“I think it’s very important to have a feedback loop, where you’re constantly thinking about what you’ve done and how you could be doing it better.” ― Elon Musk
Communication is vital to effective hospice care. Hospice is more than just symptom and pain relief. While those issues are at the core of the clinical needs, effective communication is vital to clinical and non-clinical issues. Long gone are the days when a clinician simply informs the patients of what will be done. Patient centered care puts autonomy and agency at the top of ethical health care. Keeping people in the loop and informed, including patient families, loved ones, caregivers, and whomever else the patient or POA desires to be involved, is the basis for providing care that is ethical and effective.
Tips To Improve Communication in Hospice Care
Tip #1. Tell The Truth
Telling the truth is the respect patients and their loved ones need and deserve. Truth is the only way to respect their autonomy and agency. When we speak about truth, the opposite is not just a lie, it can be withholding information, rushing through or minimizing information, it is often miscommunication through lack of clarity. Truth is not limited to the precise words you say, but is intertwined with the recipient’s understanding.
- Tell the truth. Patient’s and family’s put their trust in you and your organization. That trust is damaged when they feel dishonesty. Explain your services, what you can do, and what you cannot do, plainly and clearly to avoid incorrect expectations.
- Before you start a task, inform patients, and loved ones if present, what you are about to do. For example, “Mrs. Jones, I am going to check your blood pressure now” or “Mr. Smith, I’m going to cover you with a blanket”. This style of interaction is not only soothing to the patient but it can also keep them from becoming agitated or frightened when they aren’t sure what is happening to them.
- If you are seeing an alert and oriented patient and their family member is in the room, privately ask the patient if it is OK if the family member is present during personal care. This allows for the patient to control the level of privacy they feel comfortable with.
- Our words and actions are given significant weight during this critical time in patient’s and family’s lives. It is important to mean what you say and say what you mean.
- Make sure you understand patient and family requests clearly so you can deliver what they need, when they need it. Often the need is presumed rather than actively listening. Being heard is one of the most comforting things you can offer patients and families during this time.
- There is never anything wrong with answering a question with: “ I don’t know the answer to that questions but I will find out and get back to you”. And then follow up!
Tip #2. Make Sure You’re Understood
Ask “what questions do you have for me?” rather than “do you have any questions?”
Keeping people in the loop means more than simply passing along information. It means your job as a hospice pro is to ensure that information is communicated, received, and understood.
Have the person that you are speaking with show you, or explain back to you, what you discussed. This is an easy way to catch what they’ve missed or misunderstood. Patients and families may not want to admit they don’t understand or may feel they are bothering you by asking questions or to see the procedure again. The Teach Back is especially helpful in these cases. Asking “what questions do you have for me?” maneuvers the patient, family, and caregivers to feel as if their questions are not only welcomed but expected.
Remember the line: The shoemaker’s children go barefoot. Whether “the patient was a doctor” or “the daughter is a nurse” does not mean they don’t require the same education and explanations about hospice care as someone with no health care background. Provide all the guidance you can offer. Teach in bites prioritizing the most important information first, especially when patients and families are overwhelmed or in crisis, and let it all come together naturally.
Always allow enough time to answer questions and review what was explained. Sit down with the patient or family and be present when hearing their concerns and questions. Often there may not be enough time to cover every issue. Prioritize the information and follow up!
Tip #3. Proactively Communicate Even From A Distance
Many hospice patients have friends and family members who live far away. Despite the distance, patient will often want these family members included and even involved in decision making.
Within the guidelines of HIPPA, meaning, confirm the patient or POA wants these people included, and that the communication tools available to you are HIPPA compliant, even from a distance keeping people in the loop should be an easily achievable goal.
Rather than waiting for a phone call that may come at any random time, use patient visits to double as an opportunity for a phone call or video chat with long distance loved ones. Your patients and their loved ones should know your schedule in advance. Inform them that if there are others they’d like to include, to set up a call on speaker, or a video call, for your next visit. Not only will this allow everyone who wants to stay connected to feel that they are being respected and informed, it will prevent having to tell each family member separately at times that may not be convenient. You don’t need to send a telegram. Digital tools make long distance communication easier and cheaper than ever!
Group email and group chat apps are great tools for updating patients & family members.
Tip #4. Create A Care Plan Feedback Loop
Communicating with patients and loved one is vitally important when it comes to your care plans. Care Plans are also the most often cause of deficiencies in surveys. Click here to check out the top 10 survey deficiency compliance tip sheet.
Involve patients and caregivers in the care planning process. Don’t template out your care plan & then present a finished product to your patient and family members. Let them be heard and present options for goals, interventions, and suggestions. Especially when presenting your care plan. Think of it as a proposal, not a final report. Provide them the opportunity to question and challenge your recommendations. Perhaps their remarks will create new opportunities for new thinking and a revision to you plan. And even if it doesn’t, and nothing in your plan changes, it will be agreed to and accepted, and function with a greater chance at compliance when the patient and caregivers feel included.
Involve the patient and caregivers in updating the care plan. Any plan is only based on historical information, what you already know. Care plan updates provide the opportunity to digest new information that has become known and to adapt accordingly. Regardless of how many patients have taken the same direction in managing a problem that needs being planned for, updates to your care plans should involve a dialogue with the patient and care givers. A dialogue will help gather information, confirm the historical information, is accurate and that all involved are on the same page going forward.
Communication is crucial to patient-care.
Practicing these skills and developing a mindset of open, honest, & forthright communication will help develop patient driven care and create better outcomes which will reflect in your CAHPS surveys.
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