Conversation 5: Good example

District Nurse and son. Son goes into practice to ask DN about his father 2 days after discharge.

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Signs of expected deterioration - important to know how the family are understanding this change.
There is a perception that conversations such as this take a very long time but actually, quite significant conversations can happen in 10 -15 minutes - however, it is important not to give the impression of being rushed - in a situation like this it would be appropriate to say you only have about 10 minutes but can arrange to speak later if you don't cover everything
Set boundaries at the start of conversations

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Complex family dynamics - evident
Queue re "mixed up"

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Reflecting back
Checking what son’s understanding is of his condition
Good to ask patients early in an illness such as this if it is ok for them to share information with family members

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Gently explaining the fact that their father is deteriorating
Offer practical advice and support

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Small chunks of information
Empathy
Using components of SAGE and THYME

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Reflecting back
Families often get distressed at their loved one not eating - often causes conflict (Bazian)
Gently approach to explaining re the reduced need for fluids

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Families are more likely to be distressed by reduced ability to eat than the patient - relatives would welcome the opportunity to talk about nutrition/ hydration (Bazian report)
People are more likely to believe that clinically assisted hydration is beneficial and will improve quality of life until they have experience of it (Yamagishi et al 2010)

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