Effective communication in palliative care

1 Page 57 Page 66 Page 67 Page 6 8. Effective communication palliative care multiple Read Amanda Williams's Guidelines on how to in palliative care choice questionnaire practice profile on write a practice profile abnormal scarring Effective communication in palliative care NS321 Dunne K (2005) Effective communication in palliative care. Nursing Standard. 20,13, 57-64. Date of acceptance: June 3 2005. communicatingwith patients and family Summary members in the palliative stage of illness. This article focuses on the definitions of cotiimiinication and an Make a case for the development of examination of their relationship to palliative care nursing. The communication skills within palliative care underpinning theory is analysed as a means of understanding the nursuig. communication process. The communication process in nursing is considered in the context of nurse/patient/family communication .

2 While the focus of the article is on palliative care, the principles of communication as outlined also have relevance and applicability to with a tt-usted colleague nurses v^orking in a variety of other clinical settings. discuss palliative care terms and concepts. Choose a phrase or term such as Author 'palliation' or 'symptom management': Kathleen Dunne is nurse education consultant Educare Nurse a) Describe how you would explain this Education Consortium, Clinical Education Centre, Altnagelvin Hospital concept to lay carers. Londonderry, Northern Ireland. Email: b) Identify v^fhy it could prove confusing for patients and their supporters. Keywords communication ; Death: attitudes; Family; Nurse-patient Introduction relations; Terminal care: nursing These keyvi'ords are based on the subject headings from the British communication is the process hy which Nursing Index.

3 This article has been subject to double-blind review. information, meanings and feelings are shared by For related articles and author guidelines visit our online archive at persons through the exchange of verhal and and search using the keywords. non-verbal messages (Brooks and Heath 1985). Groogan( 1999) asserts that communication is not something that people do to one another, hut rather it is a process in which they create a relationship by Aim and intended learning outcomes interacting with each other. Adler etal{\9^9). The aim of this article is to raise nurses' awareness describe communication as being 'a continuous, of the communication process and to encourage transactional process, involving participants who them to reflect on their own practice when occupy different but overlapping environments and communicating with parients and family create a relationship by simultaneously sending and receiving messages, many of which are distorted by members during the palliative stage of illness.}

4 Physical and psychological noise'. There are a After reading this article you should he ahle to: number of elements in this description of Discuss the communication process. communication that have relevance to nurses and other healthcare professionals in the palliative care Explain the core elements of interaction for setting and require closer examination. Effective practice. communication as a 'transactional process'. Summarise the complexities involved when implies that we encode and send messages while we NURSING STANDARD december 7 ;: vol 20 no 13 :: 2005 57. learning zone interpersonal skills affect the communication process. The nurse needs ro be sensitive to the context in which communication is taking place with the famiK unit and do everything in his or her power to include are receiving and decoding other messages.

5 The them in all aspects of the communication process. processofinteractionistwo-wayand is happening continiiouslyandsimuitaneoiisly (Hargie 1997). communication in the context of nursing Nurses in the palliative care setting need to be aware ofthe equal input that patients have in the The United Kingdom Central Council for communication process and that encoding and Nursing, iVlidwifery and Health Visiting (UKCC). decoding is a complex process. We have to make (now the Nursing and Midwifery Council) stated sense of, and prepare messages for, one another in 1996 that: ' communication is an essential using both verbal and non-verbal means. part of good practice in nursing and is the basis Second, the suggestion that communication for building a trusting relationship that will has 'different but overlapping environments' is greatly improve care and help to reduce anxicry relevant to palliative care patients and their and stress for patients and clients, their families families.

6 In nurse-patient and family interaction and their carer' (UKCC 1996). It is important there is much common ground and thatnurses develop their communication skills understanding but there are also differences that so that they can become more skilled in their need to be recognised if misconceptions and interpersonal contact with patients and others. misunderstandings are to be avoided. Language Burnard (1996) writes: 'Notto be and terminology - use of medical terms - become interpersonally skilled as a healthcare all-important in the overlap ofthe nurse-patient professional is to be ineffective as a healthcare and family relationship so that those with whom professional.' This caveat should not be ignored the nurse is communicating do not experience because communication is the medium through isolation and exclusion.

7 Which nurse-patient relationships are Third, the belief that communication creates a established and some nurse theorists view the relationship is, according to Groogan (1999), interpersonal relationship with parients as the concerned with a holistic approach to care that central focus of nursing activity (Meieis 1997). involves meeting the social, psychological, Peplau (1988) defined nursing as a spiritual and physical needs ofthe patient. This is therapeutic interpersonal process, while Parse especially relevant in palliative care nursing (1992) suggested that nursing is a subject-to- where the emphasis is on care that encompasses subject interrelationship-a loving true the whole person. presence with the other to enhance the quality of (1966) posited that nursing is an interpersonal process between two human beings, one of whom needs assistance because To explore the concept of 'noise' of an illness and the other who is able to give consider the following scenario.

8 Louise such assistance. The goal of the assistance is to Is being cared for in the community help a human being cope with an illness., learn and is in the final stages of illness after being from the experience, find meaning in the diagnosed with bowel cancer. She copes with experience and grow and develop through the pain which is adequately controlled, the experience. embarrassment of unplanned bowe! King (1971) defined nursing as a process of movements and mild wound odour. She is also human interaction between nurse and patient, at the centre of an unpleasant divorce between whereby each perceives the other in the situation her daughter and son-in-law. Louise is trying to and, through communication , sets goals, and protect her granddaughter from excess hurt. explores and agrees on means to achieve these What constitutes 'noise' here?

9 Make notes on goals. Rogers (1988) added the perspective that how you think this influences the nursing is a scienceof unitary human beings and support relationship that a nurse might offer. that the goal of nursing is to promote 'symphonic'. interaction between a human being and his or her Fourth, the notion that communication can be environment through participation in a process distorted by 'physical and psychological noise' has of change. This theory considers the whole major significance for nurses when communicating individual and is based on the belief that humans with dying patients and their families. Adler etal are at the core of nursing. This theory challenges (1989) suggest that physical noise-environment, the nurse to work on mobilising individual or inability to hear-can detract from the message family resources, heightening his or her integrity being communicated, while psychological noise - and strengthening the human environment or form of address, presentation of self-can also family relationships (Rogers 1988).

10 58 december 7 :: vol 20 no 13 :: 2005 NURSING STANDARD. negative impact on the quality of care and consequently on the success or failure ofthe healing process. In palliative care nursing, a great Tliink back to your most recent nurse deal of healing (inner peace), that is, serenity and education course and the theory that ^.almness, needs to take place towards the end was used to describe nursing. What part stages of an illness. This healing is important and, does communication play within that theory? ,is demonstrated by Steele (1990), the healing that Have you been able to communicate in the way IS required before death has a major impact on the that the theory espoused? ^ grieving process and grief resolution for a patient's family. This emphasises the need for Many empirical studies on the concept of caring nurses in palliative care to engage in Effective , in nursing have identified communication as one meaningful and interactive dialogue with patients and their families so that as much heating as ofthedefiningattributes.