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					An introduction to Basic
Communication Skills:
End of Life Care in Care
Homes
          Ground Rules
• Give time for everyone to have their
  say
• Confidentiality – stays in the room. No
  real names to be used for residents,
  relatives or other professionals
• Time keeping
• Respect each others views
• Mobiles
• Housekeeping arrangements
                Aims
• Explore some essential skills of
  communication in end of life care
• Identify barriers to effective
  communication
   End of Life Care Strategy
      - Communication

All staff in health and social care, and the
 voluntary and independent sectors,
 need some training to ensure they are
 able to communicate effectively with
 people who are dying and their carers
 about issues surrounding end of life
 care
                         (DOH 2008 p.113)
        COMMUNICATE



What do you understand by this word?
   What do we want from
     communication?

• Information – delivered in a language
  we can understand
• Honesty
• Companionship
• Opportunity to reflect
              Exercise 1

• Why is effective communication so
  important in relation to end of life care?
  – Take 5 minutes to discuss in groups why
    you think it is important
    Essential communication
              skills
•    Listening skills
•    Verbal
    – Language – words used
    – Paralanguage – how it is said, tone, pitch,
      clarity
•    Non-verbal
    – what we understand and transmit from
      body language
           Listening Skills

•   Plan the environment
•   Be Attentive
•   Hear what an individual is saying
•   Use appropriate body language
 Effective skills - language
• Questioning –open, closed, leading
  and multiple
• Encouragement
• Picking up on cues
• Reflection
• Silence
• Clarification/Summarising
           Paralanguage –

•   Tone of voice
•   Volume
•   Pitch
•   Try saying ‘are you ok?’ considering
    some of the above to the person next
    to you and see what response you
    have..
Non-Verbal Communication

• Is the message or response not
  expressed or sent in words
• Over 65 percent of the social meaning
  of the messages we send are
  communicated non-verbally.
• Actions speak louder than words.
     Non-verbal behaviours

•   Personal space
•   Facial expressions
•   Posture
•   Gestures
•   Touching
Non-verbal Communication!!
 Barriers or blocks to effective
communication especially at EoL
        Barriers to effective
             Listening
•   Feeling stressed by other concerns
•   Environment noisy or disturbed
•   Not feeling confident
•   Low motivation – bored or tired
•   Being in a hurry to pass the person on
•   Interjecting with own experiences
•   Formulating answers to queries before
    hearing exactly what is needed
  ‘Verbal's’ for you to avoid
• Mumbling
• Passing judgement or giving unwanted
  advice
• Interrupting
• Discussing your own experiences
• Jumping to conclusions
• ‘I understand’
• Confusing people with multiple questions
• Using jargon
             Useful Tools
•   Listening skills - active not passive
•   Use of Questions - open not closed
•   Reflecting Back
•   Clarifying
•   Reinforcement/Encouragement
•   Paraphrasing
•   Silence
    Identifying emotions…

• Anger
• Sadness
• Surprise
• Guilt
• Anxiety
     Remember to look after
        yourself too…
• Understand that looking after a dying person
  will put added strain onto you and the team
• Beware of your own emotions, if a specific
  task is difficult, find someone who can help
• There may be events in your life that mean
  you are not the best person to help this
  client/relative on this day – that’s ok.
• COMMUNICATION IS THE KEY: informal
  chats, supervision, reflective meetings or
  talking to another professional may help
     Dealing with limits of your
          knowledge/remit
Its OK to                 Its NOT OK to
 To admit you don’t      • Block a question
  know something:            by:
  Who might know?             - Ignoring it
  How will it be              - Dismissing it
  followed up?
                              - ‘Jollying the client
  Explain likely time -
                                 along’
  frame of response
                          • Guess / say
                             something you’re
                             not really sure of
     Issues for Residents

Discuss in groups what you think the
  dangers are if staff do not possess
  effective communication skills
                  Scenario 4
You have been caring for Mary for
several months. She has become gradually
more frail both physically and mentally. On
this occasion, she seems quite agitated
and tells you “that woman has been horrible to
me. She shouts at me, hasn‟t given me
anything to eat and won‟t let me have a bath.”
         Pause for thought!
A 75 year old lady rings her local NHS hospital and
     had the following conversation:
      ‘Hello, I’d like some information on a patient Mrs
        Tiptree. She was admitted last week with chest
       pains and I would like to know if her condition has
               deteriorated, stabilised or improved’
‘Do you know which ward she is on?’
                      ‘Yes, ward P, room 2B’
‘I’ll put you through to the nurses station’
                    ‘Hello, ward P, can I help?’
            Continued……..
‘Yes, I’d like some information on a patient Mrs Tiptree.
       She was admitted last week with chest pains and I
      would like to know if her condition has deteriorated,
                     stabilised or improved’
‘I’ll just check her notes. Yes, I’m very pleased to say
     Mrs Tiptree has improved. She has regained her
     appetite, her observations are stable, and following
     a few more checks we are hoping to discharge her
     tomorrow’
        ‘Oh, thank you, I’m so pleased and happy!’
‘Are you a close relative?’
‘No I’m Mrs Tiptree in room 2B,
no-one tells you anything at all in
           this place!!!!’
Remember help is always at
     hand for you
       Useful Information
• www.endoflifecareforadults.nhs.uk
• Ellershaw J, Wilkinson S (2008 edition) Care
  of the dying „A pathway to excellence‟ Oxford
  University Press
• Local hospices
• End of Life Care Learning Resource Pack,
  Housing 21:
  www.endoflifecareforadults.nhs.uk
• http://www.nhsglos.nhs.uk/content/professio
  nals/healthprofessionals.html