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How Better Conversations Lead to Better Care
“Would you want someone stressed, flustered and panicking looking after you when you’re dying?”
Sue Marshall pauses after asking the question.
At the end of life, the way healthcare professionals speak to patients and families can shape how safe, supported and understood people feel. At ellenor, Education Lead Sue helps train care home staff, nurses and support workers to become End of Life Champions giving them the skills and confidence to support people with dignity, honesty and compassion during the most difficult moments of life.
The programme, run by ellenor across North Kent and Bexley, helps healthcare professionals feel more prepared to have difficult conversations, manage symptoms and support families before a crisis develops.
So, what is an End-of-Life Champion?
“An End-of-Life Champion,” Sue explains, “doesn’t have to have a high level of education, or top marks – only a genuine passion for delivering high-quality end-of-life care.” Sue recounts the number of anecdotes she’s heard about care home staff leaving their posts after witnessing a ‘bad death’ – an emotionally and physically exhausting experience for any healthcare professional, registered or not.
It’s this type of damaging experience, Sue claims, that becoming an End-of-Life Champion can help to offset. By gaining proper knowledge around how to handle those situations where a patient may be deteriorating, these skills and strategies can be the difference between a situation in which a carer panics and dials 999; and one where they feel calm and confident to provide high-quality care.
“I’d like our End-of-Life Champions to walk away feeling much more empowered to deal with symptoms at end of life and not panic; to not get scared or have to leave their job. I’d like care homes to be able to retain their employees, too, and for families to feel confident that they’re leaving their loved ones in the right place; to trust staff completely.”
To this end, education in a hospice environment isn’t just good for the staff receiving that training (enhancing their career prospects, for example) – it’s good for the patients, and their families, too.
“Our training courses are constantly evolving, because in our field, nothing stays the same. If we kept doing things the same way, we wouldn’t be able to cope with any new challenges that come along. It’s why we’re constantly exploring lots of different things and not sticking to a rigid regime; it’s also how educating our healthcare professionals leads to better outcomes for patients.”
At the heart of end-of-life care is communication and, just as importantly, active listening. Sue believes healthcare professionals should feel confident enough to have honest conversations, not panic when somebody is deteriorating, and truly understand what matters most to the person in front of them.
But those conversations should not begin only at the very end of life. They should start much sooner.
“We teach our End-of-Life Champions not to wait until a patient is at the end of their life to have these discussions. By teaching good communication and active listening skills, and encouraging advance care planning, we help healthcare professionals better understand the person behind the patient while they are still able to express their wishes, feelings and concerns in their own words.”
Of course, communication can be difficult: particularly when it’s between a patient and a carer from different backgrounds. That’s why ellenor’ s End of Life Champions course places a cross-cultural focus at the heart of its approach.
“We, and the healthcare professionals training with us, need to have a strong understanding of diversity,” Sue says. “We have to be aware of different cultures, and what their expectations are when one of their loved ones is dying. This includes their spiritual needs: whether they’re re-discovering their faith at end of life, or simply want to see their home, dog, or a possession that’s special to them again.”
Regionally, ellenor is recognised for its commitment to end-of-life care education. Through collaboration with local facilitators including Heart of Kent Hospice, Pilgrims Hospices and Kent Community Health NHS Foundation Trust, ellenor is helping other hospices implement this training. Additionally, ellenor has developed remote learning modules in partnership with these facilitators, providing, healthcare professionals with the opportunity to undertake end of life training.
What’s more, ellenor – through a local facilitators’ collaborative that includes fellow hospices Heart of Kent and Pilgrims, as well as the Kent Community Health NHS Foundation Trust – is empowering other local hospices to roll this training out. The hospice collaboration has also developed remote modules to enable self-paced end-of-life care training courses for healthcare professionals.
For Sue, the ability to truly listen to patients is one of the most important parts of providing good end-of-life care.
“It matters more than anything else,” says Sue. “Because the patient, regardless of their condition or their abilities, is still a person; somebody who’s walked this planet alongside us. They might not have the insight to ask questions, but we can learn strategies to find out more about them – about their needs and wants; the things they love.
“We must ask: what’s important to them? Families often step in and tell you this, but by communicating with the patient, you hear it directly from them. You begin to understand their thoughts, feelings, desires and fears and only then, can we really use this one opportunity to get it right.”
“Everyone has the potential to have a good conversation and learn what a patient’s needs are. You just have to be willing to say the first word.”
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