communicationEssentials for difficult situations

Sandra Loucks Campbell PhD

Introductory re presentation Communication basics Stress and communication? Pertinent Issues related to communication Being human Talking and listening so other really hears

and understands Difficult examples Communicating in an interdisciplinary team Differing goals Communication – What can I say?

Agenda

Looks easy but it is NOT

Nowhere is that more true than in palliative care

Skills, techniques

Being human

Communication basics

A game of ball

Channels and Interference

Channels◦ Voice /ears◦ Action ◦ Body◦ Face◦ Eyes◦ Tone◦ Timing◦ Dress◦ Other (desk location,

music, etc)◦ Touch

Blocks◦ Different life stage◦ Lifestyle differences◦ Jargon◦ Level of abstraction,

courtesy, privacy◦ Lack of understanding

of reason for meeting◦ Room noises◦ Anxiety, confusion,

depression◦ Sensory deficit◦ tests, interventions

Channels of Communication

An exercise

No matter what the stimuli, we all respond differently◦ To a string of pearls or a serious illness or the

death of one’s child

Do not assume

Why do this exercise?

Ass/u/me

Fight and flight Theories Symptoms

How does stress relate to palliative care – at work, at home, in your mind, in your heart?

1. Small group discussion – what stressors do you have in your work?

2. How does that stress impact your communication?

Stress in Palliative Care

Vignette example◦ Small child in a wind storm

Like physical shock Flight or fight

What is stress?

“stress involves situations in which environmental demands tax or exceed adaptive capacity of an organism, resulting in psychological or biological changes that may place persons at risk for disease.”

Many theoretical approaches Hans Selye

I would like to talk about one theory in particular

A Definition

Used in teaching, in research

Stressful environment Overextended people Very unwell people Incredibly difficult situations

Vicarious trauma/post traumatic stress disorder◦ Secondary trauma◦ Parallels◦ Negative OR positive

Parallel process

Look on face, body language, voice tone Energy level; not doing what they usually do Drinking, smoking, eating too much Poor sleep habits; getting sick more often than

usual Communication patterns

◦Stressed people can be irritable, touchy, find it difficult to be compassionate, easily moved to tears, physical symptoms, unprovoked anger

How can you tell when you are stressed?

Less resiliency than healthier persons Reserve capacity is less (Finch and

Seeman) Decrease in immune function where there

is a pessimistic view, particularly (Kamen-Siegel, 1991)

Turn to others for help in coping, a signal of difficulty

Financial strain may accompany illness Perception of ill health may be related to

actual declining health status

Coping with stress for chronically ill persons

Dichotomies of care◦ Accomplishment vs. hopelessness ◦ Relief vs. guilt◦ Need for control vs. ability to accept help◦ Anger vs. acceptance◦ Loss vs. gain◦ Self sacrifice vs. self preservation◦ Grief vs. fulfillment◦ Primary versus secondary setting

Component Elements of Caregiver Stress National Advisory Council on Aging. 2002. Writings in Gerontology.

giving in unlimited way difficulty seeing the value of one's work feeling drained, anger feeling apathetic, helpless, unable to

empathize omnipotence and helplessness difficult people to be cure oriented

Stressors of Palliative Care

Recent personal loss Too many deaths in short time a recent personal loss. similar issues in other areas of life

not only a stressor but can make you ineffective

work with someone who is similar to your own loved ones

to be a workaholic

Stressors of Palliative Care (cont.)

Group Exercise

Last three slidesWhat kind of communication happened? What did you REALLY need?

How does stress in palliative care relate to communication?

Sunday

Monday

Tuesday

Wednesday

Thursday

Sunday

Monday

Tuesday

Wednesday

Thursday

communicationEssentials for difficult situations

Part II

Sandra Loucks Campbell PhD

Caring for yourself is NOT an option, it is mandatory.

You cannot continue to “care” if you do not look after yourself.

The price you pay for being in this field of work

Post traumatic stress disorder◦ Secondary trauma◦ Parallel processes

What will be the impact on your client when you are suffering…secondary trauma, post traumatic stress disorder?◦ When trauma repeats itself◦ If you can barely get out of bed in the morning?◦ If you find yourself resistant to caring?◦ If you have had just too much death, pain and loss

recently?

Compassion Fatigue

Compassion fatigue and burnout in nurses who work with children with chronic conditions and their families.Maytum JC, Heiman MB, Garwick AW.

Can you make that physical?◦ Where do you feel it in your body?

A specific example◦ What did you need at that time?

Parallel process

What are YOUR symptoms when you are stressed?

Know yourself, your physical reaction, what do you really need◦ Listen to your body

Talk to people you care about, who care about you. Listen to your body Exercise, talk it out, pamper self Hobbies, leisure Assert your own control Sometimes say “no” Humour Boundaries Time for self

What is helpful?

It will help with communication◦ List issues from participants re specific

communication issues faced

If it helps with stress…

The essence of palliative care, really Look at this list you have made Talking and listening so other really hears

and understands◦ The turn of a word, a gesture◦ The subtleties

◦ Let’s try this… is their an amateur actor in the group?

a role play at being human

Let’s talk about being human

◦ Set your “professional” hat on the table beside…◦ Very human field of endeavour◦ No room for professionalism that excludes

humanity◦ It is “easier” to keep the professional hat on, but

it may not be as well received

◦ A story about Craig

Being human

How many of you have more than 3…

A listening exercise◦ No questions◦ No advice◦ At work, I feel listened to when…◦ At work, I do not feel listened to when…

How can I talk so others can hear?◦ The turn of a word, a gesture◦ The subtleties [voice tone, chosen word, a hand

movement, leaning forward, other]

Listening exercise

Communicating through the veil of dementia◦ Catching the lucidity

Even with relatively advanced dementia, made ADL decisions that are consistent

◦ Simplicity and repetitiveness Project to help patients deal with changed location

◦ Using all the channels Music, pictures, nature, touch, taste, massage, sun,

water running

Difficult examples

Let’s be an interdisciplinary team◦ Be someone you are not

Communicating in an interdisciplinary team

Sally (50), Michael (57), John (24), Alice (22) and Tom (18)

◦ Sally is sick◦ In hospital because meds are not right and they

need to be assessed◦ Sally wants to go home◦ Family, according to Michael, does not feel

comfortable with her going home

Team work

Use channels of communication◦ Reading feelings◦ Music, creativity◦ Can we relate to each other face to face in a world of texting?◦ Do you have time to really listen?

How many deaths per week?◦ Psychic numbing◦ Can we engage as fully involved humans in an age of over

stimulation, and too much death?

Touch◦ Can we touch with tenderness?◦ In a world where we can wage war, pollute our environment and

conduct invasive tests and treatments

In Palliative Care

I’m here. (takes time, timing, patience, listening)

I care. (takes real feelings, genuineness, time to feel it)

I am a person like you. (takes self analysis, risk taking, tolerance, work through the embarrassment)

I have time to give you. (must be truthful) Tell me what you want. (listening)

What can I say?

No one has the divine right to health and happiness.

There but for luck, go I. Person to Person.

We are all on this earth together.