Module 3: Communication C C E E N N L L E E End-of-Life Nursing Education Consortium Pediatric Palliative Care C C E E N N L L E E

C C E E N N L L E E The Power of Words “Sticks and stones may break my bones, but words shall never hurt me”

C C E E N N L L E E Pediatric Palliative Care Myths of Communication Communication is deliberate Words mean the same to BOTH the speaker and listener Verbal communication is primary Communication is one way Can’t give too much information Silence should always be filled

C C E E N N L L E E Pediatric Palliative Care Why/How is Communication Important? Imparting necessary information for informed decision making Requires interdisciplinary collaboration

C C E E N N L L E E Pediatric Palliative Care Tasks of Communication Interpersonal relationship building  Mutual respect  Trust  Empathy Information exchange Collaborative decision making Sobo, 2004

C C E E N N L L E E Pediatric Palliative Care Methods of Communication Verbal Nonverbal Written Play

C C E E N N L L E E Pediatric Palliative Care Health Care Professionals Communication Barriers Feeling “like a failure” Anger Spiritual concerns Fear of own mortality Lack of education Ethical issues Hurwitz et al., 2004

C C E E N N L L E E Pediatric Palliative Care How to Resolve Conflict Take a step back Identify your own emotions Define the conflict Obtain agreement Talk about it Buckman, 2001; Jeffrey, 2010

C C E E N N L L E E Pediatric Palliative Care Interpersonal Skills for Good Communication Listening Clear, timely, relevant information Shared goal setting Conflict resolution skills Sensitivity Personal awareness Age appropriate communication

C C E E N N L L E E Pediatric Palliative Care Listening Occurs at 5 levels  Hearing  Understanding  Retaining information  Analyzing  Actively empathize

C C E E N N L L E E Pediatric Palliative Care Attentive Listening Encourage them to talk Silence Acknowledge feelings Buckman, 2001

C C E E N N L L E E Pediatric Palliative Care Family Factors Influencing Communication Child/Family Unit  Family systems  Need for hope  Interpretation of information  Nonverbal communication Rabow et al., 2004

C C E E N N L L E E Pediatric Palliative Care Family Factors Influencing Communication (cont.) Siblings  Anxiety  Loss  Guilt/shame/blame  Plan of care for siblings Stevens, 2004

C C E E N N L L E E Pediatric Palliative Care Family Factors Influencing Communication (cont.) Financial/educational Physical limitations/environment Language/communication ability

C C E E N N L L E E Pediatric Palliative Care Family Factors Influencing Communication (cont.) Coping with loss  Anticipatory grieving  Anger  Fear  Spirituality  Family dynamics  Conspiracy of silence  Denial