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We Can Do THIS: Difficult Conversations By: Maria DePasquale RN, CHPN Ashton Andrews MSW, LCSW

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Page 1: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

We Can Do THIS:Difficult Conversations

By: Maria DePasquale RN, CHPNAshton Andrews MSW, LCSW

Page 2: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

OBJECTIVES

Describe communication processes and challenges in the setting of serious illnessDefine important elements to ongoing

communication and factors that influence communication with participants and familiesIdentify techniques for communicating difficult

news and discussing goals of care with participants and families

Page 3: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Case Study

Yours or mine?

Page 4: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Case Study #1- Jerri

Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near by. Sally is 55, married, has 2 adult daughters, works full time as a project manager.Jerri’s medical history includes advancing

Alzheimer disease, CHF, CVA w/facial droop, anxiety & depression, osteoarthritis of knees, CKD II, IBS w/diarrhea, R Torn rotator cuff, R knee torn ACLInterests: crossword puzzles, word search, BINGO

Page 5: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Hip Fracture

Page 6: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Goals of Communication

Convey RespectHow? Convey Genuine Care

How?Share & Encourage Hope

How?

Page 7: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Factors Influencing Communication

Cultural – curious questionsVerbal & Non-Verbal skills – words, body

language, tone (60/30/10)Environment for Conversations - quietUse of Open Ended Questions, Reflective

Statements, Intuitive Knowledge, Empathic StatementsPrevious Experience – The Good, the Bad &

the Ugly

Page 8: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Factors Influencing Communication

Power of Deep Listening Recognize EmotionsPractitioner Self Assessment

of Bias & Fears

Page 9: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Challenges/Barriers to Communication

Assuming the health care team has the right answersNot taking time to understand family values

and concerns – “what is important to you?” “Who is?”Speaking in medical termsLack of awareness, sensitivity for cultural,

racial differencesIntense emotional outbursts from

participant/family

Page 10: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Sensitive Delivery of Difficult News -Three Techniques

1. ASK – TELL – ASK Ask – What have you been told? Tell – This is what is happening. Ask – What do you know now?

Page 11: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Sensitive Delivery of Difficult News -Three Techniques

NURSE N- Naming, U- Understanding, R- Respecting, S- Supporting, E- Exploring

Page 12: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Sensitive Delivery of Difficult News -Three Techniques

. “I wish…” “I’m worried…” I wish… (this were different) (this wasn’t so) (this

stroke never happened) (your mother would have a miracle recovery) I’m worried… (about how to prepare for what may

happen next) (that you and your family may not be prepared for the caregiving now needed) (because your kidneys are not working as well as they should)

Page 13: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Bonus Technique

Motivational InterviewingOpen Ended QuestionsAffirmationsReflectionsSummaries

Page 14: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Identifying Goals of Care

Necessary during transition of care or focus of careAscertain ALL stake holders arepresent (particularly the ones that you would rather avoid!)Set Framework via structured Family MeetingAssess & acknowledge understanding of

current condition

Page 15: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Family Meeting Elements

Pre-meeting – Review medical options/recommendations/family dynamicsIntroduction & agenda reviewAsk-Tell-AskEmpathize Highlight participant's voice & wishes

in their vernacularReview next steps together

Page 16: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Family Meeting

Reflect post meeting – What did we learn??? What went well???

& Not so well?Follow up?

Page 17: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near
Page 18: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Bibliography

End of Life Nursing Education Consortium ELNEC http://www.aacn.nche.edu/elnec

Ask-Tell-Ask Video http://www.ihi.org/education/IHIOpenSchool/resourc

es/Pages/AudioandVideo/ConnieDavis-WhatIsAskTellAsk.aspx

ONCOTALK for Learners http://depts.washington.edu/oncotalk/videos/index.p

hp?cat=essentials

http://www.aacn.nche.edu/elnec
http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/ConnieDavis-WhatIsAskTellAsk.aspx
http://depts.washington.edu/oncotalk/videos/index.php?cat=essentials
Page 19: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

Bibliography

Turn Your Tormentors Into Teachers http://www.judyringer.com/resources/articles/difficult-

people-3-questions-to-help-you-turn-your-tormentors-into-teachers.php

Family Meeting Guidelines http://vitaltalk.org/quick-guides

Center to Advance Palliative Care CAPC https://www.capc.org/topics/communication-and-

palliative-care/Motivational Interviewing

https://www.slideshare.net/debraneal96/motivational-interviewing-best-practice-communication?qid=fe4cbc8f-8c7e-49eb-aea4-5418f5599475&v=&b=&from_search=9

http://www.judyringer.com/resources/articles/difficult-people-3-questions-to-help-you-turn-your-tormentors-into-teachers.php
http://vitaltalk.org/quick-guides
https://www.capc.org/topics/communication-and-palliative-care/
https://www.slideshare.net/debraneal96/motivational-interviewing-best-practice-communication?qid=fe4cbc8f-8c7e-49eb-aea4-5418f5599475&v=&b=&from_search=9
Page 20: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

We Can Do THIS: Difficult Conversations - author

Maria DePasquale RN Certified Palliative & Hospice NursePalliative Care Manager Community LIFE, Pgh Pa [email protected]

Maria has worked in Hospice & Palliative care for over 35 years, the past 8 years leading the development of Palliative/Hospice care at Community LIFE. The program continues to evolve with generous support and value recognition from the administrative team, IDT, and participants.

mailto:[email protected]
Page 21: We Can Do THIS: Difficult Conversations · Case Study #1- Jerri Jerri is 80 years old. She lives alone in a Senior Apartment building. She has one daughter, Sally, who lives near

We Can Do THIS: Difficult Conversations - authors

Ashton Andrews, MSW, LCSWLicensed Clinical Social WorkerLead Social WorkerElderhaus PACE, Wilmington [email protected] has experience in hospice and end-of-life care which brought her to the role of Clinical Social Worker at Elderhaus PACE five years ago. In her role, she not only assists the team with difficult communication with participants and families but also provides behavioral health services to those enrolled with Elderhaus PACE.

mailto:[email protected]

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