1. TNEEL-NE

2. Slide 2 Connections: Communication TNEEL-NE Health Care Training Traditional Training –Health care training stresses diagnosis and treatment rather than communication. Modern Training –Need to stress listening and understanding patient experience. –Gaining understanding can help guide health care diagnosis and treatments.

3. Slide 3 Connections: Communication TNEEL-NE Modern Training How to stress listening… –Need to develop listening skills. –Listen to words and subtle verbal and non- verbal communication. Mr. Smith and Nurse 1. Stress diagnosis and treatment 2. Stress listening and communication with patient

4. Slide 4 Connections: Communication TNEEL-NE Conceptualize Choose words Interpreted by listener May or may not understand May or may not accurately transmit Listening Listen…. To every level of communication the patient and family provide

5. Slide 5 Connections: Communication TNEEL-NE Linguistic Elements Language content and style –Pause –Pitch –Speed rate –Intonation –Choice of words –Logic –Meaning Non-verbal communication –Body position –Mood –Facial expression –Eye contact –Physical distance

6. Slide 6 Connections: Communication TNEEL-NE Language Content and Style I Pause –Patient a. I want my pain pill. b. I (pause) want my pain pill. c. I want (pause) my pain pill. –Nurse a. You want your pain pill? b. You want your (pause) pain pill? c. You (pause) want your pain pill?

7. Slide 7 Connections: Communication TNEEL-NE Language Content and Style II Pitch and Intonation: a. I get to go home today. b. I get to go home today? (with rising pitch) c. I get to go home today! (with rising and lowering pitch.) d. I get to go home today. (lowing pitch)

8. Slide 8 Connections: Communication TNEEL-NE Language Content and Style III Speed rate: –Patient a. Why can’t someone do something about this pain? (even, slow rate) b. Why can’t someone do something about this pain? (Increasing rapid rate) –Nurse a. We’ve called the doctor. (even, slow rate) b. We’ve called the doctor. (slowly increasing rate)

9. Slide 9 Connections: Communication TNEEL-NE Language Content and Style IV Word choice: –Nurse a. What did the doctor tell you about the illness? b. What did your doctor tell you about your illness? –Patient a. The doctor said it doesn’t look good. b. The doctor said the cancer doesn’t look good. c. My doctor said my cancer doesn’t look good. d. My doctor said it doesn’t look good.

10. Slide 10 Connections: Communication TNEEL-NE Language Content and Style V Logic: –Nurse a. Call your pain a number between 0 and 10? (“0” allows for no pain in patient’s report.) b. Call your pain a number between 1 and 10? (“1” indicates patient will have some level of pain to report) –Patient a. I don’t want to take strong pain medicine now, because I want it to work when I really need it. (Patients belief that strong pain medications will not be effective if used over time.)

11. Slide 11 Connections: Communication TNEEL-NE Language Content and Style VI Meaning: Nurse: How is your appetite? Patient: I try to eat as much as I can. Husband: She needs to eat more! How might you interpret this conversation?

12. Slide 12 Connections: Communication TNEEL-NE Non-Verbal Communication I Body position

13. Slide 13 Connections: Communication TNEEL-NE Non-Verbal Communication II Mood

14. Slide 14 Connections: Communication TNEEL-NE Non-Verbal Communication III Facial expression

15. Slide 15 Connections: Communication TNEEL-NE Non-Verbal Communication IV Eye contact

16. Slide 16 Connections: Communication TNEEL-NE Non-Verbal Communication V Physical distance

17. Slide 17 Connections: Communication TNEEL-NE The following video illustrates Linguistic elements Linguistic Elements Angry, distant son: Non-verbal: Sits in a protective position, avoiding initial eye contact, sitting away from his mother. Verbal: No pause, high pitch, rapid speed rate and angry intonation. Dispirited son: Non-Verbal: Stares intently into your eyes, sitting close to his mother, etc. Verbal: Several pauses, soft, low pitch, slow rate with soft, sad, bewildered intonation.

18. Slide 18 Connections: Communication TNEEL-NE Open-Ended Questions The most effective way of beginning to gather information from patient and family Mrs. Bell has the end stage ischemic cardiomyopathy. She and her daughter are in a hospital room. The daughter asks you questions about her mother. Nurse to daughter “When you think about your mother getting very sick, what worries you the most?”

19. Slide 19 Connections: Communication TNEEL-NE Reflective Statements A helpful tool to clarify everyone’s understanding. Statement “ What I heard you just say is, that you want more information regarding pain management before you take morphine. Is that right?”

20. Slide 20 Connections: Communication TNEEL-NE Intuitive Knowledge Definition: the power or faculty of attaining to direct knowledge or cognition without evident rational thought and inference. When health care professionals pay attention to intuitive knowledge, it can guide them in their exploration of the patient and family experience.

21. Slide 21 Connections: Communication TNEEL-NE Being Present Cultivating the ability to “be present” in the moment is often all that is necessary to help with patients and families at the end of life. At the hospital room A patient’s son break into tears. The nurse sit with them, touching them, just being there without attempting to stop them.

22. Slide 22 Connections: Communication TNEEL-NE Empathic Statements Empathy is the action of understanding, being aware of, being sensitive to another without having the feelings, thoughts and experiences fully communicated in an objectively explicit manner. It is the skill that assists health care providers in understanding patient’s experience.

23. Slide 23 Connections: Communication TNEEL-NE Empathic Actions Actions: –Reflecting the emotions expressed by the patient and family. –Sitting at patient level, looking into the patient’s eyes, a concerned facial expression, etc. –Paying attention and being present for the patient’s experience. “This must be very frightening news for you to hear.”

24. Slide 24 Connections: Communication TNEEL-NE Issues Related to Dying Child I For Children: –Children are never too young to know that they or someone close to them is dying. They need to know they are not responsible for their illness. –Dying children experience fear, loneliness, anxiety as well as hope, love and joy just like adults. –Like adults, dying children may or may not choose to discuss their concerns. Verbal language must be adapted to a conceptual level and vocabulary that the child can understand. They also can communicate in ways other than through speech. (ex. drawing, etc.)

25. Slide 25 Connections: Communication TNEEL-NE Issues Related to Dying Child II Continue For Children: –Children may express their fears, worries or concerns directly, indirectly or symbolically. It is important that parents and health care professionals listen closely for them. –Issues for the dying child apply equally to siblings. The same issues, barriers, and needs should be considered with them.

26. Slide 26 Connections: Communication TNEEL-NE Issues Related to Dying Child III For Parents & Family: Nurses and other Health Care Providers need... –To help prepare parents and other family members so they can meet the emotional needs of the dying child. –To recognize the pivotal role of encouraging and supporting parents in expressing their true feelings, concerns, and goals.