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Finding the words: Having important conversations from a distance

Having the confidence and skills to deliver devastating news to families is so important. How we communicate can have lasting impact on the people we help. Claire Henry MBE, Marie Cooper and Gina King at Claire Henry Associates provide some useful advice on what to think about when responding to grief and loss.

We have seen significant changes over the last year due to the pandemic. COVID-19 has reached into our lives in many ways, not just in how we live, but also how we attend to those in our care – be that in care homes, people’s own homes, or supported living.

With enforced visiting restrictions in place, many staff are having challenging, yet important, conversations concerning the wellbeing of their residents and clients on the phone or virtually rather than in person.

Many families are having to cope with visiting their loved ones under restrictions; visits can often take place from a distance or through a screen. Because visits need to be booked in advance, and care homes must adhere to policy regulation, the opportunity for family members to just ‘pop in’ has not been possible. Families have had to rely on the staff to be their eyes and ears and, most importantly, entrust even more their loved ones to those who care for them.

Many of you will have had to have important conversations with family members over the phone or virtually. These conversations really matter and they can leave a lasting impact on both the family member and you as the member of staff.

During this last year, we have all had to adapt our practice and discover new and creative ways to support the family members of those individuals in our care. When family are unable to visit their loved ones, good communication skills are critical.

Knowing what to say and how to say it can be challenging at the best of times. When we began our career, many of us were told that you should not give bad news over the phone. Thankfully, our understanding has moved on and we know that when it’s done well, breaking bad news or having to discuss concerns over the phone can be just as effective1. However, it is not easy for all staff to do and therefore preparing staff and offering support afterwards is key. For example, ensuring staff understand grief and loss, so they are more prepared for different reactions, which could range from crying to anger or silence. Therefore, the need to attend to our skillset and build our confidence in such a scenario is key.

 Considering the key points

It is important to remember how we communicate and what we need to emphasise when on the phone. Over 50% of how we communicate is not verbal, even when on the phone. The tone, pace and the words we choose become even more critical in how our communication is received when on the phone.

Always remember the family perspective. Think about what it must be like for them to be told their family member is deteriorating or has died. Reflecting for a moment on what the family may experience on receiving the call will help you to stay grounded when faced with an array of emotions. They may feel very overwhelmed or be very practical, expressing little – if any – emotion. Everyone will be different.

Preparing yourself 2,3

  • Are you able to find a quiet room where you will not be interrupted?
  • Are the family aware that their relative has been deteriorating or will this news come out of the blue?
  • Do you have all the facts to hand?
  • If the person does not answer the phone, do not leave a message.
  • There is much talk about a ‘warning shot’ when delivering bad news. Your tone of voice can be instrumental in preparing a relative to hear bad news.
  • The word ‘die’ can seem brutal, but it’s a compassionate choice because it’s clear. Euphemisms such as ‘not going to make it’ can be misinterpreted, which can lead to confusion and consequently frustration or more upset.
  • Explaining that a patient is ‘critically unwell’ or ‘deteriorated significantly’ is also unclear for a relative. A phrase that could be used instead is: ‘They are so sick that it’s possible they might die.’
  • Tone of voice, vocal clarity and verbal expressiveness make up 38% of the overall message, words (7%) and facial expressions make up 55% of the message.

When on the call

  • Introduce yourself clearly and check with the person that they know where you are calling from.
  • Check where the relative is when you call. With so many people having mobile phones they could be anywhere, such as driving or in the supermarket.
  • Check who you are speaking to, as you wouldn’t want to speak to the wrong person.
  • Remember to speak clearly and slowly.
  • Find out what they know and when they last visited their loved one.
  • Pausing is one of the most empathetic things you can do to give a relative the chance to catch up with what you are saying. If the silence feels uncomfortably long, or you are concerned that the phone connection has been lost, you could say: ‘Take your time – I’m here when you are ready to talk.’
  • Be clear with your message. If the person you are caring for is deteriorating, explain what the family could do, or if their loved one has died.
  • Any detail that you can offer a relative that demonstrates that you see their loved one as an individual is so comforting as this will probably be a conversation that they will replay in their mind. This could be the name of the nurse holding their hand, something that they said, that they had asked for a particular piece of music to be played or that you conveyed a message from the relative to them.
  • Make sure you have all the facts as to what the family will need to do next. Can they visit?
  • Have an up-to-date information sheet on current restrictions due to the pandemic for your area and your local funeral directors.
  • Find out if there is someone you can ring to support the family member.

Looking after yourself and your team

Looking after yourself, whatever role you are in, has never been so important and you may like to read more about this topic in an article from an earlier edition of Care Management Matters Magazine. There are also some helpful resources and blogs on the Skills for Care website.

Having the confidence and skills is vital in the care you deliver for the distressed and grieving family. Maya Angelou famously said, ‘I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.’

It’s important to remember that the person hearing the news may only remember how they felt on receiving that call – hence it is even more important to connect with them in a confident and compassionate way. The conversation you have could potentially stay with them forever.

If you would like to develop this area of your work, you may be interested to read about a series of short interactive workshops you can attend. Click here for more information.


Claire Henry MBE is Director of Claire Henry Associates. Email: info@clairehenryassociates.com Twitter: @clairehenry_ 

Marie Cooper and Gina King are Associates at Claire Henry Associates. Twitter: @mariecooper100 


References

 <1> Collini et all 2020 https://emj.bmj.com/content/emermed/early/2020/12/02/emermed-2020-210141.full.pdf>

<2> https://www.bmj.com/content/369/bmj.m1876

<3> https://portal.e-lfh.org.uk/LearningContent/LaunchFileForGuestAccess/611123

 

 

About Claire Henry MBE

MBE RGN Postgraduate Diploma BSc (Hons)
Independent Consultant in Palliative and End of Life Care
Claire Henry is an Independent Consultant specialising in end of life care. Her previous roles have …

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included National Director for the NHS End of Life Care Programme which supported the implementation of the National End of Life Care Strategy for England, Chief Executive of the National Council for Palliative Care and Director of Improvement and Transformation at Hospice UK.

Claire’s background is in nursing; she trained at South Lincolnshire School of Nursing. After qualifying, she worked predominately in cancer and palliative care. She was awarded an MBE for her services to improving end-of-life care in the Queen’s Birthday Honours 2013. Claire has also received a lifetime achievement award from the International Journal of Palliative Nursing Award.

About Gina King

Gina King, Associate, Claire Henry Associates

Gina is a Lead Trainer and Consultant specialising in palliative and end of life care. With more than 25 years’ experience in the field, her previous…

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roles have included Commissioner for End of Life, implementing county wide policies and services and the NHS England Lead for End of Life for Thames Valley and South West.

She is the author of ‘ Providing quality care at the end of life’ in A Textbook of Community Nursing and a Director of ‘In the End Care’.

About Marie Cooper

Marie Cooper, Associate, Claire Henry Associates

Marie is a nurse with 35 years’ experience of clinical leadership with an expertise in practice development across a range of care settings. These…

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include acute & community trusts, hospices and a South African community township. Having delivered change in her previous roles, she now supports others to do so.

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