Presentation on theme: "An introduction to effective Communication in End of Life Care"— Presentation transcript:
1An introduction to effective Communication in End of Life Care Before embarking on teaching communication skills you are strongly encouraged to complete rhe NHS Glos communications workbook and attend the study day. Resources and calendar of events available from –Calendar -The main eolc web page is ….Trainers in communication should be experienced, knowledgeable, trained and have the skills to do so.
2Ground Rules Give time for everyone to have their say Confidentiality – stays in the room. No real names to be used for residents, relatives or other professionalsTime keepingRespect each others viewsMobilesHousekeeping arrangements
3AimsExplore some essential skills of communication in end of life careIdentify barriers to effective communication
4End of Life Care Strategy - Communication All staff in health and social care, and the voluntary and independent sectors, need some training to ensure they are able to communicate effectively with people who are dying and their carers about issues surrounding end of life care (DOH 2008 p.113)
5COMMUNICATE What do you understand by this word? Brainstorm Encourage everyone to contribute.
6What do we want from communication? Information – delivered in a language we can understandHonestyCompanionshipOpportunity to reflect
7Exercise 1Why is effective communication so important in relation to end of life care?Take 5 minutes to discuss in groups why you think it is importantFlip chartCentral to high quality patient careEnsures all involved in care are aware of plans/wishes/needs of an individualHelps understand residents concern’s and feelingsGives time to residents – especially those who have communication problems (speech, hearing, sight)Broach sensitive subjects – e.g. losses associated with moving into a homeExplain illnesses to residents and familiesExplain care options to residents and familiesReduces confusion/lack of clarityBuilds good relationships within home and external agencies (GPs, DNs, etc etc)Extra pointsGood skills are the same whatever the subject or with whom we are communicating with – those with communication disabilitiesResponding appropriately importantTalking about sensitive issues can help to relieve distressActive non judgemental listening is a crucial component of good communication
8Essential communication skills Listening skillsVerbalLanguage – words usedParalanguage – how it is said, tone, pitch, clarityNon-verbalwhat we understand and transmit from body languageThree part involvement sessionListening skills – 2 people back to back. A holds a picture of a house, B has to draw it from listening to A describe it – can mention shapes and sizes only(Or talk for 3 mins (two people) and relay back to group what has been said to them – cannot make notes2 Verballanguage –Open questionsRequire more than ‘yes’ or ‘no’Often start with ‘how’ ‘what’ ‘why’ or ‘tell me’Closed questionsMore direct and specificLimits information givenExamples‘if your condition deteriorates do you want to stay at home?’ As apposed to ‘if your conditions deteriorates where would you most like to be cared for?’‘do you want your friends to visit when you are close to death?’ as apposed to ‘who would you like with you and who would you like to visit when you are close to death?‘do you want to be resuscitated?’ as apposed to ‘is there anything you would like to avoid happening to you?’Get attendees to say ‘how are you’ – Mandy and Maggie to try first!! See how it feels4 Non-verbalPracticing Communication skills (15 – 20 minutes)In 2sA – describe their first day at workB – listen and demonstrate that he/she is listening and ask a question, if appropriateA – answer and carry on a describe the eventB – reflect back what has been understoodSwitch roles after 7 – 10 minutesLearning point of this exercise is to participants listen without talking or interrupting directly or indirectly (looing at watch, out of the window) and demonstrate that they are listeningGet pairs to feed backNon verbal – use the information in slide 13!!!!GesturesIllustrates speech, emotionsPostureDemonstrates, emotions and mood. Supports or opposes the spoken wordEye contactImportant for building satisfying relationshipsFacial expressionsDisplays emotionsTouchingDevelops caring relationshipPersonal spaceCan feel threatened if too close&
9Listening Skills Plan the environment Be Attentive Hear what an individual is sayingUse appropriate body languageEnvironmentPlan – peace and quiet, no interruptions – private – do not talk in corridors etc etcAttentive – eye contact, sit at same levelHearing -
10Effective skills - language Questioning –open, closed, leading and multipleEncouragementPicking up on cuesReflectionSilenceClarification/SummarisingOpen questionsRequire more than ‘yes’ or ‘no’Often start with ‘how’ ‘what’ ‘why’ or ‘tell me’Closed questionsMore direct and specificLimits information givenLeading questionsNeed to be avoided – puts words into people’s mouths e.g. ‘I suppose you are nervous…?’Multiple questionscan cause confusion and reduces time for answering e.g. ‘how are you feeling? Pain any better? Did the pills work?’Encouragementshows an interest in the conversation – encourages continuation with the conversationPicking up on cuesResidents dropping hintsRequires staff having the ability to pick up on these e.g. ‘I didn’t like staying in hospital, don’t want to go back’ReflectionPromoted further discussionSilenceVery powerful, gives time to assess what has been saidClarification/summarisingEnsures that the meaning of the conversation has been understood
11Paralanguage – Tone of voice Volume Pitch Try saying ‘are you ok?’ considering some of the above to the person next to you and see what response you have..Tone – can change the meaning of wordsVolume – no need to shoutPitch – can change the meaning of a word, sentence
12Non-Verbal Communication Is the message or response not expressed or sent in wordsOver 65 percent of the social meaning of the messages we send are communicated non-verbally.Actions speak louder than words.Think of some examples…….Demonstrate some non verbals such as aggression, impatience,
13Non-verbal behaviours Personal spaceFacial expressionsPostureGesturesTouchingPersonal SpaceCan be invasive if someone gets too closeNeed to sit squarely, can lean forward to encourage conversation and make someone feel understoodFacial expressionsDisplay emotions – can conflict or support (smiling, frowning etc)PostureDemonstrates attitudes, emotions and moodsSupports or conflicts the words spokenGesturesIllustrates speech – hands, fingers, movementsTouchingExpresses emotionsCan help develop a caring relationship – be careful!!
15Barriers or blocks to effective communication especially at EoL Could break into 3 groups. Ask them to list all the barriers they can think of under their heading.Ourselves- Poor communication skills, poop preparation, planningThem – what do they want to know, want to hear, are they ready? Level of understandingEnvironmental –available time, difficult environments, lack of privacy, other people, lack of staff,
16Barriers to effective Listening Feeling stressed by other concernsEnvironment noisy or disturbedNot feeling confidentLow motivation – bored or tiredBeing in a hurry to pass the person onInterjecting with own experiencesFormulating answers to queries before hearing exactly what is needed
17‘Verbal's’ for you to avoid MumblingPassing judgement or giving unwanted adviceInterruptingDiscussing your own experiencesJumping to conclusions‘I understand’Confusing people with multiple questionsUsing jargon
18Useful Tools Listening skills - active not passive Use of Questions - open not closedReflecting BackClarifyingReinforcement/EncouragementParaphrasingSilenceListening – to pick up on cues – concentrateQuestions – provides the space for an individual to express themselvesReflecting back – promotes discussion – around a problem and leads into in depth conversationsClarifying – to ensure that meaning is understood ‘what do you mean by that?’Reinforcement/encouragement – shows interest and understanding, encourages the person to continueParaphrasing – summarising/interpretingSilence – very powerful – gives both parties time to assimilate (digest) what has been said
19Identifying emotions… AngerSadnessSurpriseGuiltAnxietyHow easy is this? Could they identify these in residents, family, staff?
20Remember to look after yourself too… Understand that looking after a dying person will put added strain onto you and the teamBeware of your own emotions, if a specific task is difficult, find someone who can helpThere may be events in your life that mean you are not the best person to help this client/relative on this day – that’s ok.COMMUNICATION IS THE KEY: informal chats, supervision, reflective meetings or talking to another professional may help
21Dealing with limits of your knowledge/remit Its OK toTo admit you don’t know something:Who might know?How will it be followed up?Explain likely time -frame of responseIts NOT OK toBlock a question by:- Ignoring it- Dismissing it- ‘Jollying the clientalong’Guess / say something you’re not really sure of
22Issues for Individuals in your care Discuss in groups what you think the dangers are if staff do not possess effective communication skillsIncreased anxietyWishes not taken into accountPoor quality of careSymptoms not controlled
23Scenario What would you do??? You have been caring for Mary for several months. She has become graduallymore frail both physically and mentally. Onthis occasion, she seems quite agitatedand tells you “that woman has been horrible tome. She shouts at me, hasn’t given meanything to eat and won’t let me have a bath.”What would you do???Give the group 10 mins to discuss – split into small groups or pairsCould this be role played out the front?Try and set this up at the front between you and a willing volunteer.Try and use some of the techniques already covered.Ask them afterwards what worked well or not.
24‘Hello, ward P, can I help?’ Pause for thought!A 75 year old lady rings her local NHS hospital and had the following conversation:‘Hello, I’d like some information on a patient Mrs Tiptree. She was admitted last week with chest pains and I would like to know if her condition has deteriorated, stabilised or improved’‘Do you know which ward she is on?’‘Yes, ward P, room 2B’‘I’ll put you through to the nurses station’‘Hello, ward P, can I help?’Just read this out…
25‘Oh, thank you, I’m so pleased and happy!’ Continued……..‘Yes, I’d like some information on a patient Mrs Tiptree. She was admitted last week with chest pains and I would like to know if her condition has deteriorated, stabilised or improved’‘I’ll just check her notes. Yes, I’m very pleased to say Mrs Tiptree has improved. She has regained her appetite, her observations are stable, and following a few more checks we are hoping to discharge her tomorrow’‘Oh, thank you, I’m so pleased and happy!’‘Are you a close relative?’
26no-one tells you anything at all in this place!!!!’ ‘No I’m Mrs Tiptree in room 2B,no-one tells you anything at all in this place!!!!’Does this happen in a Care home?Can it happen in a Care Home?What can we learn from this?Should it happen?
27Remember help is always at hand for you Discuss/explore and explain what help there is in this particular Care home with regard to communicationRefer people on to the Glos NHS Communication workbook and skills workshop for further training.
28Useful Information www.endoflifecareforadults.nhs.uk Ellershaw J, Wilkinson S (2008 edition) Care of the dying ‘A pathway to excellence’ Oxford University PressLocal hospicesEnd of Life Care Learning Resource Pack, Housing 21: