Difficult conversations

We have produced a 13 minute recorded PowerPoint presentation to support you when having difficult conversations at work, during the Coronavirus pandemic. We have provided some general principles around effective communication and have looked specifically at how you might use cues to provide more focus to your conversations. We also consider the importance of body language and use of your voice when wearing personal protective equipment (PPE).

• Prepare yourself and the environment as much as you can.
  • If possible, find a comfortable and private place to have this conversation.
  • Before the conversation, think about how will you end it – what advice or referral for support can you offer the person? What professional (doctor, nurse, registrar for death) do you anticipate they will speak to next?
  • Support yourself – who can you talk with to debrief?
• Engage and empathise with the person you are talking to from the outset.
• Start the conversation with a clear outline of what is going to follow.
• Find out some of what the person you are talking to knows, expects, and feels.
• At this point and not before, find out if they are with someone, or have someone to talk to afterwards.
• Bring the person towards an understanding of the situation – how things are, what has happened or is likely to happen.
• Use clear terms: either die, dying, death. If you wish to use gentler terms, make sure they can’t be misunderstood.
• If they cry, acknowledge with a soft tone of voice and express sympathy: I’m sorry. If they apologise for crying, reassure them it’s OK and understandable. If you can, avoid giving further information until they’re slightly calmer.
• Move towards ending the conversation – check they have understood everything and answer any questions.
• Offer words of comfort and tell them what happens next.

This is a summary of a blog by Real Talk training.

Below are a few things to think about when communicating using technology during this crisis:

• Planning and preparing your conversation is as important as it always has been, perhaps more so if unfamiliar technology is involved. Think about what you need to say and how you plan to say it.
• Try to make your environment as free of interruptions and distractions as possible.
• Technology is not always straightforward so be prepared for things like poor connection, distortion in sound, and not being able to access video.
• With some video conferencing technology there may be time delays, even if you can see the person’s face. Think about allowing longer pauses for the communication to reach the other person and for them to process what you’re saying.
• Check if the other person is alone or if others are going to potentially distract (or support) them.
• Find out what the person already knows and expects before you start.
• Deliver your message, clearly and unambiguously.
• Allow enough time to summarise and check they have understood, give them time to ask questions and clarify everything you’ve told them.
• Set out the next steps, and arrange a follow up if you think it is required.

Talking to relatives: A guide to compassionate phone communication during COVID-19 is a resource that has been developed by Dr Antonia Field-Smith and Dr Louise Robinson from the Palliative Care Team at West Middlesex Hospital. It is a guide for communicating with relatives with compassion during the coronavirus pandemic.

Breaking the news of a death can be particularly challenging when it has to be done over the phone. NHS Education for Scotland has produced a short film on this topic, which you can see below. It was launched before the coronavirus pandemic, but many of the key points will still be relevant for health and social care professionals.

This short animation produced by the Irish Hospice Foundation suggests a 5-step approach to delivering bad news. It’s recently been updated in response to the coronavirus pandemic.

When working in health and social care, it is inevitable that you will meet people who are bereaved. It is important to be aware of some ways to sensitively approach these interactions. This NHS Education for Scotland video about 'Talking and being with those who are recently bereaved' aims to help health and social care professionals communicate with families in this situation.

For more information on this video and other resources, please visit sad.scot.nhs.uk.