Skills for engaging in potentially difficult conversations Claire

Skills for engaging in potentially “difficult” conversations Claire O’Neill Lead Nurse Palliative Care NHSGGC

A difficult conversation • one we don’t want to have ( would rather avoid) • one we worry about what will happen during (or after) • one that when we do have it produces more thoughts and feeling than are expressed (or known).

• Bad news is the gap between a person’s expectations/perceptions about the situation and the reality.

• You can’t tell how bad any bad news is likely to be for a person unless you have some idea of that persons perceptions and expectations about their situation.

To begin the work of bridging the gap between perception and reality • Ask before you tell • Gather (and acknowledge) before you give

Are you sometimes afraid to ask? ?

It helps to have a structure in mind. Following a structure can help you safely engage in potentially “difficult” conversations. Following a structure can guide you in, through and out of a potentially “difficult” conversations.

En. GAGe

en. GAGe • environment • notice • Gather • Acknowledge • Give • end

environment (and start to notice cues) • Physical – Privacy, seating, lighting , proximity etc. • Relational – Pre conversation preparation, introductions, eye contact, body language, intentional use of active listening skills, clarify time frame, sensitively and clearly state the reason for conversation etc • Start noticing cues – How does the person look? (anxious, upset…) – What has the person said?

Cues – (verbal or non-verbal)

Verbal cues • • • Hint or direct expression of feelings Emphasis or use of metaphor The mention of significant life events Repetition of seemingly neutral statements Physiological signs of distress Requests for information (questions)

Non verbal cues • Clear expression of emotion – crying, restlessness • Hints to hidden emotions – lack of eye contact, frowning, sighing

Cues – always need clarification to check for the presence of an underlying concern.

Gather (and Acknowlege)

Gather (and Acknowlege) • the most important verbal and non verbal cues…

Gather (and Acknowlege) • the persons full perception of the situation…including any concerns the person may have and the impact of those concerns.

Gather (and Acknowlege) – Gather • Before we start, I notice that you look worried… • I wonder if you can tell me what you already know about (situation/problem/issue)… – Acknowledge (verbal and non verbal) cues • Use your skills in reflection, paraphrase, clarification, summary, silence and offer empathy

Gather (and Acknowlege) • any additional concerns (and the impact of those concerns) • • Use of summary and empathy Is there something else concerning you today? Acknowledge the concern How is (the concern) affecting you at the moment?

Give • Give information, give explanations and negotiate a plan.

Give information • Give information – If you are delivering bad news give a warning shot – Pause to let that sink in – Small chunk – Pause to let that sink in – Check. . – Gather and acknowledge new concerns • Prioritise?

Give explanations • Give explanation – Tailored to the need of the person

Give a (negotiated) plan • Give your perspective and negotiate a plan –Give person an opportunity to say what they think might help. –Give person an opportunity to say what they think you could do to help.

end • Conversation can come to an end when you have: – Gathered acknowledged and explored the main concerns (nature, extent and impact) – Offered information and explanations – Negotiated a plan

end • Steps to ending well – Briefly summarise the conversation – Check the accuracy of your recall – Ask a screening to ensure no major point is missing – Check how the conversation has left the person feeling – Return to Gather Acknowledge Give if new concerns are raised – Negotiate that it is ok to finish – Thank the person for talking with you

en. GAGe • environment • notice • Gather • Acknowledge • Give • end

Any comments or questions?