ELNEC module 1

Active listening

-be silent -repetition, reflection, "tell me more about that" -do not change the subject -try not to give advice if possible unless asked -encourage reminiscing

Mindful presence (10)

-knowing and being comfortable with oneself -knowing the other person -connection -affirmation and valuing -acknowledgement of vulnerability -skill in attentive listening -utilization of intuition -empathy and a willingness to be vulnerable -serenity and silence

Basic techniques and helpful phrases

1. Acknowledging emotions they are expressing 2. Legitimizing the normalcy of the reaction 3. Exploring what is under the emotion 4. Empathizing 5. Exploring their strengths and past coping strategies 6. Checking that what was said was heard and understood 7. Using the word "dying" effectively and appropriately 8. Providing support to patient and family 9. Identifying and using nonverbal communication; ask for clarification when verbal and non-verbal contradicts

Facilitating end of life discussions

1. Be willing to both initiate and engage in discussions about issues relating to care at the end of life 2. Use words like "death" and "dying" in discussions with the dying patient and their families 3. Maintain hope and be specific about what there is hope for (symptoms and pain control, good death, resolve issues) 4. Clarify the benefits and burdens of treatment options 5. Ensure that consistent info is being given by all healthcare providers

Patient and family expectations

1. Build a rapport with them in an effort to build trust and understanding 2. Be honest and truthful 3. Elicit and request their values and goals, and help as much as possible to achieve these 4. Keep them informed about the patient's condition and provide updates 5. Work with the interdisciplinary team to develop a plan of care and see that everyone understands the plan and they communicate the goals of care to one another 6. Listen actively to validate their concerns and needs 7. Provide a safe place for conversations about death and dying

"It is December and Mrs. B (age 81) tells the nurse she is afraid that she will not live long enough to see her grandson graduate from college next spring. The nurse knows that the team will be talking with Mrs. B. Today about transitioning to hospice care as her chronic obstructive lung disease is worsening and she probably has only a few months. The nurses best verbal response to Mrs. B.'s statement is:" A. "Can you tell me more about wanting to be at your grandson's graduation?" B. "I don't think that you will live long enough for that to happen." C. "Don't think like that, of course you will make it to his graduation." D. "You are such a fighter; I am sure you will be able to be there."

A. "Can you tell me more about wanting to be at your grandson's graduation?"

Ask-Tell-Ask

Ask: opening up with a question Tell: after patient responds, respond as to what you know is the truth "it is my understanding...." then wait for patient to respond Ask: make sure you end with an open-ended question to allow the patient to continue the conversation.

"You are listening to Mr. Grant who says, "I am so scared about how bad my heart failure symptoms have gotten lately." What would be your best action following this statement?" A. Teach Mr. Grant about the usual progression of heart failure B. Respond with non-verbal nodding, leaning forward towards Mr. Grant C. Tell Mr. Grant not to worry, that his symptoms can be controlled D. Respond with a verbal statement that his symptoms do not seem that bad

B. Respond with non-verbal nodding, leaning forwards towards Mr. Grant

"Mr. J. Has just heard from his oncologist that his chemotherapy is no longer working and that his cancer has gotten worse. The doctor shared this information with you and said that he was worried Mr. J. Is very distressed. Which of the following should you use to begin a conversation with Mr. J? A. "I heard your cancer is back and your chemo is not working." B. "I know the doctor gave you bad news, but there are always new treatments to try" C. "Mr. J., dont worry, I see you are upset, but everything will be ok" D. "Mr. J., can you tell me what the doctor just shared with you about how you are doing?"

D. "Mr. J., can you tell me what the doctor just shared with you about how you are doing?"

Ambivalent relationships

Violence, abuse, divorce, separation; leads to a harder time coping with negative feelings, anger, and guilt