1. “Communication at End-of-Life” for Personal Support Workers in Long-Term Care Module 4

2. To practice four therapeutic communication skills: Listening, Paraphrasing, Reflecting, and Summarizing. To explore the communication needs of the dying person and his/her family. To review guidelines that can help us to be present in our interactions with others. LEARNING OBJECTIVES

3. IF YOU WANT SOMETHING, GIVE IT AWAY. (MODELING) IF YOU WANT PEOPLE TO COMMUNICATE DIFFERENTLY WITH YOU, CHANGE THE WAY YOU COMMUNICATE WITH THEM.

4. Eyes Undivided Attention Heart Ear “TO LISTEN”

5. When you are worried about what words to say, pay attention to how you are saying them. DR. ALBERT MEHRABIAN NONVERBAL COMMUNICATION

6. WHAT MAKES AN EFFECTIVE COMMUNICATOR? Active listening: Be silent Maintain eye contact Attentive body language Listen without a response about yourself Use open-ended statements and questions Use communication skills to enhance your listening

7. PARAPHRASING A verbal response which accurately restates what the other person said Deals only with cognitive content - what someone has actually said Is factually based The "paraphraser" uses their own words to restate what the patient or family member has said The “paraphraser” uses fewer words than the original communicator used

8. REASONS FOR PARAPHRASING Communicate to the other person that you do understand what they have said Validate that you are listening to them Provide an opportunity for correcting misperceptions Allow the other person to hear what they have said Allow the person to expand on what he or she thinks and feels

9. BUILDING TRUST AND APPRECIATION Research has shown that a listener who paraphrases enables the speaker to build trust and feel valued by the listener. It also helps when trying to reconcile a difference of opinion in a non-judgemental way. To use this skill effectively you must want to: ‒ understand the person ‒ communicate meaningfully ‒ relate with acceptance and trust.

10. LET’S TRY TO PARAPHRASE A man is sitting at his dad’s bedside and attending to his dad who is actively dying and unconscious: "Sometimes we would all be real serious. Then Dad would walk into the room, and everyone would brighten up. We would all laugh and carry on for hours at a time before he moved here and got so frail.”

11. A elderly female resident says to you: "I used to be a good person you know. Now I am old and useless, I am no use to anyone and I can't understand why I have to go through this - what did I ever do? I just want to die” LET’S TRY TO PARAPHRASE

12. DO NOT “ADD TO” WHAT YOU HEAR You may feel tempted to “add to” the person’s message. Try to overcome the urge to interpret or project your own thoughts into the interaction. This often takes the focus off the person you are serving and puts in on you.

13. EMPATHY/REFLECTIVE STATEMENTS Verbal statements made by the care provider which accurately state what the other person feels Address the affective level – feelings/emotions Allow the care provider to express his/her perception of what the other person feels

14. To facilitate the expression of someone else's feelings To enhance the speaker's problem-solving ability by helping them move through "stuck" feelings To generate a feeling of warmth and understanding between the listener and speaker. THE GOALS OF REFLECTIVE LISTENING

15. SIMPLE TO DESCRIBE AND CHALLENGING TO MASTER The listener must identify the primary feelings that the speaker is having; and then reflect that understanding back with an empathetic tone.

16. EMPATHY/REFLECTIVE LISTENING A man is sitting at his dad’s bedside and attending to his dad who is actively dying and unconscious: "Sometimes we would all be real serious. Then Dad would walk into the room, and everyone would brighten up. We would all laugh and carry on for hours at a time before he moved here and got so frail.”

17. A elderly female resident says to you: "I used to be a good person you know. Now I am old and useless, I am no use to anyone and I can't understand why I have to go through this - what did I ever do? I just want to die” EMPATHY/REFLECTIVE LISTENING

18. It is important to practice reflective listening and to build skills in responding empathically and reflectively Ensure that you check-in with your partner about whether your responses are accurate, and whether you are fully hearing their thoughts and concerns EMPATHY/REFLECTIVE LISTENING

19. VALIDATING THE INTERACTION Validation is the message: "Your feelings make sense. Not only do I hear you, but I understand why you feel the way you do. You are not bad or wrong or crazy for feeling the way you do."

20. SUMMARIZING To reduce a large amount of information into a condensed amount Must contain the important elements of the cognitive and affective components of the message Helps us to be able to tie together the essential components of an interaction with a patient/family etc. Is usually verbal but can be written

21. TABLE TALK SUMMARY Discuss the experience of actively using paraphrasing and empathy/reflective responses with your partner What did you learn? Share new insights about your communication skills What will you practice to improve?

22. COMMUNICATION TIPS Silence is important Be nonjudgmental Ensure confidentiality Respect the resident – who they are as a person, their personal space/room. Always be honest Disclose accurate and appropriate information Support hope as residents construct it Accept the resident/family’s reactions and feelings

23. DYING WELL: NEEDS OF THE DYING To forgive and be forgiven To be loved and to express love To be appreciated and to give thanks To find meaningful ways to say goodbye

24. GUIDELINES FOR BEING PRESENT Offer the opportunity for privacy and uninterrupted time. Be aware of the ripple you are creating in the room. Be yourself. Be ordinary. When in doubt, ask.

25. Place yourself at the same level as the person you are talking to. GUIDELINES FOR BEING PRESENT Say the person’s name. Hearing your own name spoken out loud is very grounding.

26. Be specific about how you can help and what is going to happen. GUIDELINES FOR BEING PRESENT Set boundaries. Heaviness, sadness, anger, and frustration may need to be acknowledged. Don’t change the subject.

27. IF YOU WANT SOMETHING, GIVE IT AWAY. (MODELING) IF YOU WANT PEOPLE TO COMMUNICATE DIFFERENTLY WITH YOU, CHANGE THE WAY YOU COMMUNICATE WITH THEM.

28. YOUR “INTENTION” COMMUNICATES ALL THE TIME Do you know how much your love means? Do you know how many hearts you have lifted? Do you know your love is healing? What a wonderful feeling!!