An introduction to effective Communication in End of Life Care

1. An introduction to effective Communication inEnd of Life Care

2. 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

3. Aims Explore some essential skills of communication in end of life care Identify barriers to effective communication

4. 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)

5. COMMUNICATE What do you understand by this word?

6. What do we want from communication? • Information – delivered in a language we can understand • Honesty • Companionship • Opportunity to reflect

7. 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

8. 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

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

10. Effective skills - language • Questioning –open, closed, leading and multiple • Encouragement • Picking up on cues • Reflection • Silence • Clarification/Summarising

11. 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..

12. 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.

13. Non-verbal behaviours • Personal space • Facial expressions • Posture • Gestures • Touching

14. Non-verbal Communication!!

15. Barriers or blocks to effective communication especially at EoL

16. 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

17. ‘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

18. Useful Tools Listening skills - active not passive Use of Questions - open not closed Reflecting Back Clarifying Reinforcement/Encouragement Paraphrasing Silence

19. Identifying emotions… • Anger • Sadness • Surprise • Guilt • Anxiety

20. 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 – that’s ok. • COMMUNICATION IS THE KEY: informal chats, supervision, reflective meetings or talking to another professional may help

21. Its OK to To admit you don’t 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 you’re not really sure of Dealing with limits of your knowledge/remit

22. Issues for Individuals in your care Discuss in groups what you think the dangers are if staff do not possess effective communication skills

23. 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, hasn’t given me anything to eat and won’t let me have a bath.” What would you do???

24. Pause for thought! A 75 year old lady rings her local NHS hospital and had the following conversation: ‘Hello, I’d 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’ ‘I’ll put you through to the nurses station’ ‘Hello, ward P, can I help?’

25. Continued…….. ‘Yes, I’d 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’ ‘I’ll just check her notes. Yes, I’m 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, I’m so pleased and happy!’ ‘Are you a close relative?’

26. ‘No I’m Mrs Tiptree in room 2B, no-one tells you anything at all in this place!!!!’

27. Remember help is always at hand for you

28. 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-with-a-long-term-condition/eolc-training/