition Acknowledgement

Anger

Identify key areas of conflict Discuss ways these could be

improved / resolved (if possible) Consider / explore other reasons for

anger

Patient’s Not Wanting to Talk

Denial

ignorance

Depression Dementia Disengagement Talking to someone else Previously dealt with – just wanting to

forget

fact

feeling

Lack of capacity to understand Incorrect information

Denial

The function of denial is to protect the patient against distress that could be intolerable, and lead to psychological and spiritual distress

Denial

Common coping strategy

Often misunderstood

Rarely is denial ‘complete’

Level of denial can fluctuate

Requires assessment & exploration

Collusion

Focus on the relative Feelings Strain on relationship Reasons for not being truthful Support reasons Access patients questions to relatives Suggest ‘window’ on knowledge Ask for permission to assess patient Reassure no telling Confirmation if necessary

Summarising - Ensuring Effective Communication skills

Warmth/genuineness Establishing rapport Listening Acknowledgement Encouragement Open questions Picking up cues Reflection Clarifying Pacing – use of silence

Communication and Team Building

EXAMPLE OF TEAM WORKING AT ITS VERY BEST

The way a team plays as a whole determines its success. You may have thegreatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime."

-- Babe Ruth

EXAMPLE OF TEAM WORKING AT ITS WORST

How would you describe a team?

Chambers dictionary definition

“A set of people working in combination”.

What is Team Working

Work done by a group, with an organised division of labour

Co-operation Pulling together Focussing on the success of the

team as a whole rather than personal achievement

Each team is unique however and it's not as simple as it might seem to make teams work effectively.

Group work - Team working

Build the tallest tower you can using plastic cups

Each team member think about their role in building the tower

- Practical

- Supportive

- Ideas man

- Leader

- Other what makes a good team?

What do you think makes a team work well?

Good communication Good leadership Everyone feeling valued All roles filled Tolerance Everyone knowing what their role is Disharmony addressed promptly Everyone feeling that they are treated fairly

Team Effectiveness

We should recognise and celebrate the diversity of skills and personalities within the team, everyone is different, but everyone has something to contribute and should be valued for that contribution

Recognise when different personality types balance and complement each other and embrace that (support)

Make sure that everyone has the opportunity to reflect upon, and learn from their experiences……………..

Team Effectiveness

Everything that needs to be done is being done, everyone pulling together

Everyone is clear about why they are doing things in a certain way

All the efforts of the team should be directed towards the same clear goals

What are your ward goals

To strive for the best outcome for your patients…

Team Effectiveness

Everything that needs to be done is being done, everyone pulling together

Everyone is clear about why they are doing things in a certain way

All the efforts of the team should be directed towards the same clear goals – (What goals)

Everyone should know their role within the team and their responsibilities

Responsibility and Blame

Taking the Responsibility for

something as opposed to taking

the Blame for something are two

very different things:

BLAME…..

Blame is NEGATIVE it diminishes you It doesn’t change what

has happened And it doesn’t help you

prepare for the future

Responsibility is POSITIVE.

It enables you to consider your actions.

It lets you think about how you have acted and how you will act in the future, based upon the learning that has arisen from your experience…..

In this way we learn both from our mistakes and from our successes.

Responsibility…........

I’m not working at that end of the ward………..

Positive or Negative

I just do what I’m told……..

Positive or Negative

Individual ResponsibilityWe all carry some responsibility within our team.

In a team no one person takes responsibility for doing everything. Although the leader will have overall responsibility to ensure everything gets done, it is not the leader who does it all! Each of us has a role and is accountable.

By being a responsible member of a team you have to be prepared to celebrate together when things are going well

and to pull together when they aren’t……….