What On Earth Do I Say by Sue Spencer Talk about the book Morphed into a finer existence

Palliative Care Palliative care is the active holistic total care of patients whose disease is not responsive to curative treatment. Palliative care aims to: Offer a support system to help both the family and patient cope during the patient’s illness and in their own bereavement by providing: Relief from pain and other distressing symptoms. Psychological support Social support Spiritual support Affirm their life and regard death as a normal process. Not just cancer, Parkins disease, MND MS, heart failure, COPD

Establishes a team comprising of the dying person, family, friends, volunteers, religious leaders and health care professionals who communicate with one another irrespective of the place of care. Home, hospital or hospice, Care Home

There are over 200 Euphemisms for the word death Kicked the bucket Popped their clogs Pegged it Turned up their toes Fallen off their perch Given up the ghost Pushing up daisies Deceased Departed, Passed away Gone to a better place, six feet under, Brown Bread . Death denying society, don’t talk about it and it won’t happen

Visiting The Dying An important role Share concerns or fears Be sensitive Be flexible Dying can be a lonely and isolating experience The gift we can bring is friendship, making them feel valued, wanting to validate their lives. Share concerns, worries that they can’t with family or friends, be a mediator : Fatigue can be a problem, finding it hard to concentrate. Give them the permission to ask you to leave: Don’t go with a set agenda, let them set it. Be a good listener. My first patient in Dartmouth

Levels of Conversation External environment/outside world Knowledge Thoughts and feelings Hopes and desires Meaning Weather etc What you know about them or find out about family etc What are their thoughts or feelings never take hope or desires away, explore with them Never promote false hope What does their life mean to them, Validation? Most popular topic of conversation of their life

Listening Skills Listening is a skill Try and create a listening environment Body language Touch Silence Listen for cues That can be learnt Practise listening sensitively and pastorally. In the right environment they will say things that they haven’t said before. If truly listening they will trust you: Turn the TV off. Being in their own home puts them in charge, more likely to open up. Talk about seeing Drs etc. Relaxed body, eye contact, smile, Touch is important communicates that you are listening and that you care Silence is a very important tool,

We miss the cues that patients give us

Communicating With The Dying Starting a difficult discussion: Being asked difficult questions or saying the “right” or “wrong” thing Upsetting patients/relatives Exploring concerns These are a list of concerns that you may have. Anxious about visiting, what to say etc. I could introduce myself by saying what I was there for, harder for you. Start with the weather etc. Flowers on the table, photograph Don’t worry about the difficult questions, there isn’t always an answer, John’s challenge. You may have upset them because they have had to face the truth. Lots of tears. Door step

Blocking Questions Questions that only require a yes or no answer Multiple questions Leading questions Jollying along Normalising Don’t fill silences Silence is a very important tool

“Is there anything you want us/me to know?” Questions “What would you like to talk about?” “How do you feel about your situation at the moment?” “I know these are difficult things to talk about” “How do you feel you’re progressing?” “What do you hope for in the next few weeks?” “Is there anything you want us/me to know?”

Spiritual Distress Why me, what I have done to deserve this? Am I going to die? Is there a God and does he care about me? How will I be remembered? Do you believe in life after death? My husband wasn’t a Christian, will I see him again? Not going to answer the questions for you, but be aware that this can cause Spiritual pain which can cause physical pain

Reflective Questions/Clarification Closing “Can I just check that I have understood what you have just said?” “How you are feeling? “What is upsetting you?” “It sounds like….” Acknowledge that this conversation has been difficult. Offer to return Touch them as you leave Check their facial expression. You may not have the answers for them but just talking about their problems helps. Touch very powerful but do be careful

“ “I Would rather make mistakes in kindness and compassion than work miracles in unkindness and hardness” Mother Teresa, A Gift For God: Prayers for Meditation (San Francisco, Harper 1996) How we are with the dying person is as important if not more important than what we say. I still made mistakes. Visit with Treena

Holding Cross Giving a gift such as a prayer card or holding cross The use of a wooden Holding cross, deliberately uneven in order to fit in the hand between the fingers.

www.dyingmatters.org www.ncpc.org.uk

Remember “You matter because you are you. You matter to the last moment of your life.”