Talking and listening form the bulk of our work other than our routine work of caring for the patient directly.
However, nothing stresses us out more than communicating with the patients’ family members or sometimes the patients themselves. Moreover, effective communication can immediately improve the nursing care without ever changing anything else in the care.
So why not spend today “levelling up” your communication skills?
There is nothing more difficult to learn than active listening skills, yet nothing more effective and powerful than this. Learn this and the world will open up to you.
This is a core part of counselling skills that is explicitly taught in motivational interviewing and in psychotherapy, it is taught as a part of validation skills.
This document below succinctly summarises the core skills. Please read through it at least once. But don’t worry about the other skills inside. Today, we are just focusing on reflective listening.
Here is another effective communication tool – validation
Validation essentially means something is valid. When we validate our patients or their family members, we are essentially telling them whatever they are experiencing is “valid”. We are saying that it is understandable that they feel angry, shocked or sad. We are saying that it makes sense that the patient really wants to eat char kway teow when he can’t eat that. Essentially their desires and wants are normal, regardless of whether those urges can be fulfilled or not. OK, you might then ask- why do we need to validate others? Well, this is because the nature of our emotions is such that once you name it and accept it as it is, the intensity reduces. The pioneer of Mindfulness-based approach to Psychotherapy Jon Kabat-Zinn called this in short “name it to tame it”.
Now let’s take a look at how we can do it.
Validation summary sheet for Palliative Counseling
(Adapted from the book “The High Conflict Couple” by Alan E. Fruzzetti PhD)
Note: The word “patient” refers to the nursing home residents as well as their family members
- Show that you are paying attention and listening actively
- Does not require you to say anything
- Maintain presence of eye contact. Nod, use ordinary conversational cues like “um-hmm” or “right”
- Do not be judgmental
- Be accepting of what he/she is doing or saying
- Acknowledge your patient’s experience
- Acknowledge what the other person is doing, saying, feeling, thinking, or wanting
- If you see a sad expression, just say, “you seem sad”
- If the patient appears shocked, just say, “it must be shocking for you to hear this news”
- Ask questions to clarify your understanding
- When we are not sure what our patient is experiencing, asking questions to clarify can be very validating
- “How are you feeling now?” “What is on your mind?” “What are your struggles?”
- Notice your tension, position, facial expression, and voice tone. Be sure to be mindful of your patient and ask in an empathetic way
- Understand your patient’s experiences in a larger context
- Tiredness, having too much to handle and having had a long day can lead to heightened distress
- When one is self-critical, try to validate the underlying emotions and ignore the judgment
e.g. If the patient’s family member said, “I am such a bad daughter” for not being able to come and visit her mother more often, you can validate by saying “you are afraid that she will be lonely.”
- Understand historical reasons for current experiences
- Focus on how your patient’s reactions make sense, given his/her previous experience
- Helpful to learn about what your patient’s life was before, both in his/her family of origin and other relationships
- An example of helpful validating experience: “It makes sense to me that you worry that you are not doing your best if you don’t send your mother to the hospital. She has been a good mother to you and you care about her.”
- Also clarify your own reactions. e.g. “But letting her pass away in the comfort of this home might reduce her suffering in her last days.”
- Find the “Of Course” in his/her experience
- Your patient will actually respond to a lot of things in ways that most people would respond. Just notice and be aware.
- If so, say so. e.g. “Of course, you feel/want/did that. Anybody would do the same.” Or use your own words to convey how completely normal his/her reaction was.
- Allow yourself to be as vulnerable as your partner/“me, too”
- Practice noticing when your partner is vulnerable to you. e.g. making warm eye-contact, disclosing emotions to you
- It means, “I am just as invested in your health as much as you do. I want things to go well as much as you do. I am sad about your current health status just as you are” and so on. (Note: only if you genuinely feel this way.)
Watch these videos of people putting these skills in practice.
Watch this funny negative example
Where did you get all these empathy from?
First session Agenda
- Punctuality rules
- Sign attendance sheet
- Lecture on validation – 15 min
- First roleplay:
- Lecturer asked for a volunteer to share a recent distressing event and validate. (15 min)
- The rest of the students to take note how the lecturer has validated. Everyone has to say something about what they noticed. (10 min)
- Second roleplay:
- Lecturer shared an experience of loss/grief/emotionally distressing event. The volunteer (a different one from above) validates. (15 min)
- The rest of the participants (all of them) takes turn to validate (10 min)
For those who have not attended the training, you could at least watch this.