Learning The Art of Empathic Conversations
Bonnie Morgan, M.Ed., RN-BC, CHPN, FPCN
Mr. G is an 88 yo man with end-stage dementia and a FAST Scale of 7a. His initial medication list includes memantine HCL (Namenda), latanoprost (Xalatan) eye drops for glaucoma, simvastatin and hydrocodone/acetaminophen. His family refuses to stop any of these medications if admitted to your hospice service. How will you artfully communicate responsibility for coverage of these medications?
Case Study
Mrs. S is a 68 yo woman with terminal breast cancer. She was admitted to your hospice one week ago and is declining rapidly. The husband calls asking for a nurse to help with her increasing shortness of breath. When you arrive, he angrily states that the hospice service is not helping and he wants to take her to the hospital despite her desire to stay at home during the last days of her life. How will you empathically communicate in this situation?
Case study
Describe the importance of artful conversations
Identify key components of the communication process
Define five levels of listening
Recognize six key components of empathic communication.
Objectives
Helps develop relationships based on trust and mutual respect
Moves us toward a partnering relationship
Allows patient and caregiver to disclose concerns
Facilitates a safe environment for the patient and caregiver as life is nearing its end
Artful Communication
Learning to be consciously and compassionately "in the moment” with another person
Believing and affirming the other person’s potential for wholeness or growth
Learning we don’t have to solve all the problems
Clearing our minds of our own agendas
Honoring the other person as our equal
Valuing the uniqueness and blessing of the other person
Becoming a “healing presence”
Seek First to Understand
Then to Be Understood
Steven Covey
Communication Elements
Definition: the exchange of information, feelings and thoughts between individuals
55%
7%
Levels of Listening
Ignoring
Levels of Listening
Pretend listening
Giving the appearance of
listening.
I hear what you are saying.
Levels of Listening
Selective listening
Autobiographical Listening
Listening from our own paradigm.
Comparing the speaker’s experience with our own.
Evaluating the speaker’s experience.
Advising or telling the person what to do based on our experiences.
Listening to solve the problem.
Planning your responses while listening.
Attentive/Empathic Listening
Begins with the intent to understand the other person BEFORE being understood.
IT’S ALL ABOUT THE OTHER PERSON.
It’s not about YOU.
Listening only to understand
Key Components to Empathic, Artful Conversations
15
Establish “Presence”
Sit down; Stop talking; Start listening
Appropriate use of eye contact
Keep an open posture
Take notes as appropriate
Allow adequate time
Prevent interruptions
Listen or your tongue will
make you deaf!!
Ask open-ended questions
What have the last few weeks been like for you?
What are the doctors telling you about your condition?
What is the most difficult thing for you at this time?
Clarify and reflect and explore to increase understanding
Let me see if I got this right. I thought I heard you say…..
Is this what you mean………?
Listen for what is NOT being said
Do not express your views until the speaker is satisfied you understand what she is communicating.
Seek to Understand
Be aware of your preconceived ideas
Leave your agenda at the door
Avoid jumping to conclusions
Do not plan your responses while the other person is talking
Avoid: “We are right. You are wrong.”
Don’t react outwardly with negative nonverbal language
Honor and accept that the patient and caregiver have good intentions
Suspend Judgment
Silence can indicate
Manipulation—used to put pressure on the other person
Defiance or disagreement or hostility
Profound sense of awe or respect or sorrow
Creation of a sacred listening space
Empathic listening
Effective Use of Silence
Excellent communicators
Allow silence when they sense its effectiveness
Offer silence as a sign of respect
Interpret the silence of others appropriately
Avoid feeling pressured to “fill the silence” when the silence is being used to manipulate the conversation
Effective Use of Silence
Be prepared for
Outburst of strong emotions
Broad range of reactions
Acknowledge the emotions and reactions
Allow time for these emotions and reactions
Listen quietly and attentively
Encourage the description of these feelings
Use non-verbal communication
Responding to Feelings
Summarize; Check for Understanding
This is really important. Is this what you mean……….?
What is it you want me to know?
Is there anything else you want me to know?
Let me make sure I am really clear. Is this what you mean……?
Is there anything else I can do for you at this time?
Developing a partnering relationship
Learn to listen; listen to learn.
Becoming a “healing presence”
Seeking first to understand
Suspending judgment
Effective use of silence
Responding to feelings
Summarizing “next steps”
Take-Aways
“You matter to the last moment of your life and we will do all that we can,
not only to help you die peacefully, but live until you die.”
Dame Cicely Saunders
Founder of the Modern Hospice Movement
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