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E L N E C Geriatric Curriculum
E L N E C _____Geriatric CurriculumEnd-of-Life Nursing Education Consortium
SESSION 7: Communication at End-of-Life
Fairfield UniversityQuinnipiac University
School of Nursing ELDER Project
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E L N E C Geriatric Curriculum
Objectives: Upon completion of this session, the learner will be able to …
1. Explore common communication myths.
2. Identify basic principles of
communication.
3. Practice therapeutic communication
techniques.
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E L N E C Geriatric Curriculum
Myths of Communication
• Communication is deliberate• Words mean the same to
sender/receiver• Verbal communication is
primary• Communication is one way• Can’t give too much
information
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E L N E C Geriatric Curriculum
Basic Principles of Communication• Communication is a constant
two-way activity• Words and actions are
interpreted by the receiver • Much communication
is nonverbal• Listening is the most
important part of communication
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E L N E C Geriatric Curriculum
Verbal and Non-Verbal Communication
• Includes body language, eye contact, gestures, tone of voice
• 80% of communication is nonverbal
Boreale & Richardson, 2006; Buckman, 2001; Dahlin, 2010
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E L N E C Geriatric Curriculum
Which statement is true about communication?• 1. we can never give someone too much
information.• 2. We communicate only when we choose to
communicate.• 3. The majority of messages we send are
unspoken.• 4. Communication is mostly words and their
messages.
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E L N E C Geriatric Curriculum
Presence• Knowing and being
comfortable with oneself• Knowing the other
person• Connecting• Affirming and valuing• Acknowledging
vulnerability
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E L N E C Geriatric Curriculum
Presence
• Using intuition• Being
empathetic • Being in the
moment• Serenity and
silence
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E L N E C Geriatric Curriculum
“Nature gave us one tongue and two ears so we could
hear twice as much as we
speak.”Epictetus, 55 A.D. – 135 A.D.
*LISTENING EXERCISE*
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E L N E C Geriatric Curriculum
Which factor is most important to quality end of life care?
• 1. controlling the cost of pain medication• 2. limiting care to symptom management
protocols?• 3. communicating well with clients and
families• 4. using volunteers to make sure clients are
not alone.
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E L N E C Geriatric Curriculum
Factors that Influence Communication at EOL
• Culture• Age• Gender• Personal & family
experiences
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E L N E C Geriatric Curriculum
Barriers in Communicating with Dying Patients and Their Families• Societal denial of death• Lack of direct experience
with death• Older adults’ and families’
fears and emotions• Dementia and other conditions that make
conversations about the future and other abstract ideas difficult
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E L N E C Geriatric Curriculum
Barriers in Communicating with Dying Older Adults and Their Families
• Caregiver fears:• Not having “the answers”• Feeling helpless/
inadequate• Upsetting the patient/family• Fear of showing emotions• Caregiver’s personal fear of dying
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E L N E C Geriatric Curriculum
Basic Communication Concepts• Use active listening • Being present, rather than what you say, is
most important • Let the patient and the family lead you –
join in their journey; but emphasize that they are in charge
• Encourage reminiscing; let the older person and families tell their stories
• Let the patient know that their lives have meaning
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E L N E C Geriatric Curriculum
Important Messages to Communicate to Someone at EOL
• Listen• Respect• Hopes, values, and goals• Encourage questions
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E L N E C Geriatric Curriculum
A man with advanced cancer is told that his therapy is not working. He asks “Why is this happening to me?” What is your best response?
• 1. “I don’t know. I wish I had an answer for you.”• 2. “Perhaps you are being tested and this will
make you a stronger person.”• 3. “I’ll ask the doctor to more fully explain the
disease process.”• 4.”If I were you, I’d explore additional treatment
options.”
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E L N E C Geriatric Curriculum
Messages to Give to the Dying
*ACTIVITY*
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E L N E C Geriatric Curriculum
Messages to Give to the Dying• I love you• I forgive you• Please forgive me• Thank you• Goodbye
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E L N E C Geriatric Curriculum
During morning care a dying man asks the healthcare worker if he is dying. The best response is:
• 1. “Yes. I suppose you’ve know this all along. I promise I’ll be right with you all the way.”
• 2. “Not today. Why don’t we look at some of the things you would like to accomplish now.”
• 3.”Yes. Tell me about your concerns, fears, or questions you have about what will happen.”
• 4.”Why do you ask that? You look like you feel so much better today that you did yesterday.”
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E L N E C Geriatric Curriculum
Communication with health care professionals should NOT:
• 1. be honest and truthful• 2. involve the health care team• 3. decide what client issues should be
addressed first• 4. listen to a client’s concerns
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E L N E C Geriatric Curriculum
Staff Interventions withGrieving People• Support of grieving as normal• Use of nonverbal communication
- Smile- Nod- Touch- Hug- Quiet listening
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E L N E C Geriatric Curriculum
Interventions with Grieving People• Provide physical
space for grieving• Give emotional support• Encourage expression of feelings/life review• Spiritual support
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E L N E C Geriatric Curriculum
Possible Things TO Say• “I’m so sorry.”• “What is this like for
you?”• “Tell me about [your loved
one].”• “What I remember most
(or appreciated most) about [your loved one] is…”
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E L N E C Geriatric Curriculum
When You are Communicating With Someone Who is Upset• Treat the person with respect• Answer the person’s questions • Stay calm; don’t argue• Use active listening skills• Let the person talk
*Role play activity*
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E L N E C Geriatric Curriculum
Strengthen Your Skills
• Identify your communication style/your team member’s
• What communication styles are easy/ difficult for you to deal with?• Do you understand your role on the
team and communicate it to the team?
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E L N E C Geriatric Curriculum
Respect, Respect, Respect
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E L N E C Geriatric Curriculum
ReferencesCity of Hope & the American Association of Colleges of Nursing, 2007;
Revised, 2010. The End-of-Life Nursing Education Consortium (ELNEC)- Geriatric Training Program and Curriculum is a project of the City of Hope (Betty R. Ferrell, PhD, FAAN, Principal Investigator) in collaboration with the American Association of Colleges of Nursing (Pam Malloy, RN, MN, OCN, Co-Investigator).
D.J. Wilkie & TNEEL Investigators, 2001. Toolkit for Nursing Excellence at End of Life Transition, version 1.0. Cancer Pain & Symptom Management Nursing Research Group; University of Washington.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant # D62HP06858