Download Module 1 – Communication

COMFORT*
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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
• Understand the duality of task and
relational communication
• Discover foundations of narrative clinical
practice
• Learn to practice person-centered
messages
Task Communication
The content of the message
•Teaching - confirm and explain bad news
•Advocating - share information with
healthcare team (Price, et al., 2006; Radziewicz & Baile, 2001)
•Coordinating - mobilize needed resources
(Pavlish & Ceronsky, 2009)
Relational Communication
The relationship between the people as
conveyed by the message
•Caring - provide patient/family support
•Sharing - emotional reactions and providing
opportunities to process the bad news (Warnock, et
al., 2010)
Narrative Clinical Practice
• Being with and relating to others while honoring
their voice & lived experience
Bearing Witness:
1. Recognize individuality
2. Understand life prior to illness
3. Refocus beyond medical information
Kendall, 2007; Hess, 2003
Recognize Individuality
Deconstruction
 Active listening
 Use adjectives to describe patient uniqueness
to others
Your Role:
• Listen for vulnerabilities/uniqueness
• Identify story structure
– Who are the main people involved?
Recognizing Individuality
• “Tell me about
times when you
aren’t thinking
about illness/your
loved one’s
disease.”
• “How would you
describe this
illness/the shared
experience of
illness?”
• “Is there anything else
that could explain
your/his/her illness?”
• “I’m wondering if there
is more to this than
meets the eye.”
• “Who else is involved in
your/his/her illness?”
Understand Life Prior to Illness
Externalization
 Solicit/employ information
– Encourage reflection
– Incorporate psychosocial history in diagnostic
assessment
Your Role:
 Encourage sharing to identify and address
feelings
• Adopt multiple perspectives
– What are the relationships between the
people involved?
Understanding life prior to illness
• “How has your
illness (or his/her
illness) affected
your life and your
relationships?”
• “How do you think
ignoring this will
affect your life?”
• “How does your
illness (or his/her
illness) reflect on
you as a person?”
• “How do you see the
future?”
• “How are you affected by
others’ opinions?”
• “What do you think
influences this
experience?”
Go Beyond Medical Facts
Re-authoring
 Help revise and widen narrative lens beyond illness
 Solicit history to understand illness
 Help patient/family understand and accept current
circumstances
Your Role:
• Consider the mental health of patient/family member
• Creative skills (What solutions can be drawn?)
• Tolerate uncertainty as you listen to the story
Going beyond medical facts
• “What people in
your life are
supporting you?”
• “What do you think
needs to happen in
order for you to be
able to care for your
loved one/yourself?”
• “What needs to
change?”
• “What does your
success in solving
problems related to
care say about your
abilities?”
• “How is this experience
affecting your life?”
Person-Centered Messages (PCM)*
• Speaking in a supportive way to validate and
affirm patient/family
• Support is conveyed with clear language
– Be realistic, yet supportive
– Focus on the patient’s feelings
*Burleson, 1994
Practicing Person-Centered Messages
• Explicitly recognize and acknowledge the
patient/family’s feelings but does not
elaborate on those feelings.
• Provide an elaborated acknowledgement
and explanation of the patient/family’s
feelings
• Help the patient/family to gain a perspective
on his or her feelings
Person-centered messages
From the following, choose the most personcentered message:
(a) “I can see why you are upset. That’s a
normal reaction.”
(b) “I’m so sorry this has happened. Did you
think this was coming?”
(c) “Let’s talk about your treatment from this
point forward. Can I see you tomorrow?”
Examining person-centered messages
(a) “I can see why you are upset. That’s a
normal reaction.”
(b) “I’m so sorry this has happened. Did you
think this was coming?”
(c) “Let’s talk about your treatment from
this point forward. Can I see you
tomorrow?”
When sharing bad news…
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Clearly explain prognosis, elaborate
Respond to impact on life
Show clear respect for feelings
Integrate life/work into decision-making
Address pain, family role in care
Plan, present team structure,
hospice/Advance directives (if appropriate)
When communication
impairments are present
• Impairments accompany conditions
creating serious and terminal illness
• Recognize family and their values
• Assist family and patient with:
– Communicating, swallowing, cognition
– Design Interventions
– Optimize food, drink, and communication
– Keep team apprised (Toner & Shadden, 2012; Pollens, 2004)
Team Clinical Narrative Practice
• Care planning
– Team member responsibility is to collect and
share patient/family information
• Patient/family meetings
– Demonstrate knowledge of patient/family life
– Use life history to provide information
– Repetition by team members; repeat each
other