 Feelings of the Nurse:

According to Maria Browall ( 2014 ), Existential encounters: Nurses' descriptions of

critical incidents in end-of-life cancer care , The analysis of the nurses' experiences of existential
situations when caring for patients in end-of-life cancer care : Feelings about the importance of
having the courage to be emotionally intimate and take the time to sit down and let the patients tell
their story and try to inspire hope were described. Some of the nurses described that they felt
special; to be chosen by the patient as the one they felt able to communicate with about their most
difficult issues concerning death and dying. Some described feeling privileged to be let in and be
involved in the patient's life in this way and to have access to so many life stories.
While asking those questions, it felt like knowing a person deeper than you would normally
have with your close friends. Every aspect of the patient’s life is laid down in front you by asking
those questions. Their life was like an open book that was free to explore, read and to be able to
know their thoughts and plans for the future that they wish to reach. However, It is really difficult
to communicate bad news when you are in the shoes of the health care provider, luckily, as
undergraduates, we are given a training ground to do such through basic concepts given by
professors. As stated by Ahmed and Alelwani in a research entitled Medical training for
communication of bad news: A literature review, training in disclosing bad news is essential for
undergraduates and even postgraduate doctors for it enhances the skill of communicating to
patients. The skills needed to be trained not only focuses onto disclosing the news verbally but
also observing for non verbal cues of the patient and considering their cultural background in doing
such.
 Patient’s Perception:

The conversation made me somewhat explore all the aspects that are important to
acknowledge during my illness. Having all my questions answered and being provided with
information, made me less fearful of the course of my illness. Answering the questions made me
feel like I was exploring all my concerns, and one by one they are being addressed. Knowing my
options gives me the chance to really decide on what’s best for my care to ensure a quality of life
for myself.
Patient's perception of EOL needs multidimensional care. These cares are addressed in a
journal entitled "PATIENTS AND CARER PERSPECTIVES" by Stajduhar, K et al. It states in
the journal that communication has four key elements that patients are considering as important.
1. Importance of time where in it showed that the amount of time providers spend with them are
very limited to the explanation of their condition. 2. Acknowledging fear is important to these
terminally ill patients because it will help them in talking about their concerns with their care
providers. 3. Balancing honesty and hope in the information about to be given to them. 4.
Demonstration of caring is important for participants to make them feel reassured of their
condition.
 In conclusion, effective communication that achieves the criteria mentioned above,
empowers a patient. Since the patient felt less fearful and more hopeful by having the necessary
information that she needs, she is able to better plan and participate in her care.
HBO movie: Wit Reaction Paper
A. Discuss the process of communicating to clients with life-limiting condition
(DISCLOSURE), importance of communication (with the interdisciplinary team, patient
and family) throughout the end of life.

It was discussed that in palliative care setting, bad news is not only limited to the
disease of the patient, the diagnosis, recurrence, disease progression, lack of further
treatment that desires to heal the patient, comfort care and terminal prognosis of the disease
(Ferrell, 2006). In the movie, it was not elaborated comprehensively by the doctor to the
patient of how the treatment will flow, what are the tests meant to reveal and how would
the patient’s body be affected by the course of treatment. There is no full disclosure of the
treatment plan as well as the possible outcomes. According to a module about
communication with patient and family, good communication is crucial to convey the
seriousness of the illness (as difficult and sad a task as this may be), the expected course
and treatment alternatives including palliative care. Only through good communication can
pain and distress be alleviated and decisions regarding treatment and advance care planning
are made. Only through good communication can physicians convey their caring and
empathy for dying patients and provide good quality end-of-life care (Hawryluck, 2000),
this means that it is the filial duty of the health care providers to disclose relevant
information that the family and the patients should and want to know regarding the course
of treatment until the end-of-life decisions. A good communication and disclosure must
involve the understanding of the patient and family on the condition. The healthcare
provider (doctor) must also explain and explore options and /or alternatives that can be
used as a treatment for the condition.
Rapport is very important to any patient-health professional relationship. The study
of Ross (2013) stated that rapport is very important to be establishing because it has a
positive effect on the patient outcomes. It has also been said that a positive trusting
relationship between the health professional and the patient facilitates gathering of
information that is essential to the establishment of diagnosis and correct treatment options.
In addition, patients who have a positive relationship with the health professionals are less
likely to have complaints and they have better level of satisfaction to their treatment.

B. Identify the barriers of communication in palliative care (family, interdisciplinary team and
patient).

There were several communication barriers within the interdisciplinary team. The
nurse was constantly being put in the sidelines when it came to the care of the client,
everything she said was for the client’s well-being as she was exercising her role as a
patient advocate but was ignored time and time which was seen when she wanted the
physicians to lower the dosage of the chemo to alleviate its adverse effects to the client,
when she wanted to give the client the option of having a patient controlled analgesic pump
to maintain her alertness and autonomy but the doctor recommended her Morphine instead
and when the client opted for DNR but the fellow called a code and the code team ignored
the primary nurse who kept telling everyone she was DNR causing the dignity and will of
the client to be disrespected and unacknowledged. All these instances point towards the
problem of forcefully silencing or squelching of an individual team member which is also
an identified problem by Ferrell and Coyle (2006) because non-physician voices are often
discounted or disregarded and that the team members had different or conflicting ideas of
what is right or wrong for the care of the patient. Another barrier was overwhelming the
patient (Ferrell & Coyle, 2006) which is seen during the physicians rounds when the client
was outnumbered by the number of doctors in the room as she had no say in her care or
what they did to her nor did she have a family member with her to help advocate her
feelings and concerns.
To the multidisciplinary team, the Semantic barrier or the use of jargons when
conversing with the patient. It was supported by Barrier of Communication (N.A, 2013)
that the use of jargons or medical terms to a patient not in the medical field is a barrier in
understanding what is being told to the patient. To the patient, Psychological barrier which
include the patient’s perception of being too strong and not letting anyone know about her
illness. This barrier blocks the patient from opening to anyone how she feels. Another
barrier would be Information overload, which include the fast and too much information
given to the patient an being too specific with the disease and treatment course, in the
movie, the patient was unable to absorb some things because of too much information and
being left in her room after the physician discussed everything.
REFERENCES/ WORKS CITED:
Alelwani, S.M., Ahmed, Y. (2014). “Medical training for communication of bad news: A
literature review”. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113982/

Ferrell, B. &. (2006). Textbook of Palliative Nursing. (2nd, Ed.) New York: NY: Oxford
University Press.
Girgis, A., & Sanson-Fisher, R. W. (1998). Special Section: Breaking Bad News: Current Best
Advice for Clinicians. Hospital Topics, 76(3), 9-16. doi:10.1080/00185869809596500

Hawryluck. (2000). COMMUNICATION WITH PATIENTS AND FAMILIES (Vol. 5). University
of Toronto and The Temmy Latner Centre For Palliative Care, Mount Sinai Hospital : Ian
Anderson Program in End-of-Life Care .
Maria Browall ,Ingela Henoch , Christina Melin-Johansson , Susann Strang , and Ella Danielson
(2014), Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer
care, Retrieved from https://www.diva-portal.org/smash/get/diva2:746054/FULLTEXT01.pdf

n.A. (2013). BARRIERS OF COMMUNICATION. Retrieved September 20, 2017, from

http://agrieconomics.uonbi.ac.ke/sites/default/files/cavs/agriculture/agriecon/barriers%20of%20c
ommunication%202.pdf
Ross L.(2013).Facilitating Rapport through Real Patient Encounter is Health Care Professional
Education. Original Research: Australasian Journal of Paramedicine. Retrieved from
https://ajp.paramedics.org/index.php/ajp/article/view

Santos, Aliny de Lima, Cecílio, Hellen Pollyanna Mantelo, Teston, Elen Ferraz, & Marcon, Sonia
Silva. (2012). Knowing the family functionality under the view of a chronically ill patient. Texto
& Contexto - Enfermagem, 21(4), 879-886. https://dx.doi.org/10.1590/S0104-
07072012000400019

Stadjuhar, K. et.al. (2010). Patient Perceptions of Healpful communication in the context of

advanced cancer. PubMed
ACTIVITY ON COMMUNICATION

Submitted on September 22, 2017

Submitted To: Don Dacumos
Submitted By:

GROUP A1
Corpus, Gian Paolo
Felizardo, Agaton
Bartolome, Jesiree
Bastarde, Gwendyll
Campo, Lyanne Kae
Cayabyab, Caryl
Clemens, Arianne Shane
Esporo, Rovina
Ferrer, Hanna
Gaewen, Pearl Khate
Nanasca, Yra Megan
Samonte, Joy