VNAA Blueprint for Excellence PATHWAY TO BEST PRACTICES

Transcription

1 VNAA Blueprint for Excellence PATHWAY TO BEST PRACTICES Patient and Caregiver Engagement: Artful Conversations VNAA Best Practice for Hospice and Palliative Care

2 Case Study Mr. G is an 88 yo man with end-stage dementia and a FAST Scale of 7a. His initial medication list includes memantine HCL (Namenda), latanoprost (Xalatan) eye drops for glaucoma, simvastatin and hydrocodone/acetaminophen. His family refuses to stop any of these medications if admitted to your hospice service. How will you artfully communicate responsibility for coverage of these medications? 2

3 Case Study Mrs. S is a 68 yr. old woman with terminal breast cancer. She was admitted to your hospice one week ago and is declining rapidly. The husband calls asking for a nurse to help with her increasing shortness of breath. When you arrive, he angrily states that the hospice service is not helping and he wants to take her to the hospital despite her desire to stay at home during the last days of her life. How will you empathically communicate in this situation? 3

4 Objectives Describe the importance of artful conversations Identify key components of the communication process Define five levels of listening Recognize six key components of empathic communication. 4

5 Artful Communication Helps develop relationships based on trust and mutual respect Moves us toward a partnering relationship Allows patient and caregiver to disclose concerns Facilitates a safe environment for the patient and caregiver as life is nearing its end 5

6 Becoming a healing presence Learning to be consciously and compassionately "in the moment with another person Believing and affirming the other person s potential for wholeness or growth Learning we don t have to solve all the problems Clearing our minds of our own agendas Honoring the other person as our equal Valuing the uniqueness and blessing of the other person 6

7 Seek First to Understand Then to Be Understood. -Steven Covey 7

8 Communication Elements Definition: the exchange of information, feelings and thoughts between individuals 8

9 Levels of Listening Ignoring Pretend listening Selective listening 9

10 Autobiographical Listening Listening from our own paradigm. Comparing the speaker s experience with our own. Evaluating the speaker s experience. Advising or telling the person what to do based on our experiences. Listening to solve the problem. Planning your responses while listening. 10

11 Attentive/Empathic Listening Begins with the intent to understand the other person BEFORE being understood. IT S ALL ABOUT THE OTHER PERSON. It s not about YOU. Listening only to understand 11

12 Key Components to Empathic, Artful Conversations 12

13 Establish Presence Sit down; Stop talking; Start listening Appropriate use of eye contact Keep an open posture Take notes as appropriate Allow adequate time Prevent interruptions 13

14 Seek to Understand Ask open-ended questions What have the last few weeks been like for you? What are the doctors telling you about your condition? What is the most difficult thing for you at this time? Clarify and reflect and explore to increase understanding Let me see if I got this right. I thought I heard you say.. Is this what you mean? Listen for what is NOT being said Do not express your views until the speaker is satisfied you understand what she is communicating. 14

15 Suspend Judgment Be aware of your preconceived ideas Leave your agenda at the door Avoid jumping to conclusions Do not plan your responses while the other person is talking Avoid: We are right. You are wrong. Don t react outwardly with negative nonverbal language Honor and accept that the patient and caregiver have good intentions 15

16 Effective Use of Silence Silence can indicate Manipulation used to put pressure on the other person Defiance or disagreement or hostility Profound sense of awe or respect or sorrow Creation of a sacred listening space Empathic listening 16

17 Excellent communicators Effective Use of Silence Allow silence when they sense its effectiveness Offer silence as a sign of respect Interpret the silence of others appropriately Avoid feeling pressured to fill the silence when the silence is being used to manipulate the conversation 17

18 Responding to Feelings Be prepared for Outburst of strong emotions Broad range of reactions Acknowledge the emotions and reactions Allow time for these emotions and reactions Listen quietly and attentively Encourage the description of these feelings Use non-verbal communication 18

19 Summarize; Check for Understanding This is really important. Is this what you mean.? What is it you want me to know? Is there anything else you want me to know? Let me make sure I am really clear. Is this what you mean? Is there anything else I can do for you at this time? 19

20 Take-Aways Developing a partnering relationship Learn to listen; listen to learn. Becoming a healing presence Seeking first to understand Suspending judgment Effective use of silence Responding to feelings Summarizing next steps 20

21 You matter to the last moment of your life and we will do all that we can, not only to help you die peacefully, but live until you die. Dame Cicely Saunders Founder of the Modern Hospice Movement 21