Strategies for Enhancing Effective

Communication in the

Skilled Nursing Setting

Presented by: Dr. Robert Figlerski, Director of Behavioral Health Services

Team Health, Inc., Mid-Atlantic Region

Office: 914-949-1199

email: rfiglerski@ipc-hub.com

13/21/2018

WHAT IS COMMUNICATION?➢ A means of connection between people or places

➢ Exchange of information

➢ The act of conveying intended meanings from one entity or group to another through the use of mutually understood signs and rules

➢ Entering into a relationship

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➢ Interpersonal communication is an exchange of information between two or more people.

➢ Successful communication is based on the “message senders” and the “message receivers” understanding of the message.

➢ Factors that influence communication are personality, language, non-verbal signals, emotional experience and expressive ability.

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➢ Knowledge of an individual’s culture, background history, personal experiences, losses, etc. factor in

➢ This information will help us to be attentive to appropriate and sensitive communication

➢ Use your intuitive knowledge, you are smarter than you think

➢ When approaching someone who is anxious or depressed be mindful of your own anxiety/mood state and reaction to them (counter-transference)

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➢ The Art of Communication is respectfully meeting the individual where they are, with minimal interference from our own emotional experience/histories

➢ This promotes ”connection” and understanding

➢ This does not mean that you must agree, however agreement of some measure often accompanies connection

➢ Respect is the key word

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➢ Older adults often respond favorably to good communication which includes sensitivity and respect

➢ They are more likely to develop trust➢ More likely to respond to our creative “solutions”➢ Generally, older adults who feel respected will respond to

cognitive-behavioral “solutions,” such as “re-framing”➢ Limit setting and boundaries can also be achieved, both

with them and as interventions for them, with others

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Residents & Families

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FAMILIES ARE CRITICAL KEYSTO OUR SUCCESS

The Varied Roles they play:– Customers– Advocate – Partners– Watchdogs– Referral Source– Complainer– Potential Legal Adversary

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Families & Residents are influenced by:

➢ General media – sensational reporting of abuse, neglect or mistreatment

➢ Public’s negative perceptions or stigmas regarding sickness, aging & death

➢ The real and perceived loss of control and dignity in institutional, medical settings

➢ Families’ own anxiety/guilt/fear…leads to confirmation bias

PERCEPTION is 9/10ths of Reality….

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Family Factors/Reactions ➢ Adjustment problems to transition and change in role

➢ Guilt/Compensation

➢ Displacement/Projection of Feelings

➢ Introduction of longstanding family problems

➢ Vulnerability and Distrust

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Examples of Longstanding Problems

➢ Role in Family…examples:

Favorite child

Unappreciated/sacrificing spouse

Overly responsible daughter

➢ Unresolved emotions/needs

➢ Conflicts between first and second families

➢ Sibling Conflict

➢ Mental health issues

➢ Hidden agendas

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Results of Family Factors➢ Small issues escalate

➢ Struggle for power

➢ Chaotic interactions

➢Difficulty responding to concerns

➢ Targeting of staff

➢Outburst/threats

➢ Loss of boundaries

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Effects on the Caregiver➢ Increased frustration➢Arguing with Resident or Family Members➢Feelings of being manipulated/exploited➢Avoiding resident➢Feeling angry at the resident➢A loss of professional objectivity➢Contamination of care environment

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Consistent Findings

90% of unresolved conflicts are caused by a small number of families and residents!

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Common Factors Leading To Conflict With

Families

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Summary of Major Problems With Families• Families attempt to control

Staff

• Families attempt to dictate medical care

• Interested in having their way at expense of care

• Families unlimited access to Staff

• Families distorted views of Staff’s motives

• Families sense of entitlement

• Families violation of rules

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What Families Do To Get What They Want• Threats or false complaints

• Harass Staff

• Demand information from other residents

• Badger other residents

• Wait for Staff at beginning of shift at elevator door

• Complain about Staff to other families

• Spread rumors

• Intimidation/abusive towards Staff

• Interrupt care of other residents

• Disrupt Care Routine/Contraindicate Care Plan

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Major Problems With Families in Short-term Rehabilitation

Blame Staff for lack of progress

Demand more PT

Families resistant to appropriate discharge

Demand resident to be placed into LTC (not qualified)

Demands for

re-evaluations

View Short-term care as a road to Long-term care

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Major Problems With Staff Behavior➢ Complain about their job to Families

and Residents

➢ Discuss personal problems with Families and Residents

➢ Cater to demanding Families

➢ Accept gifts & gratuities from Families

➢ Act-out anger towards resident or a difficult family member

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Strategies

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Care Pyramid

21

Admin

Directors

Doctors

Specialty Staff

Supervisor

Nursing

CNA

Resident

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The Goal ofHarmonious Communication

➢Active listening by both parties

➢Establishing a shared agenda

➢Cooperative action….i.e. resolution

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Interpersonal Themes

➢Trust versus Distrust

➢Listening versus Presenting

➢Co-operation versus Competition

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What Gets You Stuck?➢Patience versus Urgency

➢Calm versus Intensity

➢Empathy versus Judgment

➢Connecting versus Defensiveness

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When Problems Arise

➢ Conflicting agenda

➢Misinterpretations

➢Fundamental distortions in perceptions

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Listening

➢Listening is not agreeing

➢Arguing is not listening

➢Listening in and of itself can be helpful

➢Listening is an active process

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Clarifying

➢People often have trouble putting their concerns into words…they aren’t sure what they want…Tsunami of concerns

➢Help narrow broad issues into actionable steps

➢Empathize…Empathy is not agreeing

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Clarifying Statements

➢“I am trying to understand your concern so I can figure out how to help…tell me more”

➢“I hear there is a lot going on…lets start with..”

➢“Lets see how you and I can develop our next step…”

➢“I think I understand what’s happening, your concern is…”

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Non Defensive Posture

➢People often feel they have been wronged, so they want consequences rather than resolution…they attack

➢Good communication often starts by allowing person to vent

➢A defensive response on your part derails progress toward resolution

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Non Defensive Response➢ “You certainly have the right to do that, but before you do let me see if

I can help resolve the matter”

➢ “I am concerned about this also, let me look into it more.”

➢ “I see you mom almost everyday and I want her to be happy with her care just like you. Let me review what’s happening”

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Suggestions & Practices

➢Goal is not establishing who is right or wrong

➢A disagreement is not the same as poor communication

➢Avoid over promising and under delivering

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Care is based on trust

• The first few days of admission are key to developing trust

• Communication is the critical link to a successful admissions process– Identify and set realistic expectations

– Educate and engage resident/family

– Implement common goals with realistic outcomes

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Other Lines of Communication

➢ Resident/Family education programs

➢ Scheduled phone calls with designated family contact points

➢ Family Councils

➢ Ethics Committees

➢ Newsletters

➢ Resident/Family Satisfaction surveys

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Interpersonal Style

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Professionalism and Objectivity

Factors that diminish our professionalism:➢ Placing our beliefs/values on others➢ Overreactions to residents and families➢ Losing sight of our role & responsibilities➢ Ignoring our contribution to the problem➢ Becoming rigid/inflexible➢ Losing sight of the bigger picture

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Effective Communication to Resolve Conflict

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Daily Practices

• Don’t personalize

• Stay calm, but set limits

• Don’t struggle for power

• Avoid contaminating the care atmosphere

• Establish realistic expectations for both

family & resident

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What is the Most Powerful Psychological Intervention

In aSkilled Nursing Facility?

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Maintaining Respect & Dignity!

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Information & Presentation by:

Team Health, Inc

3 Barker Ave, 4th Floor

White Plains, NY 10601914-949-1199

Dr. Robert Figlerski, Director of Behavioral Services, Mid-Atlantic Region

403/21/2018