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

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.

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

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

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

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.

E L N E C Geriatric Curriculum

Presence• Knowing and being

comfortable with oneself• Knowing the other

person• Connecting• Affirming and valuing• Acknowledging

vulnerability

E L N E C Geriatric Curriculum

Presence

• Using intuition• Being

empathetic • Being in the

moment• Serenity and

silence

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*

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.

E L N E C Geriatric Curriculum

Factors that Influence Communication at EOL

• Culture• Age• Gender• Personal & family

experiences

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

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

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

E L N E C Geriatric Curriculum

Important Messages to Communicate to Someone at EOL

• Listen• Respect• Hopes, values, and goals• Encourage questions

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.”

E L N E C Geriatric Curriculum

Messages to Give to the Dying

*ACTIVITY*

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

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.”

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

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

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

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…”

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*

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?

E L N E C Geriatric Curriculum

Respect, Respect, Respect

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