Presentation on theme: "Mom never said that it would be like this"— Presentation transcript:
1Mom never said that it would be like this Delivering Bad NewsMom never said that it would be like this
2A fantasyOnce upon a time, there were two families who lived next door to each other. At 110 First Avenue, lived Bob and Barbara Bluster and their two children, Morgan and Fran. At 112 First Avenue lived Larry and Lori Luster, their son Henry, Larry’s mother, Sadie and Sadie’s beloved cat Fabula. Bob and Larry had been friends since college. They married classmates. Each frequently asked each other to take care of their homes while they would go on vacations.As happens with long-term friendships and families, over the years they had grown to tolerate each other’s annoying habits. Bob had a very blunt and direct way of giving bad news. Larry, on the other hand, preferred, in his words, to “sugar” it up a bit. Fortunately, this difference had never been tested until this day.
3A fantasy (continued)Larry, Lori, Ruth and Henry were going on their annual vacation. Originally Sadie was going to go as well, but she developed a cold the night before the family was to leave and was unable to go with them. So, Larry asked Bob to keep an eye on “my mom” and Fabula while they were gone. Bob said, “Sure thing.”Three days after Larry and his family arrived at their destination, Larry called Bob to see how things were going. “How’s Fabula?” Larry asked. “She died.” “What! How can you say that. That’s terrible. What happened?” Bob proceeded to explain that the cat had crawled out an open window in Sadie’s room, tried to jump to the tree next to the house, couldn’t grab on to the tree because she had been declawed, and fell to her death. Larry was furious at Bob because he was so blunt. “Bob, why couldn’t you give it to me gently. You know, tell me about the tree next to the house, the window being open and the cat getting out and my mom called the fire department and they came and they couldn’t save Fabula. Why must you always be so darn blunt!” Well, tell me how did my mom take it?” After a long silence, Bob says, “Well Larry, you know the tree next to the house, the window was open ”
4Bad newsBad news: telling others you don’t want to tell them about something they don’t want to hearIn the Bob and Larry story, there are two choices: both are not always appropriateWhere to get guidance: from survey procedures; and from psychologyWe’ll be spending time today on both, more on the psychology of giving bad news.
5What do S&C Procedures have to say? State Operations ManualExit Conference
6Hospital, Appendix A Exit Conference Purpose: “preliminary findings”Team consistency and organizationBoundariesIf provider is represented by counsel, may refuse to conduct the conference if counsel tries to turn exit into evidentiary hearingIf provider creates an environment that is hostile, intimidating, or inconsistent with exit as informal and preliminary
7Appendix P: Nursing Homes Team communication throughout surveyTask 7 - Exit ConferencePurpose: “preliminary findings”Who: personnel; ombudsman and officer of resident’s group, if oneProvide opportunity for discussion/additional information“Ongoing dialogue” rare surprises
8Appendix M: HospiceExit conference: to inform the hospice of observations and preliminary findings of the survey.“ongoing dialogue” rarely surprises Implement the following guidelines during the conference:
9Appendix J: ICFs/MRPre-exit: Team discusses findings/make conclusions, subject to additional information provided by facility officialsDetermine need for more informationAsk for and consider additional information or clarification if necessaryIf, per facility, “acceptable practice,” request supporting references
10Summary: survey procedures PreliminaryRespectful, open to change and to listen for more informationFactualContext is informational exchangeBoundaries are
12Cognitive Therapy What is it? Where did it come from? How does it apply to this task?
13Beliefs Irrational v Rational What is Cognitive Therapy?Thinking Feeling BehavingWhere it came from:Research based: Most research based of any therapyViktor Frankl Man’s Search for MeaningThe young girl dying of Typhoid and CHEERFUL
14How Does Cognitive Therapy Apply to giving “Bad News”? Thinking makes it so: Irrational v RationalIrrational thoughts – makes bad news worse
15Distorted Beliefs Personalization (no connection to requirements) DefensivenessEntitlement Seeking -- “I deserve it”Perfectionism – No mistakesApproval SeekingOver-responsibilityD. Burns (2000). Feeling Good. NY: HarperCollins Publishers.
17Thoughts that get you into trouble All-or-Nothing Thinking. Black and white.Overgeneralization. “Always” and “Never” fallacyMental Filter. Facility’s history: in and out of compliance. New ownership. Doesn’t matterDisqualifying the Positive. “My positives don’t count”Jumping to Conclusions.a. Mind reading. You conclude that someone is reacting to you in a negative way, but you don't check it out to see if it's true.b. Fortune Teller Error. Based on observations you “know” facility is out of complianceD. Burns
18Thoughts that get you into trouble Magnification or Minimization. Either make things way out of proportion or you shrink their importance. Binocular effect. “Facility isn’t so bad. These are poor people anyway so it’s better than what they have at home.”Emotional reasoning. If I feel it, it must be true. “I feel inadequate to the rest of the team, so I must be.”Should Statements. You motivate yourself or others with shoulds and shouldn'ts, or musts and oughts, or wills and won'ts, that have no basis in law.Labeling. Extreme overgeneralization. “This team member is “a loser"Personalization. You see yourself as causing some negative external event, which you have no control over.D. Burns
19The 3 R’s of Negative Living The Negative TriadsThe 3 R’s of Negative LivingResistanceResentmentRevenge
21Solution Speak from within your framework – the requirements Attack the distorted thoughts with “EVIDENCE” -- SunshineExamples:Personalization: LD: No trace left“Shoulds”: My should or the Law?Perfectionism: Impossibility
22Change Thinking Practice Sheet Antecedents or Triggers. Next to the words that come closest to capturing what you experienced, put a number from 1 to 10.AngryAnxiousDepressedGuiltyOther. Specify __________What were your automatic thoughts? (Thoughts you have without thinking, which just come into your head)What distorted thinking was behind each automatic thought? [See previous slide]What’s the evidence that disclaims your automatic thought? What words do you use to talk back to your automatic thought? After talking back, what changes, if any, do you see in the feelings you identified above?Look back at the feelings you rated at the top of this page and rate how you feel now. You should feel at least somewhat better. If you don’t, then repeat the exercise.
23Change Outwardly: Accurate Empathy A skill. You know and express the other person’s thoughts and motivations in such a way that the response is, “Yes, that’s exactly what I mean.”
24Build Team Consistency Practice – who will say what Cohesiveness Comfortable enough to disagreeRecognize the psychological strengths / challenges of each team member and emphasize the strengths
25Overall Suggestions Know the Requirements/Procedures If you survey facilities whose procedures omit exit conference, ask supervisor if your group may adapt current procedures: preliminary, mutual, respectful, rare surprisesPractice Self-awareness – Know and minimize distortionsFocus on “fact gathering and presenting” not friendship formingReinforce your strengths and positives individually and as a team