1. Skills for engaging in potentially “difficult” conversations
Claire O’Neill Lead Nurse Palliative Care NHSGGC

2. A difficult conversation
one we don’t want to have ( would rather avoid)
one we worry about what will happen during (or after)
one that when we do have it produces more thoughts and feeling than are expressed (or known).

3. Bad news is the gap between a person’s expectations/perceptions about the situation and the reality.

4. You can’t tell how bad any bad news is likely to be for a person unless you have some idea of that persons perceptions and expectations about their situation.

6. To begin the work of bridging the gap between perception and reality
Ask before you tell
Gather (and acknowledge) before you give

7. Are you sometimes afraid to ask??

8. It helps to have a structure in mind
It helps to have a structure in mind. Following a structure can help you safely engage in potentially “difficult” conversations. Following a structure can guide you in, through and out of a potentially “difficult” conversations.

9. EnGAGe

10. enGAGe
environment
notice
Gather
Acknowledge
Give
end

11. environment (and start to notice cues)
Physical
Privacy, seating, lighting , proximity etc.
Relational
Pre conversation preparation, introductions, eye contact, body language, intentional use of active listening skills, clarify time frame, sensitively and clearly state the reason for conversation etc
Start noticing cues
How does the person look? (anxious, upset…)
What has the person said?

12. Cues – (verbal or non-verbal)

13. Verbal cues Hint or direct expression of feelings
Emphasis or use of metaphor
The mention of significant life events
Repetition of seemingly neutral statements
Physiological signs of distress
Requests for information (questions)

14. Non verbal cues Clear expression of emotion – crying, restlessness
Hints to hidden emotions – lack of eye contact, frowning, sighing

15. Cues – always need clarification to check for the presence of an underlying concern.

16. Gather (and Acknowlege)

17. Gather (and Acknowlege)
the most important verbal and non verbal cues…

18. Gather (and Acknowlege)
the persons full perception of the situation…including any concerns the person may have and the impact of those concerns.

19. Gather (and Acknowlege)
Before we start, I notice that you look worried…
I wonder if you can tell me what you already know about (situation/problem/issue)…
Acknowledge (verbal and non verbal) cues
Use your skills in reflection, paraphrase, clarification, summary, silence and offer empathy

20. Gather (and Acknowlege)
any additional concerns (and the impact of those concerns)
Use of summary and empathy
Is there something else concerning you today?
Acknowledge the concern
How is (the concern) affecting you at the moment?

21. Give
Give information, give explanations and negotiate a plan.

22. Give information Give information
If you are delivering bad news give a warning shot
Pause to let that sink in
Small chunk
Check....
Gather and acknowledge new concerns
Prioritise?

23. Give explanations
Give explanation
Tailored to the need of the person

24. Give a (negotiated) plan
Give your perspective and negotiate a plan
Give person an opportunity to say what they think might help.
Give person an opportunity to say what they think you could do to help.

25. end Conversation can come to an end when you have:
Gathered acknowledged and explored the main concerns (nature, extent and impact)
Offered information and explanations
Negotiated a plan

26. end Steps to ending well Briefly summarise the conversation
Check the accuracy of your recall
Ask a screening to ensure no major point is missing
Check how the conversation has left the person feeling
Return to Gather Acknowledge Give if new concerns are raised
Negotiate that it is ok to finish
Thank the person for talking with you

27. enGAGe
environment
notice
Gather
Acknowledge
Give
end

28. Any comments or questions?