Difficulties with Communication

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Difficulties with Communication

• Kara Fereday

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Aims/Objectives

• By the end of this session you should be able to
• Discuss the consequences of poor communication.
• Identify issues which might contribute to poor
  communication for patients and carers.
• Recognise blocking techniques and instances when
  they could be used

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(No Transcript)
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Harmful consequences of poor communication

• Alienated and frustrated patients
• Rejection of management plan
• Health Outcomes
• Reduction of anxiety levels
• Improved recall

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• Think about your clinical practice . Can you
  recall a time where you experienced difficulties
  with communication, either with a colleague,
  manager, patient or carer?
• What caused these difficulties?
• Consider personality types, ways of
  communicating, levels of understanding, emotions.

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• Social
• Death Denial
• High Expectations
• Materialism
• Changing Role of Religion
• (Buckman 1998)

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Barriers to effective communication

• Patient Related
• Reluctance to disclose concerns
• Burdening, Ungrateful, Confirmation.
• Preferences for modes of
• communication

Communication
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• Cross cultural issues
• Egan(1998)
• The needs of the patient
• Carers values
• Cultural Stereotyping

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Patient Related

• Fear
• Symptom Distress
• Denial
• Age
• Family Related
• Hospital Restrictions
• Family Conflict

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• Professional Related
• Values, attitudes and beliefs.
• Skills deficits
• Sympathetic Pain
• Personal History

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Professional related

• What patients want
• An apology
• An exploration/answer
• Accountability
• Help
• Change

• Strong Emotions
• Techniques for dealing with
• Acknowledge distress
• Reason

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Situations/People

• Withdrawn
• Dependent
• Histrionic
• Narcissistic
• Obsessive Compulsive

• Discussions about CPR
• Withdrawal of treatment
• Organ donation
• Disclosure of errors

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• Blocking Behaviours
• Distancing
• Ignoring emotional cues
• Collusion, denial, false reassurances
• Avoidance Tactics

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When you think you want to say
Try

• You are going to be just fine
• Dont talk like that you can beat this
• I cant see how anyone can help

• Are there some things that worry you?
• This must be hard to come to terms with
• We will work with you

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Which one

• Ignorer
• Facilitator
• Informer
• What would you change about interactions?

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Barriers to Communication

• Selective Listening
• Doing Harm
• Documentation
• Knowing what to say
• Time
• Emotions

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Barriers to Communication

• Culture
• Language
• People came to pay their respectsmy heart kept
  falling I felt as if my head was about to burst.
  Id tie my head and hold itI do all this
  thinking in my heart.I know it affects the
  brain, but what can I do? That blow hit me as if
  my heart had stopped.I think,I think, in my
  heartthis built up pressure I my head.
• Stereotyping

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Resources

• Bowler I (1993) Stereotypes of women of Asian
  descent in midwifery some evidence. Midwifery 9
  (1) 7-16
• Buckman R (1998) in Doyle D, Hanks GWC,
  Macdonald N (1998) Oxford Text Book of Palliative
  Medicine. 2nd Ed Oxford University Press.
  Oxford.
• Fallowfield L, Hall A, Maguire G, Baum M (1990)
  Psychological outcomes of different treatment
  policies in women with early breast cancer
  outside a clinical trial British Medical
  Journal, 301, 575-80
• Faulkner A (1998) Effective Interaction with
  Patients. Churchill Livingstone. New York.

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• Heaven C , Maguire P (1997) Disclosure of
  concerns by hospice patients and their
  identification by nurses. Palliative Medicine,
  11, 283-90
• Jenkins V, Fallowfield L (2002) Can Communication
  skills training alter physicians beliefs and
  behaviour in clinic? Journal of Clinical
  Oncology. 20,765-9
• Macdonald E (2004) Difficult conversations in
  medicine. Oxford University Press. Oxford
• Maguire P (1999) Improving Communication with
  Cancer patients. European Journal of Cancer 35,
  14, 2058-65

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• Maguire P, Faulkner A, Booth K (1996) Helping
  cancer patients disclose their concerns. European
  Journal of Cancer 32 78-81
• Regnard C, Mathews D , Gibson D, Clake C (2003)
  Difficulties in identifying distress and its
  causes in people with severe communication
  problems. International Journal of Palliative
  Nursing, Vol 9,no 4.page 173 -176
• Wilkinson S (1999) Factors which influence how
  nurses communicate with cancer patients. Journal
  of Advanced Nursing. 16, 677-88