Difficult Conversations NHS Grampian Network of Community Pharmacist Training Day 14th November 2018 Dr Claire McCullough ST5 Palliative Medicine Clinical Lecturer (Scholarship)

Aim Explore approaches to ‘difficult conversations’ faced in community pharmacy

Objectives Describe the 3 circle model of communication List key communication skills Describe model for reflective practice Discuss ‘difficult conversations’ faced in community pharmacy Just in case box Distressed Bereavement Evaluate impact on well being when working with loss, grief + bereavement

Consider a conversation…

What makes conversations difficult?

The Three Circle Model Soothing System Drive System Threat System Connection Focused Content, Connected, Kindness, Safety Soothing Drive System Incentive Focused Wanting, Pursuing, Achieving Activating Threat System Threat Focused Protective, Defensive, Safety –Seeking Activating/Inhibiting Emotional responses are strong. Those associated with threat are FEAR + ANGER

Key Communication Skills Soothing System Active Listening Reflection Clarification Using Silence Empathising Educated guesses Summarising Drive + Soothing System Agenda setting Time setting Information sharing Negotiating

Reflective Practice Experience + Reflection = Learning How do you think the other person might have felt? Any communication skills you used well? Any communication skills you would like to improve?

Scenarios | Small Group Work

Just in case box Friday afternoon John metastatic colorectal cancer Son comes into pharmacy to collect a regular repeat prescription for him There is also a prescription for a ‘just in case box’ What are your concerns? How would you proceed?

Distressed relative June has come to collect a prescription for her partner, Paul. They had an appointment earlier this week and were informed that his condition is now terminal. She is clearly upset and starts crying What are your concerns? How would you proceed?

Bereavement Samira’s father died last week, but you are not aware. She has been collecting his medicines for many weeks now. She has come to the pharmacy to return his remaining medications. ‘I’ve just come to hand in dad’s medications’. What are your concerns? How do you respond?

Bereavement | Strategies ‘What most people want is for those around them to listen to and acknowledge their loss.’ Macmillan cancer support + National Bereavement Alliance Acknowledge the person’s loss + offer sympathy Mirror words and phrases used Think about your own needs

Video | NHS Education Scotland https://vimeo.com/264030127 7.40 mins

Working with loss, grief + bereavement

Care of Self Physical, emotional, social and spiritual health Recognising signs of stress Work – Life Balance Recognising bad habits Always working late/starting early Not taking regular breaks Not taking annual leave Worrying about work when not at work

Well being at work What kinds of support do you get at work? What does your team do to support one another? What are the things outside of work that help you feel healthy and well? What kinds of support work well for you?

Questions?

Objectives Describe the 3 circle model of communication List key communication skills Describe model for reflective practice Discuss ‘difficult conversations’ faced in community pharmacy Just in case box Distressed Bereavement Evaluate impact on well being when working with loss, grief + bereavement

References Support Around Death | http://www.sad.scot.nhs.uk Turas Learn | Palliative + End of Life Care: Enriching + Improving Experience Framework https://learn.nes.nhs.scot/2452/palliative-and-end-of-life-care-enriching-and-improving- experience/palliative-and-end-of-life-care-enriching-and-improving-experience Gibb’s Reflective Cycle