C—Connect

To connect is to achieve shared understanding in communication. Patients and families facing serious, chronic, or terminal illness have a story to share. Most of them want to communicate their journey and want to believe that the providers in their midst know them. Patients and families desire a connection with their nurse and the need to be understood, especially in terms of the challenges in their illness journey. Learning to listen deeply to patient/family stories and capture important information about what they value can lead to connecting with patient/family. Encouraging storytelling, listening to quality of life issues, and practicing person-centered communication are cornerstones of communication in palliative nursing. These principles work together to accomplish narrative clinical practice.

T—Team

The interdisciplinary team is central to the labors of the palliative care nurse. Nurses need team communication skills to lead the palliative care team or establish leadership within the team. Team-building skills include encouraging other team members to actively contribute during team decision-making, fostering opposing viewpoints when they arise in care planning, and evaluating team goals and communication processes. This chapter presents an overview of team communication, focusing on interdisciplinary collaboration and interprofessional practice and warning against communication processes that lead to groupthink. In truly collaborative teams, intellectual resources are utilized; there is a commitment to interprofessional care, respect among team members, inclusion of individuals with diverse perspectives, effective meeting leadership, systems of mutual support and accountability, and productive time management focused on new information relevant to patient/family care.

R—Relating

Relating is a chapter that unpacks the complex architecture of goals always at play for each of us. Because the true motives and goals of a patient are rarely fully understood or realized, the recommendation in this chapter is to attend to the relationship to facilitate the instrumental goals of palliative nursing. Throughout this chapter, authors examine the phenomenon of the patient/family acceptance of an illness status, as well as understanding patient/family perspectives on adjusting to new information. The authors examine the role of uncertainty and how it can impact goals of care discussions and, ultimately, decision-making. Relating to a patient/family creates the opportunity to learn about acceptability of a diagnosis/prognosis, fears associated with uncertainty, and the inevitable dissonance among personal goals in the face of serious illness. Multiple, conflicted, and unrealized goals are a reality that clinicians must navigate and that patients and families must face as they work together to acknowledge a changing life and identity.

O—Openings

Openings offers specific tools to assist the nurse in traversing the challenging yet profoundly rewarding moments of transition that require the clinical practice of intimate openings with the patient/family. Replacing evasion with an opportunity to move into tension and avoidance is essential in helping a patient/family receive palliative care. Observations of tension might be clear indications of a needed transition in care. Complex interactions with patients and families coincide with transitions in care and require intimate and disclosive exchanges among patient/family and nurses. Communication privacy management theory helps us understand more about private information and how that information depends on the relationship people share. Communicating a transition to palliative care from hospital to home or to end-of-life care and hospice requires nurses to address a patient’s/family’s fears and feelings of hopelessness and to provide education about palliative care and its services. Facilitating appropriate access to private health information, creating intimate openings to process transitions in life and care, and understanding the impact of disclosure on patient/family relationships all play an important role.

F—Family Caregivers

Family is essential in navigating and delivering care for patients and is central to the success of a care plan. Nurses are information providers and communication facilitators, educating the patient/family about illness and procedures, challenging family members to consider the consequences of treatment, and encouraging awareness about a patient’s decline over time. Recognizing that family is significantly impacted when a loved one is seriously, chronically, or terminally ill can foster partnerships and bring supportive, clear communication to the family’s care experience. Learning about the family’s history, their background, the primary caregiver’s family role, and the needs of families are vital to patient- and family-centered nursing. Seeing the patient/family as one unit is vital to delivering palliative care. A family system and its pattern of communication precede any illness experience. That pattern of communication sets the stage for specific caregiver communication behaviors that impact patient care and outcomes.

M—Making Meaning

Making meaning is predicated on the notion that helping patients and families make meaning of their suffering is a valuable contribution that palliative care nurses can make. The Voice of the Lifeworld of the patient/family is juxtaposed with the Life of Medicine to help the reader recognize the powerful meaning of the life lived outside of the illness. The chapter explores the patient’s quality of life and the spiritual and/or religious life spaces of patients/families. Presence is that quality of being there for the patient or family member, either physically or psychologically, or both, and being nonjudgmental, unscripted, and spontaneous. Thus, a mindful presence means that the nurse is totally dedicated to the circumstances of the here and now, regardless of what has gone before or what is predicted to follow. It is a valuing of “being” over “doing,” in the belief that compassionately bearing witness to a patient’s/family’s suffering may be the greatest gift a provider can offer.

O—Options

Options are provisions of care that a nurse can provide, primarily through successfully created and shared messages. This chapter contends that patient and caregiver health literacy is co-created between providers, systems, and communities. This approach to health literacy moves from an information-based focus on health education with patients to the realization that knowledge does not equate with understanding and, importantly, understanding does not equate with behavior. Cultural and linguistic preferences cannot and should not be essentialized or assumed based on appearance, ethnicity, origin, or other individualized variables. Cultural humility moves beyond cultural competence to recognize each patient and their caregiver(s) as individuals. Communication accommodation theory (CAT) grounds the themes in this chapter and is a useful foundation as nurses consider all patients and families unique in their culture and health literacy needs. CAT includes three categories of accommodation that occur in all communication events. Convergence, the most successful path described in CAT, is characterized by alignment and adaptation in communication and relationship.

Introduction to the Communication Approach

The introduction to the volume emphasizes that communication between nurses and their patients and family members does not consist merely of disseminating information. Instead, nurses must view communication as the mutually beneficial creation of meaning and that the nurse and the patient/family collaboratively affect each other’s communication. Every message has two levels of meaning: the task level, usually conveyed by the words themselves, and the relationship level, generally conveyed by nonverbals. Nonverbal communication relays most of the meaning of a message and affects both the task (patient care) and the relationship (communication climate) between nurses and patients/families. For this reason, it is essential that verbal and nonverbal communication receive adequate attention. The six components of patient-centered communication include both task and relationship aspects of patient-centered care. The chapter ends with a brief description of the communication model that undergirds the entire book, the COMFORT model, which outlines palliative care communication.