Learning The Art of Empathic Conversations

Bonnie Morgan, M.Ed., RN-BC, CHPN, FPCN

Mr. G is an 88 yo man with end-stage dementia and a FAST Scale of 7a. His initial medication list includes memantine HCL (Namenda), latanoprost (Xalatan) eye drops for glaucoma, simvastatin and hydrocodone/acetaminophen. His family refuses to stop any of these medications if admitted to your hospice service. How will you artfully communicate responsibility for coverage of these medications?

Case Study

Mrs. S is a 68 yo woman with terminal breast cancer. She was admitted to your hospice one week ago and is declining rapidly. The husband calls asking for a nurse to help with her increasing shortness of breath. When you arrive, he angrily states that the hospice service is not helping and he wants to take her to the hospital despite her desire to stay at home during the last days of her life. How will you empathically communicate in this situation?

Case study

Describe the importance of artful conversations

Identify key components of the communication process

Define five levels of listening

Recognize six key components of empathic communication.

Objectives

Helps develop relationships based on trust and mutual respect

Moves us toward a partnering relationship

Allows patient and caregiver to disclose concerns

Facilitates a safe environment for the patient and caregiver as life is nearing its end

Artful Communication

Learning to be consciously and compassionately "in the moment” with another person

Believing and affirming the other person’s potential for wholeness or growth

Learning we don’t have to solve all the problems

Clearing our minds of our own agendas

Honoring the other person as our equal

Valuing the uniqueness and blessing of the other person

Becoming a “healing presence”

Seek First to Understand

Then to Be Understood

Steven Covey

Communication Elements

Definition: the exchange of information, feelings and thoughts between individuals

55%

7%

Levels of Listening

Ignoring

Levels of Listening

Pretend listening

Giving the appearance of

listening.

I hear what you are saying.

Levels of Listening

Selective listening

Autobiographical Listening

Listening from our own paradigm.

Comparing the speaker’s experience with our own.

Evaluating the speaker’s experience.

Advising or telling the person what to do based on our experiences.

Listening to solve the problem.

Planning your responses while listening.

Attentive/Empathic Listening

Begins with the intent to understand the other person BEFORE being understood.

IT’S ALL ABOUT THE OTHER PERSON.

It’s not about YOU.

Listening only to understand

Key Components to Empathic, Artful Conversations

15

Establish “Presence”

Sit down; Stop talking; Start listening

Appropriate use of eye contact

Keep an open posture

Take notes as appropriate

Allow adequate time

Prevent interruptions

Listen or your tongue will

make you deaf!!

Ask open-ended questions

What have the last few weeks been like for you?

What are the doctors telling you about your condition?

What is the most difficult thing for you at this time?

Clarify and reflect and explore to increase understanding

Let me see if I got this right. I thought I heard you say…..

Is this what you mean………?

Listen for what is NOT being said

Do not express your views until the speaker is satisfied you understand what she is communicating.

Seek to Understand

Be aware of your preconceived ideas

Leave your agenda at the door

Avoid jumping to conclusions

Do not plan your responses while the other person is talking

Avoid: “We are right. You are wrong.”

Don’t react outwardly with negative nonverbal language

Honor and accept that the patient and caregiver have good intentions

Suspend Judgment

Silence can indicate

Manipulation—used to put pressure on the other person

Defiance or disagreement or hostility

Profound sense of awe or respect or sorrow

Creation of a sacred listening space

Empathic listening

Effective Use of Silence

Excellent communicators

Allow silence when they sense its effectiveness

Offer silence as a sign of respect

Interpret the silence of others appropriately

Avoid feeling pressured to “fill the silence” when the silence is being used to manipulate the conversation

Effective Use of Silence

Be prepared for

Outburst of strong emotions

Broad range of reactions

Acknowledge the emotions and reactions

Allow time for these emotions and reactions

Listen quietly and attentively

Encourage the description of these feelings

Use non-verbal communication

Responding to Feelings

Summarize; Check for Understanding

This is really important. Is this what you mean……….?

What is it you want me to know?

Is there anything else you want me to know?

Let me make sure I am really clear. Is this what you mean……?

Is there anything else I can do for you at this time?

Developing a partnering relationship

Learn to listen; listen to learn.

Becoming a “healing presence”

Seeking first to understand

Suspending judgment

Effective use of silence

Responding to feelings

Summarizing “next steps”

Take-Aways

“You matter to the last moment of your life and we will do all that we can,

not only to help you die peacefully, but live until you die.”

Dame Cicely Saunders

Founder of the Modern Hospice Movement