An introduction to effective Communication in End of Life Care

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An introduction to effective Communication inEnd
of Life Care
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Ground 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 professionals
• Time keeping
• Respect each others views
• Mobiles
• Housekeeping arrangements

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Aims

• Explore some essential skills of communication in
  end of life care
• Identify barriers to effective communication

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End 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)

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COMMUNICATE

• What do you understand by this word?

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What do we want from communication?

• Information delivered in a language we can
  understand
• Honesty
• Companionship
• Opportunity to reflect

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Exercise 1

• Why is effective communication so important in
  relation to end of life care?
• Take 5 minutes to discuss in groups why you think
  it is important

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Essential communication skills

• Listening skills
• Verbal
• Language words used
• Paralanguage how it is said, tone, pitch,
  clarity
• Non-verbal
• what we understand and transmit from body
  language

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Listening Skills

• Plan the environment
• Be Attentive
• Hear what an individual is saying
• Use appropriate body language

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Effective skills - language

• Questioning open, closed, leading and multiple
• Encouragement
• Picking up on cues
• Reflection
• Silence
• Clarification/Summarising

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Paralanguage

• 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..

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Non-Verbal Communication

• Is the message or response not expressed or sent
  in words
• Over 65 percent of the social meaning of the
  messages we send are communicated non-verbally.
• Actions speak louder than words.

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Non-verbal behaviours

• Personal space
• Facial expressions
• Posture
• Gestures
• Touching

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Non-verbal Communication!!
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Barriers or blocks to effective communication
especially at EoL
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Barriers to effective Listening

• Feeling stressed by other concerns
• Environment noisy or disturbed
• Not feeling confident
• Low motivation bored or tired
• Being in a hurry to pass the person on
• Interjecting with own experiences
• Formulating answers to queries before hearing
  exactly what is needed

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Verbal's for you to avoid

• Mumbling
• Passing judgement or giving unwanted advice
• Interrupting
• Discussing your own experiences
• Jumping to conclusions
• I understand
• Confusing people with multiple questions
• Using jargon

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Useful Tools

• Listening skills - active not passive
• Use of Questions - open not closed
• Reflecting Back
• Clarifying
• Reinforcement/Encouragement
• Paraphrasing
• Silence

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Identifying emotions

• Anger
• Sadness
• Surprise
• Guilt
• Anxiety

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Remember to look after yourself too

• Understand that looking after a dying person will
  put added strain onto you and the team
• Beware of your own emotions, if a specific task
  is difficult, find someone who can help
• There may be events in your life that meanyou
  are not the best person to help this
  client/relative on this day thats ok.
• COMMUNICATION IS THE KEY informal chats,
  supervision, reflective meetings or talking to
  another professional may help

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Dealing with limits of your knowledge/remit

• Its OK to
• To admit you dont know something
• Who might know?
• How will it be followed up?
• Explain likely time -frame of response

• Its NOT OK to
• Block a question by
• - Ignoring it
• - Dismissing it
• - Jollying the client
• along
• Guess / say something youre not really sure of

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Issues for Individuals in your care

• Discuss in groups what you think the dangers are
  if staff do not possess effective communication
  skills

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Scenario

• You have been caring for Mary for
• several months. She has become gradually
• more frail both physically and mentally. On
• this occasion, she seems quite agitated
• and tells you that woman has been horrible to
• me. She shouts at me, hasnt given me
• anything to eat and wont let me have a bath.
• What would you do???

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Pause for thought!

• A 75 year old lady rings her local NHS hospital
  and had the following conversation
• Hello, Id 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
• Ill put you through to the nurses station
• Hello, ward P, can I help?

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Continued..

• Yes, Id 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
• Ill just check her notes. Yes, Im 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, Im so pleased and happy!
• Are you a close relative?

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• No Im Mrs Tiptree in room 2B,
• no-one tells you anything at all in this
  place!!!!

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Remember help is always at hand for you
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Useful Information

• www.endoflifecareforadults.nhs.uk
• Ellershaw J, Wilkinson S (2008 edition) Care of
  the dying A pathway to excellence Oxford
  University Press
• Local hospices
• End of Life Care Learning Resource Pack, Housing
  21 www.endoflifecareforadults.nhs.uk
• www.nhsglos.nhs.uk/your-services/help-for-those-wi
  th-a-long-term-condition/eolc-training/