1 / 20

COMFORT*

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.

clarke
Download Presentation

COMFORT*

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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.

  2. Objectives • Describe a typology of family caregivers from a communication perspective • Identify two communication skills that could be used with family caregivers

  3. Common Family Problems Nurses Face • Family doesn’t understand what is being told to them • The family doesn’t know the patient’s wishes • The family refuses help

  4. Foundations: Family as System • Family system • Bounded, interrelated, identifiable communication • Interdependent • Influence one another • Environment • Interaction, adaption/resistance • Boundaries • Define system, communication between/with other systems

  5. Nurse as a member of the family • Recognize predictable interactions • Family communication efforts become focused on the nurse • Nurse is mediator between family and physician • Nurse communication can shape or protect family identities

  6. Family Communication Climates • Over time, families establish a communication climate (McLeod and Chaffee, 1972) • Two fundamental communication orientations contribute to this environment • Conformity • Conversation (Ritchie and Fitzpatrick, 1990; 1991; 1994)

  7. Conversation Orientation • Degree to which all family: • Are encouraged to participate freely • Are encouraged to participate frequently • Are encouraged to participate without time limits • Are encouraged to participate without topic limits

  8. Conformity Orientation • Degree to which all family • Stresses homogeneity of attitudes • Stresses homogeneity of beliefs • Stresses homogeneity of values • Stresses fixed family roles

  9. Caregiver Type: Manager High family conformity/High family conversation • Caregiver dominates care planning • Caregiver as self-appointed Family Spokesperson • Caregiver controls decision-making • Context of illness exaggerates: • Limited communication within/by family • Lack of diversity in perspectives about illness • Obligation to conform in family

  10. Things to look for* • Direct blocked communication • Hang up phone • Refuse to answer • Agree not to talk about illness • Indirect blocked communication • Not responsive • Appear uncomfortable • Self-censored speech *Kenen, R., Ardern-Jones, A., & Eeles, 2004

  11. Caregiver Type: Carrier Low family conversation/High family conformity • Limited patient-caregiver discussions • Caregiver coping takes place outside of family • Illness perceived as private • Context of illness creates: • Dynamic of caregiver as a proxy for patient authority • Family conflict due to low conversation • Self imposed pressure to over-perform caregiving

  12. Understand family coping style • Could you give an example of a difficulty your family has faced when you were growing up? • What helped your family get through this? • What was tried that did not help?

  13. Caregiver Type: Partner High family conversation/Low family conformity • This caregiver partners with family and healthcare team • Ability to engage all quality of life dimensions • Family-prompted internal family meetings • Context of illness creates: • Open discussions about solutions and increased quality of life • An opportunity for this caregiver to be part of the care process • A place for family members to realize their caregiving strength

  14. Assess family stressors • What else is going on in your family’s life? • What has helped you in dealing with these stressors? • What has not been helpful?

  15. Caregiver Type: Loner Low family conversation/Low family conformity • A focus on one dimension of quality of life • Experiences caregiving as one acute crisis after the next • Can feel like a constant outsider to team and family • Context of illness creates: • Further isolation for patient, caregiver, and family • Unrelenting caregiver burden • Conflicts for healthcare team and system

  16. Assessing family relationships • Tell me about your family. • Who is close to whom?

  17. Nurse-Caregiver Communication • Managers • Initiate participation of other family members • Carriers • provide accolades and reassurance • Offer and emphasize respite care • Partners • Engage in dialogue about decision-making • Loners • Focus on one-on-one interactions

  18. Nurse Communication with Families • Adapt communication to family structure • Family meetings should address family uncertainty • Surrogate decision-maker support

More Related