Essay concepts and applications

¶ … life situation can create a lot of problems in terms of communication.

The natural thing is to want to heal the person so when that doesn't work, people feel stymied and angry. Communication in any such instance is difficult. For the palliative team that consists of different individuals teaming together to provide quality care for the patient this is all the more difficult. This is because the different members of the team - caseworkers, physicians, nurses, relatives, and friends -- have the same objective, to help the patient, but the stress and different ways of achieving that objective may merge into conflict. People who are close to the dying may feel this particularly so, and nurses who acts as intermediary between patient, physician, and family are often caught in the middle. The result are feelings that include guilt, low self-esteem, anger, misinterpretation and so forth all of which can exacerbate the situation and instead of the palliative team collaborating in making the patient feel most secure and comfortable, energy can become distracted into destructive conflict.

It is very important too that the nurse have all the information in order to provide quality care, but often times patients are confused, and anger and/or fuzzy miscommunication makes an already depressing situation even more negative and toxic. Micommunication or impediment of communciation can, at worst, worsen the patient's condition even resulting in critical issues occuring as a result.

It is to that end, that communication needs to be drastically worked on so that each member of the team is able to insert their best and most unique effort into efficiently and effectively communicating one with the other so that all can work together to the same end.

Tecomemndaitosn for nurse

Whether acute care nurse or hospice nurse both have to have excellent interpersonal skills with patience and ability to listen to the other. With the hospice nurse this is particularly important, since the brunt of her job depends more on listening to, being with, and making the patient feel good than actually treating the patient. She must also have the ability to remain calm and rational through extremely emotional situations and to assist others to deal with these situations in their best way.

As with the acute care nurse, the hospice RN has to be familiar with the ability to prescribe, diagnose, and treat her patient in all manners of ways, as well as monitoring that the nursing care is being provided as necessary.

The therapeutic relationship is different between the two professions by virtue of the fact that the former (acute care) is a short-term relationship and, therefore, emphasis is on physical treatment and monitoring of the patient with the intention of him (oftentimes, although not always) recuperating. The objective is towards the goal of effective recovery or, at least, helping him towards the motions of recovery. Hospice care, on the other hand, is a long-tem procedure, sometimes it may last for years, with the caregiver well-aware that the hospice serves as the patient's last home and is a substitute for medical care. The emphasis here is on therapy to domination of medical care, where the hospice nurse doubles over as counselor and confidante and where maximum value is placed on characteristics such as patience, empathy, communication, friendliness, and equanimity.

As Jaffe and Ehrlich (1997) demonstrate, hospice nursing differs entirely from other forms of nursing in that whilst other nurses attempt to preserve life, focusing on prevention and treatment, and, secondarily, on communications, the hospice nurse advocates, innovates, and educates. The chance for traditional methods of healing has passed. Now all the patient is left with is to live out the rest of her life in comfort, and whilst her medical system is maintained, the hospice nurse considers herself free to innovate in order to make that regimen as comfortable as possible for the patient. To this end, the hospice nurse summons a multidisciplinary spectrum of professionals -- such as chaplains, social workers, nutritionists, psychologists, and therapists -- to help her in her job.

As an aside, as with any nursing profession, in general, and with helping the dying person, in particulr, I realize that the practitioner / caregiver has to be mentally and physically healthy herself before she can help others. A licensed practical nurse, particularly if she is to help others make the most of their last dying moments, has to be aware of the preciousness of life and what it means to make the most out of it as well as to take care of herself and not allow herself to be depressed and frustrated by the challenging situation. By caring fior herslf, it will be easier to commucnaite with othrs and to be abel to negotiate stress better. This si paritucalry improatn sicn estress is an unavoidable nad regular compoentn of her life.

Tecomendations for people

Thirdly, being aware of Kubler's stages of death and relying this information to Mrs. Thomas and husband will be helpful. Elisabeth Kubler-Ross presented five distinct stages that a person goes through before he or she expired consisting of denial, anger, bargaining, depression, and acceptance. Each and every person goes through at least two of these stages although not all in the same order. Awareness of the ubiquity of these stages and their being experienced by both Mrs. Thomas as well as her immediate family will better help them deal with the situation. Hence, this is another strategy that I will employ to help Mrs. Thomas and her family move closer to the reality of her death. The five stages, in elaboration, are: Denial: The individual seeks to deny the reality of his or her situation feeling that this cannot be happening to her; Anger: Frustration, rage, and envy particularly so if the individual is young or relatively young as in the case of Mrs. Thomas; Bargaining -- The individual bargains with a higher power promising this higher power self-reformation or specific types of sacrifice in return for prolongation of life. It may also take the form of reliving past experiences, fantasizing how one may have strategized so that things would be different. In this instance, the Thomas family may be berating themselves over actions that they could have taken to prevent the cancer; Depression -- the individual (and others close to the individual)_ retreats within herself to mourn loss of her extension of life and to attempt to come to grips with that reality; Grief where the individual may refuse visitors, spend much of the time crying and grieving, and become silent; and finally acceptance where the individual is reconciled to the inevitability of her demise.

In aparitucalry moving story, Jaffe and Ehrlich (1997) talk about a dying preacher who was trying to reconcile his family to his approaching death and the RN nurse's advice was particularly thought provoking in that she urged him not to fight the pain but to recognize it and to focus on life despite it. This would be my message -- not only for myself in turns of enabling me to go through the emotional circumstances but also to help my patient and those related to my patient (whether Mr. Thomas in this case or the extended family) deal with the pain and focus on making the most of the remaining moments. My recommendation would be to recognize the pain but to continue despite it so that all individuals in this scenario -- Mrs. Thomas as well as Mr. Thomas and their children can make the most of the remainder of Mrs. Thomas' life.

Tecommendaitons for the family

Carign for a dyign person si but one of many different stressors that hit the family at oen go and cvan become overwhelming, paritualry if other emtoiosn sucha as loss, sentumetn, or guilt are involed. A wonmderful model that has been developed for just sucha sitution consists of the I would use the diathesis model of depression helpful since it merges all explanatory accounts of and treatments related to depression and provides a holistic method. The diathesis model was created by Schotte et al. (2006) who recommended a two-tier model of depression built upon a psychobiological approach. The first tier offers a descriptive diagnosis of depression, whilst the second tier is therapy-oriented and connected to a biopsychological theory.

The treatment phase of the model proceeds in three stages. 1. The demoralization phase aims to educate the Mr. Thomas as well as his family regarding the details of his condition using the biopsychological perspective as a framework (i.e. that his condition is caused by a combination of biological and psychological components particularly stress) and my aim would be on generating hope that Mr. Thomas, with the help of family and friends, can overcome his depression. Counseling skills and patience will be used to break down depression whilst emphasizing and making Mr. Thomas aware of the possibilities for remission. 2. The remediation or symptom reduction phase stresses that the patient need not be actively involved with recovery, therefore he need not feel responsible for its process or guilty if he doesn't see immediate results; rather, that recovery incrementally occurs without his knowledge. The objective is to impede rumination. 3. In the third stage -- relapse prevention or rehabilitation -- Mr. Thomas will be encouraged to participate in activities (such as hobbies that he enjoys, listening to music, socializing, his work and so forth) and to move towards increased interest in his work, and other components of his life outside of his depressing domestic situation. The whole model would focus around prevention and intervention where prevention aims at reducing the individual's psychobiological vulnerability (via for instance reducing the stress facing Mr. Thomas by enlisting the aid, for instance, of his children and coworkers) whilst intervention seeks to strengthen that same vulnerability (via for instance cognitive-behavioral techniques or other depression-reducing interventions).

Soemtiems, conflicts in commucantion occur inthis type sof stiaution when ethical condudresm are invoeld such as a perosn wishing to die whislt eveyroen else wants her to live on, or the gnawing unceratiny about whehtre or not teo tell a perosn tha the is fatllay ill. All of this is aggravated in the case of a child. In all, the patient's wishes should come before all else and this concerns child as well as adult. The United Nations Convention that states that children should have a voice. Indeed, Article 12 of the United, United Nations Convention on the rights of the child, talks about children having a voice in all matters that affect their welfare (CDA6002 Transcripts). The conflict is between parental rights and that of child; if the parents feel it is damaging for child to be told, (or if the parents -- knowing the child better than anyone else may know the individual -- feel that the child will opt out of the procedure due to the pain) whose wishes take precedence?

For the nustes, e this too is a conflict paritucalry sicne her nature desire is to cure and when a child is ivovked the cionfklcuit is intenisified. Ultimately, the nurse is there to make the last few days of the patient as comfortable and as painless as possible., a nd this has to be done according to the wishes of the patient.

Characteristics of te commucaniton in a conflict sitution according to game theory.

game theory proposes that interpersonal communication is marked by people trying to guess each other's decisions and outsmart one the other. It may also act as a tool for predicting the outcome of the game.

many aspects of communication could be explained by the game theory approach, where players (in strategic manipulations) compete against the other, each desiring and aiming to receive their own outcome.

There are various games in game theory. One may be that existent between genders (the 'gender' game) where men and women have different ways of communicating and of attempting to persuade the other. For instance, Tannen (1996) believes that males "try to achieve and maintain the upper hand if they can, and protect themselves from others' attempts to put them down." (Tannen, 1996, 25), whereas females play that game that "conversations are negotiations for closeness in which people try to seek and give confirmation and support, and to reach consensus" (ibid.). The objective is for controlling the conversation ('being in the driver's seat') and for power.

Each of the communication styles are bounded and guided by 'information' or rules. For instance, communication games, howsoever much the intent of the participant is otherwise, is controlled by the 'rule' of politeness. According to Cook (1997), for instance, females have "learned to cajole and please." In situations when this rule is broken, women are, consequently, perceived as being 'unwomanly'.

Non-zero-sum ness is another example of another sort of game that exists in communication where the players' interests overlap one another. Their separate goals are congruent one with the other, and, therefore, there is no disagreement, but an atmosphere of good will. Zero sumness on the other hand, represents the reverse situation; here players vociferously compete with one another, whilst the 'equilibrium' situation represents a case where each player has adopted a strategy that they are unlikely to change. Other categories of games are: cooperative and non-cooperative where players do, or do not, form commitment to playing / agreeing; symmetric and asymmetric, where the game's outcome (or the communication's outcome) depends, or does not, depend on the identity of the players); simultaneous and sequential where players either move simultaneously (not having information about the other player's earlier actions or intentions), or where players move sequentially (where one player possesses knowledge of the other's intentions); perfect information and imperfect information (where all players do, or do not, know the moves made by other players; in other words whether they are, or are not, in sync with other players); infinitely long game (the focus here being not so much on winning, but on knowing whether one of the players has a certain strategy); discrete and continuous games (possessing only certain rules or extensive rules); one-player or many-player games; and metagames (where this game formulates or assesses the rules of another communication game).

Listneing

Jaffe and Ehrlich's book, All kinds of love: Experiencing hospice, rells a story that shows better thatn anything else how I mproatn open commucnaiton, acceptance and lsuitenign is to te h moraltly ill. Sandy was gay and revealed this fact to his parents when he was 23 who, shocked by the news, rejected him. Shortly after, Sandy was diagnosed with a terminal illness and was hospitalized demoralized and depressed. Janice, the hospice nurse was summoned by his boyfriend to the scene and she was followed by Sandy's grandmother, who arranged to help Sandy through the illness. Existentialist questions on Sandy's part gave Janice the original idea of adding a chaplain to their team. Chaplain Frank suggested that the patient's parents be contacted. Sandy's mother soon came and, in the hospital environment, the two female family members acknowledged Sandy's lover as part of their family. After a ten-day interval of Sandy finding respite, the chaplain prepared the family for the end, and Janice instructed the grandmother and Joe regarding symptoms of death and how they should deal with it. Janice's innovation was bringing the chaplain into the case. Doing so resulted in ramifications that helped Sandy achieve closure and, accordingly, die in peace.

What communcaiton is

Communcaiton entails the give and take so that each side understands, is open with, and directly communcaites their perspective and sittuion to the other so that potential conflict is broken theorugh and a stae oof peaceful transparency exists.

How to best do this is illustrated by the follwoign stoy:

Jon the dying preacher is an example of where dying in peace and comfort is the most important aspect that a hospice nurse can gift a patient. Both Rose and Jon had adjusted to Jon's imminent death and attempted to encourage their daughters, Susan and Joan to show Jon that they could easily communicate and come to grips with his transition to death. Joan was the least able, but realizing that Jon wanted to make the most of his last moments on earth and that he, as terminally-ill patient wanted to live each and every one of those moments to the fullest without remorse and pain, Janice, the hospice nurse, enabled the daughters to express their feelings, to be mutually open with their feelings, and, letting themselves feel the pain, to savor each moment to the fullest.

Communication is a process between sender and recipient. It is meant to be effective so that the process is as smooth as possible with both recipient and sender, regardless of different context, background and experience, sending and receiving the message in a way that each intends the message to be deciphered. The goal of the communication process is to accomplish a certain bond of shared meaning and understanding to transpire between sender and recipient for message, and that this message come across intact and be rebounded time and again intact, without any breaks and conflict; at least until the end of the session.

Active or emphatic listening, on the other hand, involves a state of mind where the recipient fully engages himself to tuning it to the other's words and gestures, and accords the message and messenger his/her fullest attention.

Skills of listening are achieved by paraphrasing, reflecting, and summarizing the other's words in order to ascertain that one understands and that one has been understood as intended; to intermittently investigate by asking whether the other has understood the content of one's words and agrees with the content and structure; to openly state that one feels misunderstood (if one feels so) and request feedback; to absorb gestures and emotions of the other as one is listening; to lean forward in order to convey interest and so forth. In short, active listening requires the ability to attend which means focusing in on the message and screening out distracting elements.

Spielberg compared the listening brain to a sponge -- soaking it all up. That is a very powerful image.

Usually, stories can teach us better than straightforward prescription how to behcae in ceritn way.

This is the sotry of Janice a hospice nursebrough down by th e heroine herself, who shwoed how she best communcaited with the family when they had difficutly caring for Minnie, their elderly moteher hwo was dying. Minnie, a widow in her early 60s had spent the last few years struggling to defeat her breast cancer. Succumbing, she moved in with her daughter Jane and her lover, Howard, together with Jane's two adolescent daughters Amy and Beth. Each member of the family (Minnie included) experienced frustration and difficulty with the arrangement, hence Janice arranged that a volunteer visit the family on a frequent basis, and both Janice and the volunteer (Elaine) served as mediator (and sometimes arbitrator) between Minnie and the various family members. For instance, when Minnie was aggravated by Jane and Howard's unmarried status, Janice encouraged Minnie to speak to Jane, which was accomplished with satisfactory results. In a similar way, Elaine empathetically helped Amy understand why her grandmother 'usurped' her bedroom and that this 'living-in'; arrangement would be only temporary. Educating the family regarding the contingencies of death and how to best deal with the challenges of the situation, Elaine and Janice helped Minnie receive the loving care that she most needed. After her death, both case worker and assistant continued helping the family.