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E-Learning Module C:

Information Sharing

This module requires the learner to have read chapter 4 of the CAPCE Program Guide and the other required readings associated with the topic. See the CAPCE Program Guide required and recommended reading list for more information.

Revised: January 2017

Contents of this e-Learning Module may be reproduced in whole or in part provided the intended use is for non-commercial purposes and full acknowledgement is given to the Southwestern Ontario Hospice Palliative Care Education Program and St. Joseph’s Health Care London.

Please reference as follows:

Southwestern Ontario Hospice Palliative Care Education Program. Comprehensive Advanced Palliative Care Education e-Learning Modules. London: Southwestern Ontario Hospice Palliative Care Education Program, St. Joseph’s Health Care London; 2013; second edition 2017.

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GETTING STARTED

This e-Learning Module has been designed to consolidate key concepts from the required readings and provide an opportunity to begin applying these concepts through self-directed reflection and scenario-based work, in preparation for the case-based discussions, in-person, with other learners.

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GETTING STARTED

In this module, you will review the content highlights associated with Information Sharing.

You may be asked to write down your thoughts or ideas during this module. You can do so in the Notes section at the end of Chapter 4 in your Program Guide. Have your Program Guide with you as you complete this module.

These notes are just for you; you won’t be required to submit them. However, you may be prompted to use your notes for discussion in your Peer-to-Peer Exchange and Coaching Sessions. Please be respectful of confidentiality.

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TOPICS COVERED

✓ Information Sharing: Critical Concepts

✓ Effective Communication

✓ Self-Awareness in Palliative Care

✓ Conflict in Palliative Care

✓ Culture in Palliative Care

✓ Sharing Information about Diseases, Pain and Other Symptoms

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INFORMATION SHARING: CRITICAL CONCEPTS

Key concepts associated with Information Sharing include:

✓ Effective communication helps build the therapeutic relationship

✓ Conflict is common in palliative care and must be managed.

✓ Culturally sensitive care is driven by person-centered and self-aware.

✓ Knowledge related to disease, pain and other symptoms is critical for information sharing that supports informed decision making.

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EFFECTIVE COMMUNICATION

Effective information sharing, through effective communication, enables effective health care decision-making by the person and family.

In order to make informed choices, the person (or substitute decision maker) needs a clear understanding of the disease and treatment being offered, including:

✓ Prognosis

✓ Treatment options

✓ Potential benefits/risks/side effects and burdens of each treatment offered

✓ Likely consequences of not receiving treatment

✓ Alternative courses of action

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EFFECTIVE COMMUNICATION

The art of effective communication involves:

✓ Gentle truth telling

✓ Understanding that silence is a form of communication

✓ Active listening

✓ Self-awareness

In your Notes section, list other techniques you typically use, or considerations you take, when communicating with the person. For example, how you position your body, how you arrange the environment, etc.

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EFFECTIVE COMMUNICATION

No one is a perfect communicator. What strategies would you like to begin using more often? Less often? List them and explain why. For example, “Eye contact sometimes makes me uncomfortable. I think I could use eye contact more effectively in silence to actively listen in a non-verbal way”.

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EFFECTIVE COMMUNICATION

Communication needs are different between the person and family. For Example, the person may have a need to disclose feelings. The family may need permission to speak.

How else might the communication needs of the person differ from those of the family? Be specific and write your answer in the Notes section.

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EFFECTIVE COMMUNICATION

Silence is a valuable communication tool and doesn’t always mean that the conversation has ended.

The person often needs time to process overwhelming thoughts and feelings and put them into words.

Respecting silence allows the person to organize his order thoughts and consider a response.

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EFFECTIVE COMMUNICATION

How do you feel when in silence with the person or family? How can you prompt yourself to utilize silence more effectively?

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EFFECTIVE COMMUNICATION

Active listening includes hearing the person’s message, understanding the meaning of the message and then providing feedback about what was heard.

What barriers can challenge your ability to engage in active listening in your workplace? How do you overcome them, or compromise?

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EFFECTIVE COMMUNICATION

How does a response sound if you are engaging in active listening? For example, “So if I understand what you have just said, you feel that ….”

Provide three examples of a response that demonstrates active listening. Be prepared to use these in your next Case-Based Learning Session.

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SELF-AWARENESS IN PALLIATIVE CARE

To best facilitate information sharing, you must explore and understand your own cultural norms and instinctive responses to conflict, as well as your personal management style.

This knowledge will allow you to anticipate, moderate and adjust your approach to therapeutic conversations.

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CONFLICT IN PALLIATIVE CARE

Conflict is inevitable, and particularly complex in hospice palliative care.

Brainstorm a brief list in your notes of the emotionally-laden issues that come with living with a life-limiting illness and may compound conflict. For example, “varying views about the meaning of quality of life”.

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CONFLICT IN PALLIATIVE CARE

Not all conflict is harmful or costly.

Use your notes to identify when conflict can have positive outcomes.

If you have experienced a conflict that resulted in a positive change for the person and family, briefly outline:

a.The cause of the conflict

b.How it was managed, and

c. The outcome

Use these notes to share the experience with your partner(s) at your next peer-to-peer conversation.

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CONFLICT IN PALLIATIVE CARE

The RNAO recommends engaging in the reflective activities below to help develop self-awareness related to conflict.

Identify the following in your Notes:

1. Your own behaviours or attitudes that may contribute to creating or escalating conflict

2. Your own conflict management style (e.g. accommodating, avoiding, collaborating, competing or compromising)

3. The conflict resolution skills you feel you currently possess

4. The conflict resolution skills you would like to develop.

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CONFLICT IN PALLIATIVE CARE

Capture your answers to the following questions in your Notes:

▪ How do you like to receive feedback?

▪ What do you do when you are angry?

▪ What motivates you?

▪ What do you do to understand someone else’s behaviour?

▪ How would you deliberately build a relationship with someone?

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CONFLICT IN PALLIATIVE CARE

Reference:

Registered Nurses Association of Ontario, 2012. Managing and Mitigating Conflict in Health-care Teams. Available from:

http://rnao.ca/sites/rnao-ca/files/Managing-conflict-healthcare-teams_hwe_bpg.pdf

Sources of Insight. Five Conflict Management Styles at a Glance. Available from:

http://sourcesofinsight.com/conflict-management-styles-at-a-glance/

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CULTURE IN PALLIATIVE CARE

Culture refers to the learned values, beliefs, norms and ways of life that influence an individual's’ thinking, decisions and responses to life circumstances.

How would you define your own personal culture? Use your Notes at the end of this chapter.

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CULTURE IN PALLIATIVE CARE

The Nurse's role includes the provision of culturally sensitive care. Self-awareness of personal values and beliefs is key to understanding the impact that this may have on the therapeutic relationship with the person and family.

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CULTURE IN PALLIATIVE CARE

Its unrealistic and unnecessary to expect that the nurse will have complete knowledge of the various cultures of persons in his or her care.

Developing an understanding of the person, who they are and what they value as an individual, will enable you to work across the lines of difference and provide culturally sensitive, person-centered care.

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CULTURE IN PALLIATIVE CARE

To provide culturally sensitive care, a first step is to recognize in what way your values and beliefs are similar to, as well as different from, the person's and to reflect on how these values and beliefs impact on this relationship.

Norms are the agreed-upon expectations and rules by which a culture guides the behavior of its members in any given situation.

In your Notes identify:

a.Your own personal cultural norms (think back on the definition of your personal culture that you crafted earlier in this module)

b.The cultural norms associated with your workplace (list at least 3)

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SHARING INFORMATION ABOUT DISEASE, PAIN AND OTHER SYMPTOMS

Information sharing takes place within the context of the person’s current condition as well as anticipating what symptoms may develop as the illness progresses.

Regardless of the disease, stage of illness, or care setting, you will journey with the person and family to facilitate a positive change in the illness experience.

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SHARING INFORMATION ABOUT DISEASE, PAIN AND OTHER SYMPTOMSIn order to share information with the person and family you will require a clear understanding of the disease processes in both cancer and non-cancer diseases including clinical presentation, anticipated symptoms and management strategies.

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SHARING INFORMATION ABOUT DISEASE, PAIN AND OTHER SYMPTOMSAs a Nurse in palliative care, you will be expected to be familiar with the information about diseases, pain and other symptoms in the Pallium Palliative Pocketbook, and various RNAO and Cancer Care Ontario guidelines, tools, frameworks, etc. Knowing when and how to access resources is a key skill for every nurse; researching answers to questions, and leveraging resources such as peer reviewed articles to continuously build your knowledge base is also an expectation.

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SHARING INFORMATION ABOUT DISEASE, PAIN AND OTHER SYMPTOMSIf you haven’t reviewed all of the required resources associated with Information Sharing yet, identify which three you will review next and capture in your Notes.

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BRINGING IT TOGETHER

A vital component in the therapeutic relationship is the nurse’s ability to share information that combines effective listening, conflict resolution and cultural sensitivity.

Your Coaching and Case-Based Learning Sessions will focus on details of information sharing as it relates to disease, pain and other symptoms.

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WHAT HAPPENS NEXT

To prepare for the next e-Learning Module, you will need to red the associated Program Guide chapter in advance.

In order to complete the next e-Learning Module, you will need to have the program Guide and the Pallium Palliative Pocketbook with you.

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This e-Learning resource is the property of:

The Palliative Pain & Symptom Management Consultation Program - Southwestern Ontario St. Joseph’s Health Care, London ON

www.palliativecareswo.ca