COMFORT* Communication (narrative) Orientation and opportunity Mindful presence Family Openings Relating Team * Wittenberg-Lyles, E., Goldsmith, J., Ferrell, B., & Ragan, S. (2012). Communication and palliative nursing. New York: Oxford.

Objectives Define mindfulness and presence in clinical encounters Describe active listening Identify two communication skills that can assist with mindful presence

Mindfulness Originated in Buddhist philosophy Tenets of mindfulness: – Purposefully attentive – Awareness – Flexible state of mind Contrast with mindlessness – Habitual behaviors

Mindful Presence Mindful Communication – Awareness of situation – Being in the moment – Attention focused on present moment Presence emphasizes personal experience – Acceptance – Patience, Trust – Suspension of personal preference/critical thought

Core Attitudes* Perception Active listening Getting involved Creating space “Being is as valuable as “doing” *Simon, T., Ramsenthaler, C., Bausewein, C., Krischke, N., Geiss, G. (2009). Core attitudes of professionals in palliative care: A qualitative study International Journal of Palliative Nursing, 15(8) p. 408.

Mindful Presence Patients/family – indirect cues of emotion – missed empathic opportunities

Healing/Compassionate Presence Empathy – Patients/families: hesitant to express emotions present indirect cues instead Listen for feelings Witness the suffering of others (Ferrell & Coyle, 2008) – Be mindfully present – Practice empathy – Offer compassionate voice – Recognize impacts of illness

Active Listening (Wood, 2000) Hearing versus Listening Listening involves: – Attend to nonverbal cues – Listen without interruption – Ask questions to clarify – Paraphrase interpretation in own words – Ask if interpretation is correct – Empathize (paraphrase feelings of speaker)

Five Principles of Effective Listening 1.Focus on feeling words 2.Note the general content of message 3.Observe speaker’s body language 4.Do not fake understanding 5.Do not tell speaker how he/she feels Adapted from R. Bolton (1979). People Skills. Englewood, NJ: Prentice-Hall in MacPhee, M. (1995) The family systems approach and pediatric nursing care. Pediatric Nursing, 21, 5,

Other Aspects of Listening* Silence – Listen without interruption – Provides opportunity/permission to disclose – Conveys empathy – Allows for deeper expression of concern *Dahlin (2010)

How we see others… 1.Experience (perceived by I-IT*) – Person seen as object – To be manipulated/changed 2.Relation (perceived by I-THOU*) – Person seen as unique – Culmination of life experience/complex – Positive regard *Martin Buber’s work on the dichotomy of viewpoints

Seeing Differently* Perception-shifting Vivid sense of appreciation and beauty Seeing what needs to be done Leaning into stillness of activities Cultivating openness without agendas *Bruce & Davies, 2005

Mindful presence of the Nurse Family meetings – Watch for indirect emotional cues – Remind team members to practice silence Team meetings – Observe team members for compassion fatigue – Encourage self-compassion – Allow for self-reflection and self-healing

Nurse specific topics Pain Be aware of quality of life domains – Spiritual, physical, psychological, social Communicating about spirituality

Mindful of Self-Care Needs Burnout and compassion fatigue Be aware of: – Motivations – Thoughts, feelings, attitudes, beliefs, compassion Engage in self-reflection, self-healing