COMMUNICATION
Aims of the Session
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Identify core communication skills
Explore communication issues that
you face in your daily work with
patients, and their families/carers
Practice ways of using
communication skills to deal with
difficult situations
Identify the importance of team
working
Definition
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Communication is
the imparting or
exchange of
information, ideas
or feelings
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Not simple –
complex interplay
of experiences and
attitudes affecting
what is given and
what is received
Communication
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Verbal
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Non-verbal
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Para-verbal
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Environment
Communication
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Verbal – the words we
choose 7%
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Para verbal – how we
say the words 38%
account for what is
perceived and
understood by others
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Non-verbal – our body
language 55%
account for what is
perceived and
understood by others
Verbal/Para-Verbal
communication
What you say
 Meaning
 How you say it (tone, volume, clarity)
 Jargon
 Open questions
 Responding appropriately
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Non-verbal Communication
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Behaviour
Facial expression
Gestures
Eye contact
Touch
Listening skills
Environment
Privacy
 Find a room
 Draw screens
 Noise levels
 Decor
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Process of
Communication
LISTEN
OR
BLOCK?
INFORMATION
SENDER
RECEIVER
Behaviours which Encourage
Communication
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Demonstration of empathy -warmth and
genuineness
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Active listening
Body language
Meaningful silence
Acknowledgement of strong emotion
Encouragement to continue
Picking up cues by use of
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Reflection
Open questioning
Clarification
Examples of Open Questions
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“Could you tell me what the most important things
are to you at the moment?
Can you tell me about your current illness and how
you are feeling?
Who is the most significant person in your life?
What fears or worries, if any do you have about the
future?
In thinking about the future, have you thought about
where you would prefer to be cared for as your
illness gets worse?
What would give you the most comfort when your
life draws to a close?”
Horne, G., Seymour J.E. and Shepherd, K. (2006)
International Journal of Palliative Nursing.12(4): 172178.
Listening……
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Why bother?
 To understand
 To show compassion
 To encourage talking
 To improve symptom management
 Therapeutic in itself
Still listening?
 What
inhibits
listening?
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Interruptions
Distractions
Language barriers
Blocking tactics
Blocks to effective
communication for HCP
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your own
problems
stress/anxiety
physical
environment
non-verbal skills
verbal skills
Blocks to effective communication
for patient’s/families
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Out of control
Don’t understand
Afraid
Distressed
No privacy
Poor continuity
The unknown
Facing loss
As HCP how do we block?
Passing the buckSelective attention to cues
Switching Topics
Inappropriate Encouragement or Advice
Premature or
Closed Questions
False Reassurance
Giving Your
Premature Problem
Opinion
Solving
Normalising or
Switching focus to
Stereotyped
Relatives
Comments
Talk about yourself
Avoiding the person
Having conversations with
patients and families at the
end of life is challenging
Group Discussions - What aspect of
having these conversations do you
find challenging?
Difficult Questions
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Am I dying?
How long have I
got?
Is my mother
going to get
better?
Difficult Questions
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Explore why they are asking this.
For examplePatient: Am I dying?
Nurse: What makes you ask that
question just now?
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Difficult Questions
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Always focus on the patient and
their perspective, it doesn’t matter
what we think they have been told,
the important thing is what they
remember!
Use listening skills.
Difficult Questions
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Use reflection to check
understanding and encourage the
person to talk.
example
Patient: I just feel so afraid…
Nurse: You said you feel afraid can
you tell me a bit more about those
feelings.
Difficult Questions
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Use of clarification, don’t assume
you understand the use of a word.
Example
Patient: I just feel so sick and tired all
the time.
Nurse: When you say sick and tired,
can you describe how that feels for
you.
Anger
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Can take many
forms
Common reaction
to ill-health by
patient or family
Sometimes
‘masks’ feelings of
guilt, fear, stress
If not addressed
can escalate
Anger
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Be safe
Acknowledge emotion(s)
Permission
Listen to story to get as
much information as
possible
Focus on stress/feelings
Apologise
Reasons
Negotiate a solution
Anger
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Talking in a private environment
Listening
Open body language
Reflection, repetition
Acknowledgement
Anger
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Identify key areas of conflict
Discuss ways these could be
improved / resolved (if possible)
Consider / explore other reasons for
anger
Patient’s Not Wanting to Talk
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Denial
ignorance
fact
feeling
Lack of capacity to
understand
Incorrect information
Depression
Dementia
Disengagement
Talking to someone else
Previously dealt with – just wanting to
forget
Denial
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The function of denial is to protect
the patient against distress that
could be intolerable, and lead to
psychological and spiritual distress
Denial
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Common coping
strategy
Often
misunderstood
Rarely is denial
‘complete’
Level of denial can
fluctuate
Requires
assessment &
exploration
Collusion
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Focus on the relative
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Feelings
Strain on relationship
Reasons for not being truthful
Support reasons
Access patients questions to relatives
Suggest ‘window’ on knowledge
Ask for permission to assess patient
Reassure no telling
Confirmation if necessary
Summarising - Ensuring
Effective Communication skills
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Warmth/genuineness
Establishing rapport
Listening
Acknowledgement
Encouragement
Open questions
Picking up cues
Reflection
Clarifying
Pacing – use of silence
Communication and Team
Building
EXAMPLE OF TEAM WORKING AT
ITS VERY BEST
EXAMPLE OF TEAM WORKING
AT ITS WORST
The way a team plays as a whole
determines its success. You may have the
greatest bunch of
individual stars in
the world, but if they
don't play together,
the club won't be
worth a dime."
-- Babe Ruth
How would you
describe a team?
Chambers dictionary definition
“A set of people working in
combination”.
What is Team Working
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Work done by a group, with an
organised division of labour
Co-operation
Pulling together
Focussing on the success of the
team as a whole rather than
personal achievement
Each team is unique however and
it's
not as simple as it might seem to
make teams work effectively.
Group work
- Team working
Build the tallest tower you can using
plastic cups
 Each team member think about
their role in building the tower
- Practical
- Supportive
- Ideas man
- Leader
- Other
 what makes a good team?
What do you think makes a
team work well?
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Good communication
Good leadership
Everyone feeling valued
All roles filled
Tolerance
Everyone knowing what their role is
Disharmony addressed promptly
Everyone feeling that they are treated fairly
Team Effectiveness
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We should recognise and celebrate the diversity
of skills and personalities within the team,
everyone is different, but everyone has
something to contribute and should be
valued for that contribution
Recognise when different personality
types balance and complement each
other and embrace that (support)
Make sure that everyone has the
opportunity to reflect upon, and learn
from their experiences……………..
Team Effectiveness
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Everything that needs to be
done is being done, everyone
pulling together
Everyone is clear about why
they are doing things in a
certain way
All the efforts of the team
should be directed towards the
same clear goals
 What
goals
are your ward
To strive for the best
outcome for your
patients…
Team Effectiveness
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Everything that needs to be
done is being done, everyone
pulling together
Everyone is clear about why
they are doing things in a
certain way
All the efforts of the team
should be directed towards the
same clear goals – (What goals)
Everyone should know their role
within the team and their
responsibilities
Responsibility and Blame
Taking the Responsibility for
something as opposed to
taking
the Blame for something are
two
very different things:
BLAME…..
Blame is NEGATIVE
 it diminishes you
 It doesn’t change what
has happened
 And it doesn’t help you
prepare for the future
Responsibility…........
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Responsibility is POSITIVE.
It enables you to consider your
actions.
It lets you think about how you
have acted and how you will act
in the future, based upon the
learning that has arisen from your
experience…..
In this way we learn both from
our mistakes and from our
successes.
I’m not working at that end of
the ward………..
Positive or Negative
I just do what I’m told……..
Positive or Negative
Individual Responsibility
We all carry some responsibility
within our team.
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In a team no one person
takes responsibility for doing
everything. Although the
leader will have overall
responsibility to ensure
everything gets done, it is
not the leader who does it
all! Each of us has a role
and is accountable.
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By being a
responsible
member of a team
you have to be
prepared to
celebrate together
when things are
going well
and to pull
together
when they
aren’t……….