COMFORT*

2. 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.

3. Objectives • Define mindfulness and presence in clinical encounters • Describe active listening • Identify two communication skills that can assist with mindful presence

4. Mindfulness • Originated in Buddhist philosophy • Tenets of mindfulness: • Purposefully attentive • Awareness • Flexible state of mind • Contrast with mindlessness • Habitual behaviors

5. Mindful Presence Mindful Communication • Awareness of situation • Being in the moment • Attention focused on present moment Presence emphasizes personal experience • Acceptance • Patience, Trust • Suspension of personal preference/critical thought

6. Core Attitudes* • Perception • Active listening • Getting involved • Creating space “Being is as valuable as “doing” *Simon, T., Ramsenthaler, C., Bausewein, C., Krischke, N., Geiss, G. (2009). Core attitudes of professionals in palliative care: A qualitative study International Journal of Palliative Nursing, 15(8) p. 408.

7. Mindful Presence • Patients/family • indirect cues of emotion • missed empathic opportunities

8. Healing/Compassionate Presence • Empathy • Patients/families: • hesitant to express emotions • present indirect cues instead • Listen for feelings • Witness the suffering of others (Ferrell & Coyle, 2008) • Be mindfully present • Practice empathy • Offer compassionate voice • Recognize impacts of illness

9. Active Listening (Wood, 2000) • Hearing versus Listening • Listening involves: • Attend to nonverbal cues • Listen without interruption • Ask questions to clarify • Paraphrase interpretation in own words • Ask if interpretation is correct • Empathize (paraphrase feelings of speaker)

10. Five Principles of Effective Listening • Focus on feeling words • Note the general content of message • Observe speaker’s body language • Do not fake understanding • Do not tell speaker how he/she feels Adapted from R. Bolton (1979). People Skills. Englewood, NJ: Prentice-Hall in MacPhee, M. (1995) The family systems approach and pediatric nursing care. Pediatric Nursing, 21, 5, 417-437.

11. Other Aspects of Listening* Silence • Listen without interruption • Provides opportunity/permission to disclose • Conveys empathy • Allows for deeper expression of concern *Dahlin (2010)

12. How we see others… • Experience (perceived by I-IT*) • Person seen as object • To be manipulated/changed • Relation (perceived by I-THOU*) • Person seen as unique • Culmination of life experience/complex • Positive regard *Martin Buber’s work on the dichotomy of viewpoints

13. Seeing Differently* • Perception-shifting • Vivid sense of appreciation and beauty • Seeing what needs to be done • Leaning into stillness of activities • Cultivating openness without agendas *Bruce & Davies, 2005

14. Mindful presence of the Nurse • Family meetings • Watch for indirect emotional cues • Remind team members to practice silence • Team meetings • Observe team members for compassion fatigue • Encourage self-compassion • Allow for self-reflection and self-healing

15. Nurse specific topics • Pain • Be aware of quality of life domains • Spiritual, physical, psychological, social • Communicating about spirituality

16. Mindful of Self-Care Needs • Burnout and compassion fatigue • Be aware of: • Motivations • Thoughts, feelings, attitudes, beliefs, compassion • Engage in self-reflection, self-healing