1. EELLNNEECC Geriatric Curriculum E L N E C _____ Geriatric Curriculum End-of-Life Nursing Education Consortium SESSION 7: Communication at End-of-Life Fairfield University Quinnipiac University School of Nursing ELDER Project

2. EELLNNEECC Geriatric Curriculum Objectives: Upon completion of this session, the learner will be able to … 1.Explore common communication myths. 2.Identify basic principles of communication. 3.Practice therapeutic communication techniques.

3. EELLNNEECC Geriatric Curriculum Myths of Communication Communication is deliberate Words mean the same to sender/receiver Verbal communication is primary Communication is one way Can’t give too much information Communication is deliberate Words mean the same to sender/receiver Verbal communication is primary Communication is one way Can’t give too much information

4. EELLNNEECC Geriatric Curriculum Basic Principles of Communication Communication is a constant two-way activityCommunication is a constant two-way activity Words and actions are interpreted by the receiverWords and actions are interpreted by the receiver Much communication is nonverbalMuch communication is nonverbal Listening is the most important part of communicationListening is the most important part of communication

5. EELLNNEECC Geriatric Curriculum Verbal and Non-Verbal Communication Includes body language, eye contact, gestures, tone of voice 80% of communication is nonverbal Boreale & Richardson, 2006; Buckman, 2001; Dahlin, 2010 Includes body language, eye contact, gestures, tone of voice 80% of communication is nonverbal Boreale & Richardson, 2006; Buckman, 2001; Dahlin, 2010

6. EELLNNEECC Geriatric Curriculum Which statement is true about communication? 1. we can never give someone too much information.1. we can never give someone too much information. 2. We communicate only when we choose to communicate.2. We communicate only when we choose to communicate. 3. The majority of messages we send are unspoken.3. The majority of messages we send are unspoken. 4. Communication is mostly words and their messages.4. Communication is mostly words and their messages.

7. EELLNNEECC Geriatric Curriculum Presence Knowing and being comfortable with oneselfKnowing and being comfortable with oneself Knowing the other personKnowing the other person ConnectingConnecting Affirming and valuingAffirming and valuing Acknowledging vulnerabilityAcknowledging vulnerability

8. EELLNNEECC Geriatric Curriculum Presence Using intuitionUsing intuition Being empatheticBeing empathetic Being in the momentBeing in the moment Serenity and silenceSerenity and silence

9. EELLNNEECC Geriatric Curriculum “Nature gave us one tongue and two ears so we could hear twice as much as we speak.” Epictetus, 55 A.D. – 135 A.D. *LISTENING EXERCISE*

10. EELLNNEECC Geriatric Curriculum Which factor is most important to quality end of life care? 1. controlling the cost of pain medication1. controlling the cost of pain medication 2. limiting care to symptom management protocols?2. limiting care to symptom management protocols? 3. communicating well with clients and families3. communicating well with clients and families 4. using volunteers to make sure clients are not alone.4. using volunteers to make sure clients are not alone.

11. EELLNNEECC Geriatric Curriculum Factors that Influence Communication at EOL CultureCulture AgeAge GenderGender Personal & family experiencesPersonal & family experiences

12. EELLNNEECC Geriatric Curriculum Barriers in Communicating with Dying Patients and Their Families Societal denial of deathSocietal denial of death Lack of direct experience with deathLack of direct experience with death Older adults’ and families’ fears and emotionsOlder adults’ and families’ fears and emotions Dementia and other conditions that make conversations about the future and other abstract ideas difficultDementia and other conditions that make conversations about the future and other abstract ideas difficult

13. EELLNNEECC Geriatric Curriculum Barriers in Communicating with Dying Older Adults and Their Families Caregiver fears:Caregiver fears: Not having “the answers”Not having “the answers” Feeling helpless/ inadequateFeeling helpless/ inadequate Upsetting the patient/familyUpsetting the patient/family Fear of showing emotionsFear of showing emotions Caregiver’s personal fear of dyingCaregiver’s personal fear of dying

14. EELLNNEECC Geriatric Curriculum Basic Communication Concepts Use active listeningUse active listening Being present, rather than what you say, is most importantBeing present, rather than what you say, is most important Let the patient and the family lead you – join in their journey; but emphasize that they are in chargeLet the patient and the family lead you – join in their journey; but emphasize that they are in charge Encourage reminiscing; let the older person and families tell their storiesEncourage reminiscing; let the older person and families tell their stories Let the patient know that their lives have meaningLet the patient know that their lives have meaning

15. EELLNNEECC Geriatric Curriculum Important Messages to Communicate to Someone at EOL ListenListen RespectRespect Hopes, values,Hopes, values, and goals and goals Encourage questionsEncourage questions

16. EELLNNEECC Geriatric Curriculum A man with advanced cancer is told that his therapy is not working. He asks “Why is this happening to me?” What is your best response? 1. “I don’t know. I wish I had an answer for you.”1. “I don’t know. I wish I had an answer for you.” 2. “Perhaps you are being tested and this will make you a stronger person.”2. “Perhaps you are being tested and this will make you a stronger person.” 3. “I’ll ask the doctor to more fully explain the disease process.”3. “I’ll ask the doctor to more fully explain the disease process.” 4.”If I were you, I’d explore additional treatment options.”4.”If I were you, I’d explore additional treatment options.”

17. EELLNNEECC Geriatric Curriculum Messages to Give to the Dying *ACTIVITY*

18. EELLNNEECC Geriatric Curriculum Messages to Give to the Dying I love youI love you I forgive youI forgive you Please forgive mePlease forgive me Thank youThank you GoodbyeGoodbye

19. EELLNNEECC Geriatric Curriculum During morning care a dying man asks the healthcare worker if he is dying. The best response is : 1. “Yes. I suppose you’ve know this all along. I promise I’ll be right with you all the way.”1. “Yes. I suppose you’ve know this all along. I promise I’ll be right with you all the way.” 2. “Not today. Why don’t we look at some of the things you would like to accomplish now.”2. “Not today. Why don’t we look at some of the things you would like to accomplish now.” 3.”Yes. Tell me about your concerns, fears, or questions you have about what will happen.”3.”Yes. Tell me about your concerns, fears, or questions you have about what will happen.” 4.”Why do you ask that? You look like you feel so much better today that you did yesterday.”4.”Why do you ask that? You look like you feel so much better today that you did yesterday.”

20. EELLNNEECC Geriatric Curriculum Communication with health care professionals should NOT: 1. be honest and truthful1. be honest and truthful 2. involve the health care team2. involve the health care team 3. decide what client issues should be addressed first3. decide what client issues should be addressed first 4. listen to a client’s concerns4. listen to a client’s concerns

21. EELLNNEECC Geriatric Curriculum Staff Interventions with Grieving People Support of grieving as normalSupport of grieving as normal Use of nonverbal communicationUse of nonverbal communication -Smile -Nod -Touch -Hug -Quiet listening

22. EELLNNEECC Geriatric Curriculum Interventions with Grieving People Provide physical space for grievingProvide physical space for grieving Give emotional supportGive emotional support Encourage expression ofEncourage expression of feelings/life review feelings/life review Spiritual supportSpiritual support

23. EELLNNEECC Geriatric Curriculum Possible Things TO Say “I’m so sorry.”“I’m so sorry.” “What is this like for you?”“What is this like for you?” “Tell me about [your loved one].”“Tell me about [your loved one].” “What I remember most (or appreciated most) about [your loved one] is…”“What I remember most (or appreciated most) about [your loved one] is…”

24. EELLNNEECC Geriatric Curriculum When You are Communicating With Someone Who is Upset Treat the person with respectTreat the person with respect Answer the person’s questionsAnswer the person’s questions Stay calm; don’t argueStay calm; don’t argue Use active listening skillsUse active listening skills Let the person talkLet the person talk *Role play activity* *Role play activity*

25. EELLNNEECC Geriatric Curriculum Strengthen Your Skills Identify your communication style/your team member’sIdentify your communication style/your team member’s What communication styles areWhat communication styles are easy/ difficult for you to deal easy/ difficult for you to deal with? with? Do you understand your role on the team and communicate it to the team?Do you understand your role on the team and communicate it to the team?

26. EELLNNEECC Geriatric Curriculum Respect, Respect, Respect

27. EELLNNEECC Geriatric Curriculum References City of Hope & the American Association of Colleges of Nursing, 2007; Revised, 2010. The End-of-Life Nursing Education Consortium (ELNEC)- Geriatric Training Program and Curriculum is a project of the City of Hope (Betty R. Ferrell, PhD, FAAN, Principal Investigator) in collaboration with the American Association of Colleges of Nursing (Pam Malloy, RN, MN, OCN, Co-Investigator). D.J. Wilkie & TNEEL Investigators, 2001. Toolkit for Nursing Excellence at End of Life Transition, version 1.0. Cancer Pain & Symptom Management Nursing Research Group; University of Washington. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant # D62HP06858