Talking to People who are Dying
Transcript of Talking to People who are Dying
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Talking to People who are Dying
Eileen Reilly / Senior Social WorkerPalliative Care Study Day
Beaumont Hospital29/9/2016
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Active ListeningActive Listening
f lki li i• Before talking comes listening• Careful listening is key to engaging successfully• Responding to silence• Allows us to check that the patient’sAllows us to check that the patient s understanding is correct and up‐to‐date
• Not the same as agreement• Not the same as agreement• Skills include restating, paraphrasing, reflecting back responding to feelings summarizing andback, responding to feelings, summarizing and allowing for silence. (Fraser)
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Body Language and TouchBody Language and Touch
• Difficulties in communication and emotion may be expressed in body language rather y p y g gthan words.
• Body language eye contact gestures and tone• Body language, eye contact, gestures and tone of voice are important. (Research suggests h b fthat between 55 ‐ 80% of communication is non‐verbal)
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Tips for Non‐verbal CommunicationSOLER
S Sit S l t i t d• S Sit Squarely to communicate presence and availability
• O Open Posture communicates your openness• O Open Posture – communicates your openness – not hiding anything / receptive
• L Leaning Forward• L Leaning Forward• E Eye contact – good eye contact but not starring communicates your interest and desirestarring, communicates your interest and desire to hear what the person has to say
• R Relaxed – Being relaxed and natural –R Relaxed Being relaxed and natural comfortable with your own body and situation
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Emotions• Many people find it difficult to talk about emotions• Emotions are complexEmotions are complex• People who fear dying may seek to avoid communicating about it.
• Anger – common at the end of life• Can be targeted at something or someone specific, or it
b li d d f dmay be generalised and unfocused.• It is helpful if the anger is acknowledged and allowedIt i ft i th th ti t h• It is often care‐givers rather than patients who express anger
• Patients may show a disproportionate response toPatients may show a disproportionate response to what seems to be a simple event
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Denial
D i l b i t t d f ll• Denial can be an important defence as well as an adaptive strategy
• “The principle of autonomy permits the dying• “The principle of autonomy permits the dying person to choose to remain in ignorance, or with a limited explanation” (Sheldon 1997)a limited explanation (Sheldon, 1997)
• Helpful communication techniques• Useful to ask ‘Who’s problem is it?’• Useful to ask Who s problem is it?• Open‐ended listening, neutral, empathic responses silence developing trustresponses, silence, developing trust
• Patients can move in and out of denial
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Symptom Talk
S l h k th d i id• Some people who know they are dying avoid talking about it completely, or until close to deathdeath.
• They may, however, wish to speak about symptoms such as pain shortness of breath orsymptoms, such as pain, shortness of breath or nausea.
• Helpful to acknowledge that these concerns mustHelpful to acknowledge that these concerns must be worrisome.
• You might say “Tell me more about what you are g y yexperiencing”, or ask “What do you think is happening?”
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BarriersBarriers
h di i lf• The disease process itself may prevent open communication
• Language barriers can cause misunderstandings, misdiagnosis and g , gtreatment difficulties
• Cultural religious and language difficultiesCultural, religious and language difficulties• Communication Tips…• communication aids / Check with patient / family about relevant cultural norms
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Intrapersonal factorsIntrapersonal factors
• The HSCP may lack confidence in their ability to engage with the patientg g p
• May be dealing with painful / unresolved issues of personal lossissues of personal loss
• The patient needs to feel the HSCP has time to listen and engage
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Questions to keep in mindQuestions to keep in mind
P i i h ld b ht f th ti t• Permission should be sought from the patient before opening up issues for discussion
• Some questions should be asked in a timely• Some questions should be asked in a timely manner.
• Use open and closed questions as appropriate• Use open and closed questions as appropriate. • Open‐ended questions can allow for deeper conversation creating openings for exploration ofconversation, creating openings for exploration of thoughts, feelings, behaviour and relationships.
• These questions are asked tentatively givingThese questions are asked tentatively, giving space for time to think and reply
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Examples of open ended questionsExamples of open‐ended questions• What is your understanding of your illness?• What kind of impact has the illness had on you and your family?y y y
• How have roles and relationships changed within your family?within your family?
• How would you describe your communication t l ?style?
• What do you fear most?• Who do you rely on to help you?
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• Who should be involved in decision making?• What is most important to you?What is most important to you?• What would be most helpful to you at this
i ? (F )time? (Fraser)
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But I’ve already answered thatBut I ve already answered that…
h i ll i f h h i ’• There is usually a series of phases as the patient’s awareness grows, rather than one clear moment f i ti (Gl & St 1965)of communication (Glaser & Strauss, 1965)
• As the patient begins to understand the consequences of the news they have been given, they may ask questions of anybody.
• People may need information repeated or highlighted over the course of their illness.
• Written information and contact details may be helpfulp
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Impact of deaths of other residents / patients
LTC i d l i f l b d i h h• LTC patients develop meaningful bonds with other patients / residents (Kovach & Robinson, 1996)D th t ti t d t b 331 ti hi h th• Death rate estimated to be 331 times higher than community rates – high death exposure(Maranzan & Stone 2005)Stone, 2005)
• Residents may experience a desire to connect better with staff at an emotional levelwith staff at an emotional level
• Residents need avenues to share personal experiences, speak about previous losses and participate in p p p pcommunity remembrance and ritual for person who died.
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HumourHumour
R h fi di i l id if h i• Research findings consistently identify the importance of humour as a means of enabling communication, fostering relationships and managing emotions (Deanfostering relationships and managing emotions. (Dean and Gregory, 2005)
• Humour contributes to quality of life (Shanagher DHumour contributes to quality of life (Shanagher, D. 2014)
• Tips for using humour include:Tips for using humour include:• Observation of patient / family• Assess receptivity (patient’s mood comfort cognition)Assess receptivity (patient s mood, comfort, cognition)• Put the humour on yourself
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ReferencesReferencesD & G / C N i V l 28 4 2005 M• Dean & Gregory / Cancer Nursing, Vol 28, no 4, 2005 More than Trivial: Strategies for Using Humor in Palliative Care
• Glaser & Strauss (1965)Awareness of Dying. Chicago: ( ) y g gAldine.
• Kovach, S & Robinson, JD (1996). The Roommate relationship for the elderly nursing home resident Journalrelationship for the elderly nursing home resident. Journal of Personal and social relationships, 13, 627‐634
• Lugton, J, McIntyre, R. Palliative Care: The Nursing Role. g y gPub Elsevier, 2005
• Shanagher, D. The Experience of Healthcare Assistants in Providing End of Life Care in a Continuing Care UnitProviding End of Life Care in a Continuing Care Unit. hospicefoundation.ie