Unit 2 Palliative Flashcards
Nursing Roles
(Professional)
Demonstrates caring, respect, deep
listening, authenticity, and trust.
- Responsible to:
- Assess own communication ability
- Continuous improvement of
communication skills - Utilize alternate strategies for
communication difficulties - Convey accurate information
- Maintain interprofessional team
communication
Emotional Intelligence
Correct identification of emotions in
oneself and others.
* The use of emotion to facilitate
reasoning
* Understanding emotions; and
* Manage emotion
Self Awareness
Our knowledge about ourselves, our
motives and how these translate into our behaviour.
- Become aware of how we are
interpreting the signals of others. - Crucial factor in forming a therapeutic relationship with others.
Nursing Roles
(Behaviour)
Valued by patient and family
* Being present
* Connecting
* Affirming and valuing
* Acknowledge vulnerability
* Utilizing intuition
* Providing serenity and silence
(Ferrell & Paice, 2015)
Communication Skills in
Palliative Care
Active Listening
* Summarizing
* Paraphrasing
* Empathy
* Clarifying
* Silence
* Acknowledgement
* Encouragement
Active Listening
Requires concentration
Allows message to be heard and
acknowledge
Summarizing
Stopping at intervals throughout the conversation
(and the end) to summarize what has been
spoken
* To check the patient/loved one and yourself have
shared common understanding and agreement
* Provides additional time to think
Paraphrasing
Repeat what patient/loved one has said, using
your own words
* Demonstrates active listening
* Allows patient/loved one to correct any
inaccuracies or misunderstanding.
Empathy
To recognise how another person might be feeling.
* “Experience of walking in another person’s shoes
Silent
Can be uncomfortable to many of us.
- Allows quiet reflection and taking stock of the conversation.
- Make some sense of what is happening and form
next questions.
Acknowledgement
Words, expression and intonation that
demonstrates interest or understanding.
Encouragement
Positively encourage patient to continue
talking.
Promote further possibility of disclosure
Forms of non-verbal communication and their use in palliative care
Haptics - touch.
Kinesics- body movement
Proxemics- using space.
Physical characteristic.
Environmental factor- surroundings.
Vocalics-paralinguistic aspects.
Haptics - touch.
Positive
Negative
To reassure a distress patient.
When the touch is misinterpreted or
inappropriate.
Kinesics- body movement.
Positive
Negative
Positive
Head nodding to encourage a patient
to talk about his/her concern.
Negative
Shrugging shoulders in response to a
question
Proxemics- using space
Positive
Negative
Coming down to the patient’s level to
talk to them.
Standing at the foot of the bed to
hold a conversation
Physical characteristic.
Positive
Negative
Wearing a clean, uniform,
appropriate hair. Nails etc.
Appearing untidy, paying little
attention to physical appearance.
Environmental factor- surroundings.
Positive
Negative
A quiet conversation in a private
area.
Having a conversation in an open,
non private space
Vocalics-paralinguistic aspects.
Positive
Negative
Using a soft, gentle, slow tone to
break bad news.
Loud, aggressive tones.
SPIKES Protocol and Ask-Tell-Ask
SPIKES (setting, patient perception, invitation, knowledge, emotions, summary and strategy).
- Goals:
- Gather information from patient and family.
- Provide medical information.
- Support patient and family.
Ask-Tell-Ask
Ask patient and family what they know and
understand
* “Tell” the patient medical information.
* Ask about their emotions.
Ask-Tell-Ask
Ask patient and family what they know and
understand
* “Tell” the patient medical information.
* Ask about their emotions.
Anticipate/Assess emotions and respond with
empathy
Observe patient
- Identify the emotion (vary from shock/disbelief/sad to anger)
- Eg: “This must be difficult for you”, “I can see you are not expecting to hear
this, it must be upsetting for you.” - Allow patient to cry, talk or silent
- Do not be in a hurry
What is ACP?
A process of discussion
regarding decision on future
health and personal care in the
contexts of individual’s values
and beliefs.
Why ACP?
Identify and clarify own personal values and goals about future health and personal care.
- Determine substitute decision maker.
- Build trust.
- Reduce uncertainty.
- Avoids conflict and confusion.
- Enhance peace of mind.
- Exercise autonomy.
Be considered by medical team as
part of decision for patient best
interest of care during acute crisis
and patient unable to participate
in care process by reason of
impaired consciousness.
Who is ACP for?
Everybody, regardless of age or
health status.
*It is not compulsory and not a
legal document.
Approaches of ACP Discussion
- General ACP
- Disease specific ACP
- Preferred plan of care
General ACP
Identify Nominated
Healthcare Spokesperson
and consider goals of
treatment should a serious neurological
injury occur
Early onset and medically
stable patient
Disease specific ACP
Determine the goals of
treatment as the
complication escalate.
Patients with progressive,
life-limiting illness, and
frequent complications
Preferred plan of care
Establish a specific plan of care when patient deteriorates
Patients with <12 months
prognosis and/or requiring
long term institutional care
Key Components of ACP Discussion
- Understanding of health condition.
- Understanding of “Living Well”.
- Identify Substitute decision maker.
- Religious or spiritual belief.
- Resuscitation or life support measure.
- Preferred place of care.
- Preferred place of death.
The importance of ACP Discussions
Encourage expression of end-of-life
preferences.
Allow family and medical team to know patient’s preferences and to prepare in advance.
Provide opportunity to clarify expectations, choices between individual and loved ones.
Empower patient autonomy.
Promote quality of life.
Requirements for ACP Discussions
The patient has adequate mental capacity for discussions and with no mood disorders.
Patient’s comfort is optimized (mentally and physically).
Patient’s sensory impairment is optimized.
ACP facilitator has good communication skills and
exhibits sensitivity (verbal and non-verbal).
Optimal time allocation.
Why Assessing Decision Making Capacity is Important
Adults with decision-making capacity always make their own decisions; it is not their documents that
make decisions.
An ACP document is valid only if completed by an adult
who has the decision-making capacity.
An ACP document becomes relevant only if patients
are determined to have lost the ability to make their
own decisions.
Barriers of initiating ACP
Patient factor
* Clinician factor (example:
doctors/nurses)
- System factor
Patient factor
Denial of diagnosis/unclear
diagnosis
Inclined to protect family
Low health literacy
Death topic avoidance
Strategies of Denial of diagnosis/unclear
diagnosis
Discuss goals of care.
Strategies for inclined to protect family.
Include family members in the care
discussion.
Strategies for Low health literacy
Avoid jargons, use simple medical
information, integrated explanation
with pictorials or diagrams.
Strategies for Death topic avoidance
Create more ACP awareness in the
community.
Clinician factor
No enough time
Lack of continuity during
care transition
Lack of knowledge and
confidence.
Unclear prognosis
Focused on curing of disease
Strategy for No enough time
Time management.
Strategy for Lack of continuity during
care transition
Integrate and enhance continuity of
care and communication among
stakeholders.
Strategy for Lack of knowledge and
confidence.
ACP facilitator training.
Strategy for Unclear prognosis
Goals of care discussion.
Strategy for Focused on curing of disease
Mindset change- focus on quality of
life.
System Factor
Focus on life sustaining care.
Ownership
Interpretation
Concordance
Focus on life sustaining care
Focus on quality of life in the care
goal discussion.
Ownership
ACP is everyone’s business
Interpretation
Interpret correct context.
Concordance
Advocate for achieving patient’s
goals.
