Minding Our C s & Q: Compassion + Communication = Quality Care

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1 NHPCO s 2013 Virtual Conference on Grief, Loss, and Bereavement Helping Families and Communities INTRODUCTION Minding Our C s & Q: Compassion + Communication = Quality Care Betsy Clark, PhD, MSW, MPH Presented November 4, 2013 Explore the power of our words and the legacy they may leave Recognize the importance of assessing family dynamics including cultural variations, family hope, and family burnout Investigate our own hoping style and how it influences our professional caregiving and communication Apply communication strategies that create better quality care for patients, caregivers, and co-workers Clark, No matter how committed we are to our work in hospice and palliative care, witnessing suffering is very difficult. It changes us in many ways. SUFFERING & COMPASSION Suffering involves all aspects of the person. Compassion is the sensitivity to others suffering. The depth and intensity of compassion differs from person to person. Clark, Clark,

2 We know we are clinically competent; we hope we are culturally competent; but we may not always feel communication competent THE CONTEXT OF OUR WORDS Personal Professional Political Philosophical Poetic Clark, Clark, WORDS CAN BE Blessings Curses Oaths Promises Laws Prayers Poems WORDS AND THEIR POWER Impact I love you/i hate you Will you marry me/i want a divorce You passed/you failed There s no hope Clark, Clark,

3 LANGUAGE OF ILLNESS & DEATH You failed chemotherapy Expired/passed Jargon symptomatology, palliation LEGACY OF OUR WORDS I will always remember what s/he said to me. The words echoed in my head for days. Example: There is nothing more anyone can do to help him now. This is a difficult family to work with. Clark, Clark, WORD WOUNDS (those heard & overheard) Why did you wait so long to call? Why didn t you give him more pain medication? Couldn t you see that she needed her oxygen turned up? This crisis could have been prevented. You can t be in that much pain. The wife is a bit hysterical. PATTERNS OF DIALOGUE: HARMFUL WORDS Are cold or cynical Disregard feelings or concerns Suggest lack of control over the situation Take the form of platitudes Indicate support was conditional Compare patients to statistics Destroy hope Clark, Clark,

4 PATTERNS OF DIALOGUE: HELPFUL WORDS Are proactive and empowering Normalize the experience Reframe problems positively Validate feelings and concerns Acknowledge individual differences Assure continuing support Show genuineness and compassion Convey hope Clark, AVOID USE OF PLATITUDES He s in a better place. I know you re glad his suffering is over. Only the good die young. She s with her maker now. Well, we all have to die sometime. I m so sorry for your loss. Don t assume what would comfort you is what the family member needs. Clark, SPEAKING WITHOUT WORDS Visual cues/body language Approachability/distancing Bedside/chairside manner Active listening Touching/handholding Being fully present Silence speaks when words can t. Clark, Clark,

5 QUESTIONS FOR ASSESSING GOALS Tell me what you hope for in the coming days Are there things you have left to do? What are your worries about the future? Are there things you wish you could talk about? Are there things your family needs help with? How can I/we help you the most? HOPE IS COMPLEX People learn to hope differently People define hope differently People use hope differently Hospice Quickflips, The Corridor Group, 2006 Clark, Clark, TYPES OF HOPE Therapeutic hope Generalized hope Particularlized hope Transcendent hope HOPE IS A psychological asset A guard against despair A way of coping A quality of life enhancer An essential experience of the human condition Clark, Clark,

6 THE CHANGING MOSIAC OF HOPE Hope is flexible, evolving as situations and realities change Even foreshortened life does not lead to hopelessness HOPE IN END OF LIFE CARE SETTINGS Hope for pain and symptom control Hope for a peaceful death Hope to make amends or say good-byes Hope for a positive legacy Hope for help for bereaved loved ones Hope for salvation/religious goals Clark, Clark, MAINTAINING FAMILY HOPE Assessing family hope constellation Avoiding family and professional hope conflicts Recognizing the importance of trust, openness and teamwork FAMILY BURNOUT The concept of burnout is applicable to families. Many illnesses have long and difficult trajectories. The burden of caregiving can be overwhelming. Hospice can help alleviate family burnout. Clark, Clark,

7 TEAM BURNOUT Work factors can lead to team conflict Teamwork may falter and become parallel episodes of care Poor team communication can be both a cause and outcome of team burnout PROTECTIVE FACTORS FOR WORKING IN HIGH LOSS ENVIRONMENTS Commitment to perceived value of the work Feeling capable and competent Sense of personal control Understanding personal limitations Peer support Courage Hope Clark, Clark, PROFESSIONAL GRIEF Losses accumulate Professional grief can result Grief is a social process and must be sanctioned Professionalized grief is internalized rather than expressed With proper training and support, we shall find that repeated griefs, far from undermining our humanity and care, enable us to cope more confidently and more sensitively with each succeeding loss. C. Murray Parkes Clark, Clark,