I'm struggling in general with therapeutic communication... Especially younger patients and their families. I've found myself in those awkward silences where I NEED to tell the families what to expect and those symptoms of dying, but then what?? They stare at me and I can't think of anyway to lighten the mood... The questions they have for me never have a good answer and I try my best to help in other aspects but I'm feeling so inadequate... My manager says there isn't anything else to do, that I've "done" everything, but surly there are a few key phrAses I can use to comfort them, just not the "god has a plan" because I've noticed younger generations are not as receptive to that...
Would love some therapeutic communication pointers from any vets out there!
Jul 27, '12
In the PICU (not necessarily a hospice convo but a critically ill child convo) I tell parents that there is no 'script' for these conversations, and that no topic is off-limits. I also stress that no judgement is EVER made regarding their parenting no matter HOW they choose to deal with the situation. The 'no script' statement usually open up the floodgates. They then feel free to express / ask / vent whatever it is that NEEDS to come next. Hope this helps.
Jul 27, '12
I think your manager is right. It's unrealistic to expect that you could lighten the mood or find a magical phrase to comfort a family when you're giving them bad news. All you can do is be as honest as possible about what to expect, and then LISTEN, and answer any questions they may have. If they're too stunned or upset to have questions at that time, let them know that you and the other nurses will be available if/when they do have more questions. I don't think there's much else you can do - "therapeutic communication" doesn't mean you make the pain go away, it means you're there when they need you.
Jul 27, '12
Your hospice/palliative care office has some good books on the subject--I would see what they have. I find that when I say that if I don't have an answer to a question they have, I will find one. If they ask "how much longer" I say "It is hard to say, however, the breathing that you are seeing is part of the process". And that my philosophy is to make everything as peaceful as possible, what is the family's concern, and most importantly what is the patient's concerns? If you notice gurgling that is making everyone uncomfortable, get a scopolomine patch. Keep the patient as comfortable as possible with Morphine. If a younger person says "I am scared" then you need to use your "I am going to make you as comfortable and peaceful as I can". Use your hospice counselors, and if the family is religious, use your clergy. When you go in to see the patient, and if the patient is unresponsive, ask the family "Does he look comfortable to you? Can I get you some coffee or water? Would you like to see our social worker?" You don't need to lighten the mood. But you can end with the "My goal is for this patient to be comfortable and peaceful, let me know if you need anything, and I will be back to check on patient in a half an hour. Ring me if you need me before then".
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