CONVERSATIONS THAT MATTER Pam Cummer RN CHPCN(c) Colette Howery RN October 2015

Our Hopes for Today To review different styles of communication. To learn how to listen and truly hear. To become effective communicators. To instill confidence in our ability to have the conversations that matter.

Truly Hearing listening

HEAR STRATEGY  HALT  ENGAGE  ANTICIPATE  REPLAY

DEEP LISTENING The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention…A loving silence often has far more power to heal and to connect than the most well-intentioned words. Rachel Naomi Remen

* “When you talk you are only repeating what you already know. …but, if you listen, you may learn something new.” Dalai Lama

* Ulay, Ulay, Ohhttp:// iKO5Yhttp:// iKO5Y

Case Study Josephine is a 53yr. old woman who recently visits the ER with complaints of shortness of breath and chest pain. Josephine is accompanied by her husband and daughter. Diagnosis is lung cancer. You are the nurse who goes in with the doctor to explain the results of the x-ray and CT scan. How best could this be handled?

SPIKES S-Setting: Getting the physical context right P-Patient’s perception: Find out how much the patient knows I-Invitation: Find out how much the patient wants to know K-Knowledge: Share the information E-Exploring and Empathy :Respond to the patient’s feelings S-Strategy and summary: Make a plan

Case Study cont’d Josephine has had a lung biopsy, and a visit to the CCI. Surgery is not an option, chemotherapy and possible radiation has been offered. Josephine asks what her prognosis is with or without treatment. She is told one year with treatment and 6 months without; she shares this with you.

Case Study cont’d Josephine has severe side effects from the chemo and a recent CT scan shows disease advancement. When her HCN arrives for a visit, Josephine shares that she is considering stopping all treatments. How does the nurse respond?

Case Study cont’d Josephine has invited her family, home care nurse and her doctor to a conference in her home. She advises them that she chooses to stop all treatment which is surprising and alarming to her family. An end of life conversation follows.

Case Study cont’d Josephine has died…. What are her family/friends experiencing? What do they need from us?

This is What Will Help People in Their Time of Grief Say the name of the deceased person Acknowledge that they have died Find out if they have questions about the death event Explore how they want to be helped or supported Be empathetic, be kind, spend time AVOID CLICHES AND ADVICE

It’s OK to say nothing…..at times there are no words. Let your heart speak through your eyes

Follow Up Conversations that Matter I’d like to hear more about______. What was he/she like? What do you miss most about being together? How have you been affected? What has been the hardest part of your grief journey? How are things going for you…for your family? Did you have a celebration of his/her life?

Cont’d How are you feeling? Are you sleeping, getting fresh air and sunshine, eating well, staying hydrated? What kinds of things are you doing to help you get through? How are you staying connected to your loved one? Are you remembering him or her well?

Cont’d Have you been through bad times before and what has helped you? How is your family planning to manage special occasions? What brings you joy and happiness? Is there anything special you are looking forward to? Would you like a list of upcoming workshops and support groups?

20 dFounder of the modern day Hospice Movement “ How people die remains in the memories of those who live on.” Dame Cicely Saunders

RELATIONSHIP COMPLETION I forgive you Forgive me Thank you I love you Good bye “Dying Well” by Dr. Ira Byock MD

Thank you