Shedding Light at the End of Life A recap of the 5/4/17 ONS Congress presentation by: Maureen Leahy, RN, BSN, MHA, CHPN Judy Fihn, RN, CHPN, OCN

End of Life

Gathering “Emotional Data” Is there emotion in the room? *Gather that data and respond to it. *Attend to changes in emotion. *Track your emotion.

Silence Silence is a good first response to emotional reactions. Remain silent but present. Allows patient and families to say what’s on their mind. Slip your hand under theirs to hold their hand. They can pull away if they want.

Ask-Tell-Ask Ask- Always invite conversation: “May I tell you what I’m seeing?” “Would it be helpful if I gave you some information?” Tell- them what you have to say. Ask- if it’s okay to move forward with the conversation/what their emotional reaction is/what their understanding is(teach back).

N*U*R*S*E Statements N: Name the emotion- “You seem frustrated, worried, relieved.” U: Understand- “It must be so hard for you to go through this.” “I can see how much pain is affecting you.” “It must be so hard facing all these uncertainties.” R: Respect- “I am so impressed you have been here every day to visit your mother.” “I know how strong you have had to be through all of these difficult treatments.” S: Support- “My team and I will be here to help you through this.” E: Explore- “Tell me more about how you felt.” “What do you mean when you say ___?”

I wish….. Statements that are tools for complex conversations We may use these tools when there is resistance to hearing bad news or a strong emotional reaction. Examples: “I wish things were different.” “I wish we had stronger medicine.” “I wish the team was able to give you better news today.” Avoid “but” after “I wish” to build rather than negate the support statement. Instead use “and”. Example: “I wish we had stronger medication to treat this cancer, and our whole team is here to support you through this.”

Original presentation references: Arnold, R., Back, A., Tulsky, J.(2009). Mastering communication with seriously ill patients. New York: Cambridge University Press. Arnold, R., Back, A., Edwards, K., Tulsky, J. Track and Respond to Emotion. Retrieved from: http://www.vitaltalk.org/clinicians/track-respond-emotion Center to Advance Palliative Care. Delivering serious News. Retrieved from: https://www.capc.org/providers/courses/communication- skills-34/

Thank you Questions Contact: Kaylin King, RN, BSN, BMTCN kingk9@uw.edu