The art of meaningful conversation

The Art of Conversation

15th January 2024, 11 am 

Why communication matters

An important element of the Soul Companions Death Doula Training programmme is the importance as quasi professional to be clear about the role you play and also about the eco-system in which we operate and the many other professional groups (health, medical, care, welfare, religious) that we will find ourselves working with. Each of these professional groups are themselves working to national standards, codes, policies and practices. For this course, there was a strong alignment with nursing codes, quality statements, national health guidance and government policies and strategies linked to end of life, palliative care and bereavement, allowing us to begin to explore the frameworks shaping how other professional groups work, and underpinning priorities, approaches, and area of focus of importance.

A cross-cutting theme is that of communication – its role, value and importance in the delivery of support and care for dying people. In benchmarking communication (2010) communication is defined

a process that involves a meaningful exchange between at least two people to convey facts, needs, opinions, thoughts, feelings or other information through both verbal and non-verbal means, including face-to-face exchanges and the written word’ (p. 95)

 As we learned in the course, verbal communication is a complex mix o

•       the words chosen

•       the rhythm, pitch and speed of speech

•       the accent and dialect

•       the pattern and structure of the language, e.g. the use of open and closed questions and pauses.

As important is non-verbal communication, that provides an interpretative framing that shapes understanding with the use of

•       facial expression

•       gaze and eye contact

•       touch and distance between people

•       gesticulation

•       posture, stance and body positioning

•       odour

There is also a human presence our auric field (and its layers) that shapes interpersonal dialogue and encounters which cannot be forgot. Everything has its own aura and often we can sense the auric field of a person - their ‘vibe’.

In terms of the importance of communication at end of life in key guidance and in Welsh policy:

People approaching the end of life and their families and carers are communicated with, and offered information, in an accessible and sensitive way in response to their needs and preferences. (National Institute for Health and Care Excellence, 2020)

 

All people identified as having palliative care needs will be given the opportunity and support for conversations with someone well placed to discuss their personal needs, wishes and preferences for care at the end of life, through regularly reviewed Advance and Future Care Planning (Quality statement for palliative and end of life care for Wales, 2020)

Thus perhaps unsurprisingly, in my previous blogs covering my 2023 doula training, I have reflected on the importance of talking and the role of the doula as a facilitator – someone who holds space to allow families to arrive at a shared understanding of how to care for a dying loved one and with each other.  Also, our role as normalising the dying process and getting people to talk about and document their dying wishes and concerns through conversations and dialogue. Talking and holding conversations allows you to understand the desires, views, priorities and wishes of your clients, and to support them to make informed decisions about their care. Importantly, as dying person’s needs and preferences can change quickly in their last months, weeks and days. Good communication is essential to making sure a dying person’s needs are understood and are respected.

The benchmarks devised by the England Department of Health (2010) remain important markers and another helpful guide for me in terms of what is expected in health and care environments.

Benchmarks for Communication

Factor	Best practice
1. Interpersonal skills	All staff demonstrate effective interpersonal skills
2. Opportunity for communication	Communication takes place at a time and in an environment that is acceptable to all parties
3. Assessment of communication needs	All communication needs are assessed on initial contact and are regularly reassessed. Additional communication support is negotiated and provided when a need is identified or requested
4. Information sharing	Information that is accessible, acceptable, accurate and meets needs is shared actively and consistently with all people and carers and widely promoted across all communities
5. Resources to aid communication and understanding	Appropriate and effective methods are used to enable people and carers to communicate
6. Identification and assessment of principal carer	The principal carer is identified at all times and an assessment is made with them of their needs, involvement, willingness and ability to collaborate with staff in order to provide care
7. Empowerment to perform role	People and carers are continuously supported and fully enabled to perform their role safely
8. Co-ordination of care	All staff communicate fully and effectively with each other to ensure that peopleand carers benefit from a comprehensive and agreed plan of care which is regularly updated and evaluated
9. Empowerment to communicate needs	People and carers are enabled to communicate their individual needs and preferences at all times
Factor	Best practice
1. Interpersonal skills	All staff demonstrate effective interpersonal skills
2. Opportunity for communication	Communication takes place at a time and in an environment that is acceptable to all parties
3. Assessment of communication needs	All communication needs are assessed on initial contact and are regularly reassessed. Additional communication support is negotiated and provided when a need is identified or requested
4. Information sharing	Information that is accessible, acceptable, accurate and meets needs is shared actively and consistently with all people and carers and widely promoted across all communities
5. Resources to aid communication and understanding	Appropriate and effective methods are used to enable people and carers to communicate
6. Identification and assessment of principal carer	The principal carer is identified at all times and an assessment is made with them of their needs, involvement, willingness and ability to collaborate with staff in order to provide care
7. Empowerment to perform role	People and carers are continuously supported and fully enabled to perform their role safely
8. Co-ordination of care	All staff communicate fully and effectively with each other to ensure that people and carers benefit from a comprehensive and agreed plan of care which is regularly updated and evaluated
9. Empowerment to communicate needs	People and carers are enabled to communicate their individual needs and preferences at all times
10. Valuing people’s and carers’ expertise and contribution	Effective communication ensures that the people’s and carers’ expert contributions to care are valued, recorded and acted upon and reviewed with staff
11. People’s and/or carers’ education needs	People’s and carers’ information, support and education needs are jointly identified, agreed, met and regularly reviewed

 What works?

Communication is rooted in conversations – findings ways of cultivating meaningful exchange of thoughts and feelings. During the course, we reflected on key communication skills that include the following. What is evident is that there are skills to be cultivated and importantly, there is a need for self-refection and ongoing engagement with just how we communicate, not least in charged situations.

I can give you an example.

My Mother

My Mother is my muse. By that I mean that in my professional life I have worked with my mom to develop participatory methodologies that are compassionate, person-centred and aimed at facilitating voice, agency and dialogue. Mom has conducted literature reviews, and produced digital stories as part of my studies and she has also co-authored a book chapter exploring mothering as a woman of colour  Mom is also my first death doula client – I am working with her on her future care planning with the aim of ensuring that each subsequent client I get will be treated with the care and consideration and love I gave to my Mom. She is my blue/black print.

So, we were having out first formal meeting about her end-of-life care planning.  The question that arose: where would you like to be in the last day so life?

Cue family dynamic.

Cue me wanting to finish her answers.

Cue me getting annoyed with her particular way of not saying what she wants but knowing I can read her unspoken code to decipher exactly what she is not saying.

Finally (after 10 minutes)

Cue me remembering my role and the art of communication. From that point of realization, there was a shift. I remembered:

The importance of paraphrasing

The role of silence

The open questions (not assuming knowledge)

The stepped approach to talking about complex or charged topics

The need to plant seeds (by that I mean indicating what we could talk about next to give Mom time to gather her thoughts)

The need to prepare carefully beforehand and centre myself

The Result?

I was able to practice how to communicate as a death doula for the first time…

With my Mom…

Using skills - some new, some ‘re-freshed’.

We got there in the end.

The first step taken