Health_Anf_Social_Care

jane reid A8134562 TMA02 What role does communication play in the dying process and what challenges can effective communication presents to professional carers' “How communication happen can have a significant impact on the quality of life in the dying process” (quoted from block2, pg. 40). Attitude towards death and dying influence how dying people are cared for. Communication is a two way process where the message is conveyed to someone or a group of people whether good or bad. Whenever the message is conveyed clearly and unambiguously, then it is known as effective communication. However, a communication becomes successful only if the receiving person understands what the other person has said. For many people the thought of dying evokes as much fear as does the thought of death itself. Therefore discussing the dying process as well as thinking about how one’s last days or months might be spent can be very beneficial. Many individuals experience difficulties in communicating with dying people. For some people the grief that they experience in anticipation of a love one’s death may help to explain difficulties in interacting with terminal ill individuals. This takes me back to my first assignment. According to Robert Buckman (1998) there are three main reasons why he thinks people may find it difficult to discuss about death. (Block 2, pg. 44, 45) First social causes where as death and dying is seen as the forbidden subject. Secondly, Psychological causes, not feeling emotionally able to handle the intensity of the situation. Last Buckman mentioned difficulties related to the person delivering care. For example, since I have helped cared for my late grandmother I sometimes find it uneasy in being around dying persons. It has become more difficult speaking or even maintaining eye contact with dying persons. Having awareness on how death is talked about is very important. It should be taken into consideration the use of language in any situation. For example, (in Activity 3.5) the biomedical approach by the consultant in the vignette left the patient feeling at fault for his illness. From reading the accounts (Activity 3.3), understanding one’s own fears and concerns about death can help a great deal on how we communicate with dying and bereaved people. If open communication is not achieved professionals can sometimes operate on preconceptions rather than the dying person thoughts and feelings. “In order to communicate effectively, it is helpful to understand the experience of dying from a dying person point of view” (quoted from Block 2, pg.48). Therefore it is important to build a relationship and get to know the dying person. This help in understanding their feelings and how to implement the right tools to support them. A good example would be Janice relationship with her aunt Louise (Block 2, case study 3.2). In the past professionals used to withhold information about grave illness from patients, believing this would cause them unnecessary distress. It is much different now where as patients and health professionals are encouraged to share the responsibility of managing the illness and the dying process. However, this is not always the case. Sometimes people rather stay in the dark about their situation or relatives may not wish their love one to know they are dying, believing it might protect them. On different occasion it is professionals suggesting illness should not be discussed with the patients. In relation to this Glaser and Strauss (1965) identified four types of awareness process which have a strong influence on the interaction between the dying person and the carers. The first one being open awareness (Block2, pg. 49), which is the most common types. It describes all parties, patients, relatives and all carers as being open with each other. A good example would be the article from the course website and Ollie’s situation (Anthology, piece 60). Because patients are sometimes aware of their situation that does not mean they would want to talk about it all the time. Another type is suspected awareness. In this case, where Marion (Anthology, piece 43) suspected something was seriously wrong with her. Mutual pretence awareness, suggest that “both know that the other knows but do not acknowledge this to each other”. (Quoted form Block2 pg.50) The last type closed awareness the opposite of open awareness. Another good example, Mary knew that her dad was going to die (Anthology, piece 42) and regretted not saying it to him. It could be argued that those persons whose attitude and actions most influence the quality of end of life care are professionals because they have primary control of information that drives medical decision making. However, this has proven from time to time to be challenging. Being told one’s illness is grave is most shocking. How bad news is presented is therefore important. Such bad news usually follows a number of visits to different health departments specifically selected to ensure the diagnosis is accurate. The professional would often be the one breaking the bad news to the person and /or his carers and relatives. For example, with cancer patients, doctors may suggest some treatment to delay the dying process. Unfortunately, this is often used to cushion the bad news and to divert patient’s immediate feelings away from hopelessness. Professionals can find it difficult to say, “There is nothing else we can do”. Often doctors may feel that terminal patients are medical failure and mostly seems to view death as the ultimate enemy. Based on Buckman (1995) steps in breaking bad news some of the challenges professional face can be very difficult sometimes. For example, listening to Fiona (Audio, 3.8) she has expressed a feeling of helplessness with minimal skills on how she should have managed the situation. Drawing from his guidelines it is also not always possible to get everything right as there are different circumstances around a person’s death. It is important for professionals to build an empathetic relationship with the dying and bereaved people. Whether it is breaking bad news or continuing communication about the care with the dying person, it is important to remember who is central to the process. As Rogers (1957) stated a person centred approach not only helped to understand the dying person but helped to build trust. A good example is Louise’s approach with the resident in (Activity 3.9). Relationships with professional and people in end of life care rely on the ability to communicate from person to person. Due to this reliance, it is critical to ensure effective communication skills to avoid making assumptions by misunderstanding, but what happens when we do not' The affect would probably cause minor confusion, hurt feelings or even ruined lives. Having the skills set required for effective communication can have an impact on professional overall effectiveness in any situation and ultimately determine success or failure. No matter how good communication is in any working environment, barriers can and do often occur. This may cause by a number of factors which I may summarised as being physical barrier, cultural, individual ability and psychological factors. Physical barriers are often due to the nature of the environment. This is why majority of private care settings take pride in their home like environment, which is often promoted in the clinic’s advertisement. First impressions are established as much by environment as they are by attitude. Dying people need to know that they are welcome, safe and listened to as a precondition for being able to talk about their health concern. So how can these challenges overcome' Nigel Hartley’s discussed ideas of using creative arts in effective communication during difficult times. His model aimed to encourage professionals to use their craft and staying engaged with dying people. If practice, not only will this help dying people emotionally and physically but benefit professionals in developing a more compassionate and empathetic connection. From listening to the audio (Activity, 4.6), professionals experience situation like this on a daily basis. For one, our emotional interference could be a barrier to effective communication, hence affecting our ability to listen clearly and staying focus. Therefore is important to recognise and be aware of personal emotions. Dying for some people is normal. The fact that someone is dying does not mean that something is wrong with them. People just want someone to listen to them, maybe to tell their story. (Nigel Hartley) I further go on to say effective communication with people of different culture is especially challenging. Culture provides people with ways of thinking, seeing, hearing and interpreting things. We live in a cultural diverse world. Professional will encounter individuals from different race, religious background in their day to day encounter. So as Hartley stresses the need to pay attention, knowing what the dying person wants and making them feel valued is offering good quality end of life care. The difficult set back we all face is that communication skills are not what we spend our time focusing on in our day to day interactions. The truth is, most people do not place a high priority on communication skills, and place them at the bottom of their list of skills. Neglecting communication skills will affect how we do our job. Training on communication for professional is essential. Word count: 1571 words Reference: Open University: K260 Death and Dying, Block 2, end of life care in context Death and Dying: A reader, By Sarah Earle, Carol Komaromy and Caroline Bartholomew Making Sense of Death, Dying and Bereavement: An Anthology, by Sarah Earle, Caroline Bartholomew and Carol Komaromy Course Website Article: Yedidia and Macgregor, Audio, Block 2, Unit 3, Video, Block 4 Unit 4