COMFORT*
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Communication (narrative)
Orientation and opportunity
Mindful presence
Family
Openings
Relating
Team
* Wittenberg-Lyles, E., Goldsmith, J., Ferrell, B., & Ragan, S. (2012). Communication and
palliative nursing. New York: Oxford.
Objectives
• Define mindfulness and presence in clinical
encounters
• Describe active listening
• Identify two communication skills that can
assist with mindful presence
Mindfulness
• Originated in Buddhist philosophy
• Tenets of mindfulness:
– Purposefully attentive
– Awareness
– Flexible state of mind
• Contrast with mindlessness
– Habitual behaviors
Mindful Presence
Mindful Communication
– Awareness of situation
– Being in the moment
– Attention focused on present moment
Presence emphasizes personal experience
– Acceptance
– Patience, Trust
– Suspension of personal preference/critical
thought
Core Attitudes*
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Perception
Active listening
Getting involved
Creating space
“Being is as valuable as “doing”
*Simon, T., Ramsenthaler, C., Bausewein, C., Krischke, N., Geiss, G. (2009). Core
attitudes of professionals in palliative care: A qualitative study International Journal of
Palliative Nursing, 15(8) p. 408.
Mindful Presence
• Patients/family
– indirect cues of emotion
– missed empathic opportunities
Healing/Compassionate Presence
• Empathy
– Patients/families:
• hesitant to express emotions
• present indirect cues instead
• Listen for feelings
• Witness the suffering of others (Ferrell & Coyle, 2008)
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Be mindfully present
Practice empathy
Offer compassionate voice
Recognize impacts of illness
Active Listening (Wood, 2000)
• Hearing versus Listening
• Listening involves:
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Attend to nonverbal cues
Listen without interruption
Ask questions to clarify
Paraphrase interpretation in own words
Ask if interpretation is correct
Empathize (paraphrase feelings of speaker)
Five Principles of Effective Listening
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2.
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Focus on feeling words
Note the general content of message
Observe speaker’s body language
Do not fake understanding
Do not tell speaker how he/she feels
Adapted from R. Bolton (1979). People Skills. Englewood, NJ: Prentice-Hall in MacPhee, M. (1995)
The family systems approach and pediatric nursing care. Pediatric Nursing, 21, 5, 417-437.
Other Aspects of Listening*
Silence
– Listen without interruption
– Provides opportunity/permission to disclose
– Conveys empathy
– Allows for deeper expression of concern
*Dahlin (2010)
How we see others…
1. Experience (perceived by I-IT*)
– Person seen as object
– To be manipulated/changed
2. Relation (perceived by I-THOU*)
– Person seen as unique
– Culmination of life experience/complex
– Positive regard
*Martin Buber’s work on the dichotomy of viewpoints
Seeing Differently*
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Perception-shifting
Vivid sense of appreciation and beauty
Seeing what needs to be done
Leaning into stillness of activities
Cultivating openness without agendas
*Bruce & Davies, 2005
Team-based mindful presence
• Family meetings
– Watch for indirect emotional cues
– Remind team members to practice silence
• Team meetings
– Observe team members for compassion fatigue
– Encourage self-compassion
– Allow for self-reflection and self-healing