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N450 - gero-midterm (1).
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N450 - gero-midterm (1).
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N450 - gero-midtermMyths about Communication - ANS-- Communication is deliberate
- Words mean the same to sender/receiver
- Verbal communication is primary
- Communication is 1-way
- Can't give too much information
Communication - ANS-- Communication is the foundation of excellent palliative care
- Words alone don't effect communication
- Majority of messages are non-verbal
- People need time to process information
Challenges in Communicating w/Dying Older Adults & Families - ANS-- Societal denial of death
- causes difficulty talking about death & dying
- Lack of direct experience w/death
- Older adults' and families' fears and emotions & don't feel comfortable talking about it
- Dementia and other conditions that make conversations about the future and other abstract
ideas difficult
Caregiver Fears - ANS-- Caregiver fears:
- Not having "the answers"
- Feeling helpless/inadequate
- Upsetting the older adult/family
- Fear of showing emotions - may bring up past
experiences etc
- caregiver's personal fear of dying
- First question is always how long do I have to live - can give a best guess but everyone is
going to do this differently - this makes us uncomfortable b/c we don't know
- Most difficulty w/people who we identify with
Basic Concepts - ANS-- Use active listening - being involved and engaged, summarize what pt
says, ideally sit at eye level and let them know you are present - listening and validating their
feelings
- Being present, rather than what you say, is most important
- Let the older adult and the family lead you - join in their journey; but emphasize that they are in
charge
- Encourage reminiscing; let the older person and families tell their stories - this validates their
life has meaning
- Let the patient know that their lives have meaning
,Verbal & Non-Verbal Communication - ANS-- 80% is non-verbal - Body language, eye contact,
gestures, tone of voice, echoing words, head nodding, leaning toward the speaker
- Verbal - Solicit information, explanations, validation, encouragement, avoid interrupting ,
paraphrase facts and feelings
Mindful Presence - ANS-- Nonverbally present while being attentive; in the moment and
nonjudgmental
- Being silent
- Numerous components: knowing oneself, knowing the older adult, foster meaningful
connections, affirmation, valuing, intuition, empathy
Timing - ANS-- Make sure the older adult and/or family is physically comfortable before starting
a conversation.
- Whenever possible, use the older adults/resident's and family's timetable, not yours.
- Making sure family isn't overly stressed
- Sit at eye level and make sure you are in a private area
Breaking Bad News - ANS-Barriers - provider doesn't have knowledge or experience to break
bad news, RNs can't provide this information, family is unwilling to discuss, family isn't able to
be contacted, lack of privacy or time, cultural differences, acute changes, intubated, cognitive
changes
- SPIKES
SPIKES - ANS-- Setting and listening skills
- Patient's perception of condition/seriousness - how much do they know
- Invitation from patient to give information - how much do they want to know
- Knowledge in giving medical facts - don't overwhelm and give info in small amounts
- Explore emotions and empathize as patient responds
- Strategy and Summary
Asking Questions - ANS-- address their concerns first
- Ask only necessary questions
- Focus questions on the older adult and family's concerns
- Respect privacy, including the privacy of the older adult's and family's emotions
- If you need to ask a sensitive question, explain first why you need to ask it
End-of-Life Discussions - Review - ANS-- Initiate and engage in EOL discussions
- Use words such as "death" and "dying"- avoid passing on etc.
- Maintain hope
- Clarify benefits and burdens
- Consistent information-sharing is necessary among IDT members
- Ethical considerations
, Ways Dementia Can Impact Older Adult's Communication - ANS-Aphasia, Agnosia, Anomia,
Apraxia, losing train of thought, word salad, withdrawal, perseveration, paraphrasia, using curse
words, speaking less, reliance on nonverbal gestures, reverting to foreign language
Aphasia - ANS-- loss of ability to speak or understand
Apraxia - ANS-- inability to perform purposeful action - not on demand
Agnosia - ANS-- inability to recognize objects, faces, voices or places
Anomia - ANS-- inability to recall names of everyday objects or pts have word finding problems
Word Salad - ANS-- all words are there but don't make sense
Perseveration - ANS-- repeatative verbal or motor response to stimuli
Paraphasia - ANS-- loss of ability to speak intelligently - confuse word terms
Tips for Communicating w/Older Adults w/Dementia - ANS-- Environment - least bit of
distraction, decrease noise, eye level, id yourself, use preferred name
- Treat older adult with respect
- Respond to emotions rather than words
Behaviors When Talking w/Older Adults w/Dementia - ANS-- Smile
- Use humor
- Do not argue or confront
- Be positive
- Know the older adult
**YOU do most of the work in communicating**
Messages to Give to the Dying - ANS-We accept you and we will not abandon you
- I love you
- I forgive you
- Please forgive me
- Thank you
- Goodbye
Communicating Hope at the End of Life - ANS-dimensions of hope, accepting & moving beyond
current suffering, setting goals & maintaining control, connecting w/others
Dimensions of Hope - ANS-- Accepting and moving beyond current suffering - manage &
prevent symptoms as much as possible
- Setting goals and maintaining control
- Connectedness to other people, God, something "bigger" than oneself
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