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Mindful Communication in Palliative Care: Enhancing Presence and Active Listening

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This guide focuses on the importance of mindfulness and active listening in palliative nursing. By defining key concepts like mindfulness and presence, we explore how these principles can enhance communication with patients and their families. The text emphasizes developing core attitudes such as empathy, acceptance, and attentiveness during clinical encounters. Practical communication skills are outlined to help healthcare professionals practice mindful presence, which can significantly improve patient experiences and relationships within teams.

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Mindful Communication in Palliative Care: Enhancing Presence and Active Listening

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  1. COMFORT* • Communication (narrative) • Orientation and opportunity • Mindful presence • Family • Openings • Relating • Team * Wittenberg-Lyles, E., Goldsmith, J., Ferrell, B., & Ragan, S. (2012). Communication and palliative nursing. New York: Oxford.

  2. Objectives • Define mindfulness and presence in clinical encounters • Describe active listening • Identify two communication skills that can assist with mindful presence

  3. Mindfulness • Originated in Buddhist philosophy • Tenets of mindfulness: • Purposefully attentive • Awareness • Flexible state of mind • Contrast with mindlessness • Habitual behaviors

  4. Mindful Presence Mindful Communication • Awareness of situation • Being in the moment • Attention focused on present moment Presence emphasizes personal experience • Acceptance • Patience, Trust • Suspension of personal preference/critical thought

  5. Core Attitudes* • Perception • Active listening • Getting involved • Creating space “Being is as valuable as “doing” *Simon, T., Ramsenthaler, C., Bausewein, C., Krischke, N., Geiss, G. (2009). Core attitudes of professionals in palliative care: A qualitative study International Journal of Palliative Nursing, 15(8) p. 408.

  6. Mindful Presence • Patients/family • indirect cues of emotion • missed empathic opportunities

  7. Healing/Compassionate Presence • Empathy • Patients/families: • hesitant to express emotions • present indirect cues instead • Listen for feelings • Witness the suffering of others (Ferrell & Coyle, 2008) • Be mindfully present • Practice empathy • Offer compassionate voice • Recognize impacts of illness

  8. Active Listening (Wood, 2000) • Hearing versus Listening • Listening involves: • Attend to nonverbal cues • Listen without interruption • Ask questions to clarify • Paraphrase interpretation in own words • Ask if interpretation is correct • Empathize (paraphrase feelings of speaker)

  9. Five Principles of Effective Listening • Focus on feeling words • Note the general content of message • Observe speaker’s body language • Do not fake understanding • Do not tell speaker how he/she feels Adapted from R. Bolton (1979). People Skills. Englewood, NJ: Prentice-Hall in MacPhee, M. (1995) The family systems approach and pediatric nursing care. Pediatric Nursing, 21, 5, 417-437.

  10. Other Aspects of Listening* Silence • Listen without interruption • Provides opportunity/permission to disclose • Conveys empathy • Allows for deeper expression of concern *Dahlin (2010)

  11. How we see others… • Experience (perceived by I-IT*) • Person seen as object • To be manipulated/changed • Relation (perceived by I-THOU*) • Person seen as unique • Culmination of life experience/complex • Positive regard *Martin Buber’s work on the dichotomy of viewpoints

  12. Seeing Differently* • Perception-shifting • Vivid sense of appreciation and beauty • Seeing what needs to be done • Leaning into stillness of activities • Cultivating openness without agendas *Bruce & Davies, 2005

  13. Mindful presence of the Nurse • Family meetings • Watch for indirect emotional cues • Remind team members to practice silence • Team meetings • Observe team members for compassion fatigue • Encourage self-compassion • Allow for self-reflection and self-healing

  14. Nurse specific topics • Pain • Be aware of quality of life domains • Spiritual, physical, psychological, social • Communicating about spirituality

  15. Mindful of Self-Care Needs • Burnout and compassion fatigue • Be aware of: • Motivations • Thoughts, feelings, attitudes, beliefs, compassion • Engage in self-reflection, self-healing

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