Wednesday Nov 19= Lecture 10 -Communication Approaches with Communication Challenges / Communication in Palliative Care

Palliative Care

• Goal: Improve function and quality of life, regardless of disease stage, focusing on symptom control, pain management, emotional support, dignity, and comfort.

• Person-centred care: Guided by individual needs, values, and preferences, supporting patients and families in end-of-life (EOL) decision-making.

. Nursing Role in Palliative Care

• Ethical responsibilities: Obtain informed consent, relieve suffering, provide culturally and spiritually appropriate care, support families, and care for the deceased with dignity.

• Values: Safe, compassionate, competent, ethical care; health promotion; respect for decision-making; advocacy; privacy and confidentiality.

• Self-awareness: Reflect on personal beliefs, fears, and past experiences with death to maintain empathy and emotional balance.

Supporting End-of-Life Decision Making

• EOL as a continuum: From diagnosis to death, decisions about interventions should be informed and transparent.

• Avoid futile treatments and support informed choices regarding fluids, antibiotics, ventilators, and other interventions.

• Advance directives and Medical Assistance in Dying (MAiD) are legal options in Canada; nurses advocate for autonomy and surrogate decision-making if needed.

Communication in EOL Care

• Effective communication is as crucial as clinical skill; individualized conversations uncover values, preferences, and concerns.

• Therapeutic relationships build trust, emotional closure, and understanding of perspectives.

• DNR orders and care preferences must be respected and documented.

• Narrative inquiry and reflective listening help uncover emotional and existential concerns.

• Guidelines: Avoid clichés, reframe hope, let the patient guide discussions, use humor/empathy, listen deeply, honor privacy, be honest, show vulnerability.

Communication With Families

• Families process impending death differently; short, consistent conversations are most effective.

• Discuss life support, family conflicts, place of death, and hospice engagement.

• Encourage storytelling and memory sharing to strengthen emotional bonds.

Supportive Interventions for Children

• Encourage visits, use age-appropriate language, maintain daily routines, involve siblings, provide parent respite, respect traditions, promote emotional support.

• Children grieve differently; use concrete language, honest explanations, ongoing conversations, and creative ways to connect.

Family Conferences

• Purpose: Reduce anxiety and conflict, facilitate shared decision-making, ensure consistent information.

• Interdisciplinary collaboration addresses holistic needs; include all key family members.

• Nurses provide clarification and emotional support post-conference.

Imminent Death: Family Communication Needs

Honest, repeated information and updates; opportunities to express feelings; guidance on what to expect physically, emotionally, and spiritually; discussion of legal, cultural, and funeral planning; private time with the dying person.