Hospice Friendly Hospices - Report On Relating Well To Residents in End of Life Care

Amended Final Report
Pilot Project:
Relating Well to Residents in
End-of-Life Care
Anonymised version of report to the
Health Services National Partnership Forum
by
Helen Harnett & Denise Robinson
on behalf of the
Hospice Friendly Hospitals Programme
October 2009
Pilot Project: Relating Well to Residents in End-of-Life Care
Proposal to HSNPF
Amendments to original report
Staff, residents and relatives who participated in this Pilot Project were promised that their
feedback would be treated confidentially. To protect participants in this regard the following
elements have been removed from the original report: Appendix 1 - Summary of Feedback
from Residents, Appendix 2 - Summary of Feedback from Relatives. Appendix 6- Report on
Follow-up Interviews with Participants- has also been edited for this reason. The name of the
community hospital where this Pilot Project was carried out and names of staff and
management who were involved in the design and delivery of this Pilot Project have also been
removed.
Origin
The proposal for a Pilot Project on Relating Well to Residents in End-of-Life Care was
prepared in response to a desire to improve the quality of communication between staff and
residents and between staff and residents’ families and friends in a residential unit for Older
Persons in Dublin.
While the issue of poor/insufficient communication between staff and residents in community
hospitals predates the arrival of overseas staff, their presence highlights an existing problem
and necessitates a culturally sensitive response. Sixteen different nationalities are
represented on the staff and over 80% of Staff Nurses, 50% of Managers and 40% of Care
Assistants were born and trained outside Ireland. Staff Nurses and Nurse Managers work in a
context where few Irish role models for communication are available to them. This staffing
profile is replicated in many other residential units throughout the country.
It is with the objective of improving the quality of communication in the Unit, and thereby
increasing residents’ quality of life, that the current proposal for a pilot project was
submitted.
Proposal
To develop and pilot a training programme for all staff in the Unit on
‘Relating Well to Residents in End-of-Life Care.’
As the proposal was a result of work engaged in by the Hospice Friendly Hospitals (HfH)
Programme, the training programme focused on relating well to residents at the end-of-life to
tie in with the aims of the HfH Programme. However, the skills built during the training are
transferable to other contexts and therefore should enhance communication in other
interactions, not just those related to end-of-life care. This improvement in interaction
should lead to increased resident and staff satisfaction, as residents feel their needs are
being heard and staff feel more confident about communicating with residents. A Needs
Analysis carried out with residents, staff and relatives shaped the original proposal.
Residents, staff and relatives were assured of confidentiality so that feedback would be
honest. To protect confidentiality it is not possible to include feedback from residents, staff
and relatives from the Needs Analysis. The proposal was drawn up using a partnership
approach between staff from the HfH Programme and staff from the Residential Unit focusing
on:
Hospice Friendly Hospitals Programme October 2009 Page 2

Proposal to HSNPF
1. joint responsibility for developing and implementing the training,
2. results-orientated coordination of both organizations’ resources to support the training
The HfH Programme sought the assistance and support of the Health Services National
Partnership Forum in ensuring the roll-out of this project and in securing the balance of funds
to allow the project to proceed.

Proposal to HSNPF
Aims
The overall aim of the pilot project was to build staff skill level in relating well to residents
with a specific emphasis on:
• Enriching and increasing personal and social communication between staff and
residents.
• Building staff skill level in the effective handling of ‘awkward’ communicative
situations.
Approach
A Needs Analysis was conducted to ascertain key concerns of residents, relatives and staff in
relation to communication in the unit. The Needs Analysis included a focus group with
residents, interviews with relatives and an in-depth questionnaire for staff on communication
between staff and residents, their relatives and friends. Residents expressed the view that
staff do not have much time to chat with residents and that it is easier to chat with Irish staff
because they are more familiar with the Irish context.
Relatives thought that staff do not talk enough to residents and that more interaction
between staff and families is needed to ensure that staff have a fuller picture of the person
they are dealing with and how to interact most effectively with them.
The Staff Questionnaire revealed that staff believed that cognitive and speech problems were
the biggest obstacles to communication with residents. They identified specific tasks which
they considered difficult or very difficult including talking with dying residents, talking about
sad/bad news, dealing with anger and dealing with residents’ depression and frustration. A
third of respondents said that they would like to know more about Ireland and Irish life in
order to talk more easily with residents. Content for the proposed pilot training is based on
building skills for specific tasks which pose problems for staff (Appendix 3).
In addition to the training programme, the pilot also aimed to identify broader macro and
micro organisational issues that impact on the quality of communication in residential
settings. At a macro level issues include how recruitment procedures, job descriptions,
induction and orientation programmes select and prepare staff for their key function as
communicators. At a micro level issues include how communication is modelled, monitored
and supported by Management in the Unit. Managers agreed to review and develop existing
systems for monitoring and supporting communication between staff and residents during the
Pilot Project. They also agreed to put systems in place that ensure that staff are more aware
of residents’ backgrounds and interests. In this way the training programme supported a
Whole Organisation approach to the improvement of communication between residents and
staff. The training focused more on micro level issues, while addressing macro level issues
with management as a supporting function.

Proposal to HSNPF
Training Project
Target Group All staff in the Unit – 72 in total
Group Size 9 participants
Number of Training Days 1.5 days x 8 groups =12 days in total
One Key Facilitator. One Assistant Facilitator and

Facilitators one Clinical Nurse Manager who provide feedback
on small group role plays.
The Key Facilitator worked with a group of nine participants for the two Workshops. The
Assistant Facilitator and a Clinical Nurse Manager provided feedback on role play activities to
ensure that each participant received quality individualised feedback from an experienced
facilitator. An individual feedback session between Workshop 1 and 2 allowed time and space
to address differing cultural perspectives on interaction in the Unit and to raise awareness of
the communication styles and expectations of both staff and residents.
55 staff members actually completed the training instead of the projected 72. 17 staff
members did not participate for the following reasons:
• It was decided that the 5 members of kitchen staff would not participate because they
do not have any one-to-one contact with patients or relatives
• 7 members of staff were on maternity leave
• 5 members of staff were unavailable to attend the training each time they were
offered a place.
Project Design and Delivery
This Pilot Project was designed by Helen Harnett, Intercultural Advisor for the HfH
Programme in consultation with the Director of Nursing and the Practice Development
Coordinator from the Unit, a HSE representative from the Services for Older Persons and Aoife
O’Neill from the HfH Programme. The Key Facilitator of the project was Helen Harnett who
also drew up the Proposal in conjunction with Denise Robinson, Programme Administrator,
HfH Programme.
Project Schedule
The schedule for the project was agreed with the Unit. It was anticipated that the training
would commence in October 2008 and be completed by April 2009.

Proposal to HSNPF
Training Design
The outline of the training sessions was as follows:
A one-day workshop exploring how to relate well to

Workshop 1 – 1 day residents and including role plays
Participants completed active reflection activities

Skills Building Exercise between workshops 1) ‘on-the-job’ audio recoding
of their interactions with residents1and 2) workbook
activities involving research on one resident’s life,
recording of external events of interest to residents
and identification of difficulties with
communication between Workshops 1 and 2
Facilitator provided 30 minute feedback session for

Individual Feedback Session each participant base on the Communication Self
Profile
A half-day follow-up session was used to embed the

Workshop 2 – ½ day
learning & skills gained through Workshop 1 plus
reflection and skills building exercise. Took place
3-4 weeks later to allow time for exercises &
reflection
Content for Workshops
Content for workshops focused on the ‘awkward’ situations identified by staff in the Needs
Analysis including:
• Talking about sad/bad news

• Relating to dying residents and their families
• Dealing with resident’s frustration and depression
• Dealing with anger
• Dealing with complaints
While working on the development of these skills the broader communicative aims below
were also addressed:
• Enhancing/deepening relationships with residents
• Relating well to residents' relatives and friends
Workshop 2 was used to reinforce the learning from Workshop 1 and the skills building
exercises. The research underpinning the training methodology is available in Appendix 4.
A detailed breakdown of the training days and participants’ activities is included on the
following pages.
1
Participation in audio-recording exercise was voluntary for staff and permission was sought from residents to record their
interactions with staff for 2 hours. First hour was used to build comfort level with using equipment. Second hour was
analysed. Feedback was given on second hour only.

Proposal to HSNPF
Full Timetable & Participant Activities
Workshop 1 – Awareness & Skills Building (Day 1)
09.00 Welcome & Introductions

09.05 Awareness Raising Activity – Video vignettes featuring poor and better
communication between staff and residents in the Unit. Discussion on how
staff might have communicated more effectively and sensitively. Input
from facilitator on what constitutes good communication.
09.40 Brainstorming and group discussion on the issues around
communicating with older people in residential care
10.10 Input on active listening skills and simple conflict resolution skills
10.30 Tea/coffee
10.45 Role Play
Presentation of role play guidelines and observer feedback sheet to
promote safety & trust. Video recorded role play done by a facilitator &
one participant volunteer on a situation of participant’s choice. Use of
freeze technique when volunteer is unsure what to say/do. Group input
on best approach.
11.30 Participant Role Plays
Work in groups of three on role plays chosen by individuals in group. Two
participants in role play with one observer. One facilitator per group.
Video recordings of role plays.
12.15 Delivery of both planned and unexpected bad news.
Group analysis of good and bad practice using ‘Breaking Bad News’ DVD
12.45 LUNCH
13.30 Participant Role Plays Continued
Further role plays video-recorded
14.30 Communicating Across Cultures & Generations

Brainstorming and group work on the social and historical contexts of
residents, their lives and interests, their experiences of and expectations
regarding communication.
15.30 Presentation of skills building exercises to be completed between

Workshops 1 and 2
15.50 Evaluation – Day 1
16.00 Finish
Rationale for Workshop 1
• Build up core awareness of the issues involved in communication with residents and
exploration of why it is that staff sometimes find it difficult to respond to residents.
• Role plays to build skill level. Each participant had the opportunity to play the role of a
staff member. Role plays were video recorded for the purposes of giving quality
feedback. Sample role plays are included in Appendix 5.
• Set the context for communication across cultures and generations – Irish culture past
and present and residents’ interests.
• Introduced active reflection on skills building activities in preparation for Workshop 2.
Proposal to HSNPF
Skills Building Activities (between Workshops) & Rationale
1. Workbook activities were completed on communication across cultures and

generations including one resident’s life and interests, external events of interest
to residents and communication difficulties experienced by participants between
the two Workshops.
2. Audio recording of interaction with residents while working2 – 2 hours, first hour
was used to allow participants time to adjust to audio recording process and
become more comfortable, the aim was being to facilitate more natural interaction
with residents. Thirty minutes of the second hour was analysed by facilitator.
Participants then listened to and analyse their own recordings using a grid provided
in the Workbook prior to undergoing an individual feedback session. Participation
was voluntary and permission of participants was sought. The permission of hospital
management for staff to engage in this process had already been given. 26 of the
54 participants opted to undertake the audio recordings, (48%), which was a good
response rate.
3. Individual feedback session for each participant on audio recordings and Workbook
Activities- 30 minutes were completed. Individualised feedback provided
sensitively and in a safe environment helped participants to gain maximum benefit
from activities and learning. Recordings provided invaluable insights for staff on the
nature and quality of their communication with residents.
Workshop 2 – Awareness & Skills Building (Day 2 - Half-day)
09.00 Welcome
09.05 Structured Group Feedback – participants gave feedback on the skills
building exercises (audio recordings, experience of researching one
resident’s life and external events relevant to residents).
09.30 Structured Group Feedback - on handling of awkward situations which
arose since Workshop1 (progress made and difficulties remaining).
09.50 Role Play – Further videoed role plays to address outstanding issues raised
in feedback on awkward situations. Work in groups of three on role plays
chosen by individuals in group. Two participants in role play with one
observer. One facilitator per group.
10.35 Tea/coffee
10.50 Structured Discussion on Video Recordings of Role Plays from
Workshops 1 and 2
12.15 Communication Self Profile – participants privately filled out
communication self profile activity in the Workbook identifying individual
strengths and weaknesses and an action plan to address weaknesses.
12.30 Details of Management Follow-up & Support
Evaluation
Rationale for Workshop 2
• Group discussion and feedback on active reflection activities. Sharing of increased

awareness and skills developed between workshops. Gap between Workshop 1 and
2
Participation in audio-recording exercise was voluntary for staff and permission was sought from residents to record their
interactions with staff for 2 hours. First hour was used to build comfort level with using equipment. Second hour was
analysed. Feedback was given on second hour only.
Proposal to HSNPF
Workshop 2 facilitated skills building exercise, feedback by facilitator to each

participant and participant learning.
• Feedback on ‘awkward’ communication situations which arose since Workshop 1 and
how they were handled/could be handled more effectively.
• New role play activity covered the issues raised and was used to re-enforce and further
develop skills learnt in Workshop 1. Analysis of video recordings of role plays.
• Evaluation of the pilot using a participant questionnaire. This allowed the trainer to
assess how successful the pilot has been and to make any amendments to the
programme in light of the feedback from participants. An Evaluation Form was
developed to capture the learning from the project.
Resources for Training
1. A Workbook (in colour) was designed by the HfH admin team for all participants consisting
of materials for training and skills building/active reflection activities.
2. Two audio recorders were purchased to enable staff to audio record their interactions with
residents and play recordings back afterwards.
3. Video recorder and tripod was used to record vignettes for training and role plays.
Projected Outcomes and Benefits of the Pilot Project
The main projected outcomes and benefits were identified as follows:
• For Participants: Significantly increased awareness in relation to communication,

enhanced communication skills, a profile of individual strengths and weaknesses in
communication and practical steps to take to address deficiencies.
• For the Unit and Staff: Enhanced communication with residents, their relatives and
friends and other staff. This being particularly important for staff who are from other
countries and whose first language may not be English.
• For the Residents & Relatives: Enhanced satisfaction with the level and quality of
staff communication which should impact on the quality of life of residents as research
indicates that staff communication with residents accounts for 80-90 % of an older
person’s total life communication.
• Other Care Settings: The model is extremely relevant and transferable to all
residential care settings. Implementation would be cost effective because the
programme design was developed and tested in the Pilot Project.
Measurable outcomes
1. Audio recordings – each participant will evaluate recordings of their own interactions
with residents using a grid based on the learning from Workshop 1. By completing the
grid, participants will demonstrate that they have gained new knowledge and applied

Proposal to HSNPF
the learning form Workshop 1. The grid will be monitored by the Key Facilitator in
the Individual Feedback Session.
2. Communication Self Profile - each participant will complete a Communication Self
Profile in the final part of the training which will highlight individual strengths and
weaknesses in relation to communication and practical steps to address weaknesses.
This Profile will give concrete evidence of development in participants’ awareness
and skills.
Plan/process of ongoing and overall evaluation
1. An extensive Needs Analysis determined both the content and design of the project.
2. Feedback from participants on both the usefulness and effectiveness of the learning
activities was closely monitored all through the Pilot. After Workshop 1 a feedback
sheet was distributed and after Workshop 2 participants evaluated the programme
using a Likert scale to evaluate their perceptions’ of increases in knowledge, skills and
confidence in relation to communication and each element of the Pilot Project.
3. Follow-up interviews with 20 participants 4-8 weeks after the Pilot. These interviews
gave provided detailed qualitative feedback on the usefulness of the Programme.
4. A key element in the overall evaluation was the monitoring of outcomes and support of
learning after the Project by local Management who remain extremely committed to
the Project.
Feedback & Evaluation
Overall there was a very positive response to the training programme from both staff
attending the training and management who were involved in monitoring the progress of the
training. Some of the key findings from the participant evaluations are included below:
New knowledge about how to communicate
4
Score
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Participant
Average score: 4.63 (Where maximum =5)
With an average score of 4.63 it is clear that most participants felt that they had gained new
knowledge about how to communicate following participation in the training programme.

Proposal to HSNPF
(A score of ‘0’ does not mean that a participant gave a rating of ‘0’ to an item, rather, no
answer was provided by the participant).
More confident about my communication skills
4
Score
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Participant
With an average score of 4.47 most participants felt they were more confident about their
communication skills following the training. (A score of ‘0’ does not mean that a participant
gave a rating of ‘0’ to an item, rather, no answer was provided by the participant).
Improved skills in talking with dying residents &

their families
4
Score
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Participant
With an average score of 4.47, most participants felt they had improved their skill in talking
with dying residents and their families. (A score of ‘0’ does not mean that a participant gave
a rating of ‘0’ to an item, rather, no answer was provided by the participant).

Proposal to HSNPF
Usefulness of video role plays
4
Score
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Participants
The usefulness of the video role plays was considered to be high with participants giving it an
average score of 3.96. (A score of ‘0’ does not mean that a participant gave a rating of ‘0’ to
an item, rather, no answer was provided by the participant).
Usefulness of 'on-the job' audio recordings
4
Score
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Participant
The usefulness of the ‘on-the-job’ audio recordings was rated slightly lower by participants
but still above the median value. Only 26 of the 54 participants took part in the ‘on-the-
job’ audio recordings so this helps to account for the proportionately low score. An
average score was calculated based on the total number of participants on the programme
rather than on the total number of participants who opted to do the ‘on-the-job’ recordings.
This average is therefore skewed downwards. (A score of ‘0’ does not mean that a
participant gave a rating of ‘0’ to an item, rather, no answer was provided by the
participant).

Proposal to HSNPF
Satisfaction with trainer
4
Score
3 Series1
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Participant
Average: 4.65 (Where maximum =5)
There was a high-level of satisfaction with the trainer, with participants giving an average
score of 4.65. (A score of ‘0’ does not mean that a participant gave a rating of ‘0’ to an
item, rather, no answer was provided by the participant).
From this quantitative feedback, it is clear that the programme met its overall aim to build
staff skill in relating well to residents. Furthermore, most participants also rated their ability
to communicate effectively with dying residents and their families higher than prior to the
training, which is also aligned to the training goals.
Qualitative Feedback
In addition to scoring the various elements of the course, participants wrote comments on
their learning during the programme. A sample of replies to the question ‘what was most
useful/interesting in the
course?’ is included below:
‘How to communicate with people who are dying and appropriate things to say to them’
‘ Keeping the communication flowing. That body language has to coincide with what you
are saying’
‘This communication training is very useful for the participant and it will do good for the
residents’ care’
‘Tools in managing communication. My difficulties of separating task-orientated from

listening’
‘Learning that communication is a skill with many facets, and you must be aware of how
of how you are communicating at all times on duty.’
‘The proper approach and the right word to say was the one enlightened me on this
course’

Proposal to HSNPF
‘How to approach an elderly person about the death of a loved one and the residents’
family’
‘The fact that I never think about death and it’s around me all the time’
‘Knowing that it’s important to know about your residents’ hobbies and pick a point to
start conversation as well as dealing with angry patients’
Follow-up Interviews
On completion of the training, follow-up interviews were conducted with a sample of 20

participants 4-8 weeks after completion of the programme. Between 3 and 6 representatives
of each of the four job categories (Managers, Staff Nurses, Care Assistants and
Household/Porters) were interviewed. The purpose of these interviews was to ascertain
participants’ perspectives on learning four to eight weeks after the programme ended. In
particular, we wanted to elicit qualitative feedback and this is presented in Appendix 6.
The first question was: ‘Which element/s of the programme did you find most useful and
why?’ From a quantitative perspective, role plays and role plays played back on television
were judged to be most useful (18 in total out of 20), followed by video vignettes made by
staff to illustrate key programme concepts (13 out of 20). Of the 10 interviewees who had
opted to do ‘on the job’ audio recordings, six selected the audio recordings as a most useful
element (if adjusted for comparison with other elements this would be 12).
The second question was: ‘What did you learn?’ Many answers reflected general learning
about communication:
‘I learnt what not to do. I learnt to talk, listen and to take time out’
‘How important communication is, that our job is not just doing things and problem –
solving. By being in a certain way you can actually solve their problem without any
medical intervention’
‘How to deal with people. It gives confidence to communicate with people and that’s
our job’
‘Communication is a very important element in our profession, body language,

intonation…it makes a lot of difference how we convey our message’
A marked increase in confidence and skill in relation to communicating with dying

residents and their families was also reported:
‘I learnt an awful lot, especially how to answer questions about dying’
‘How to deal with complaints and End of Life Care which we are experiencing now, that
role play helped, we are now more confident in how to deal with the family because of
the role play’
The third question was: ‘How could this course be improved?’

Proposal to HSNPF
Suggestions for improvements included:
• Produce more videos on poor and better practice, more role plays and more
scenarios.
• It was also suggested that video recordings of staff interacting with residents
would be helpful and that Support staff connected with the Unit would benefit
from the programme.
• The need for a Refresher course/ongoing programme/recaps was also emphasised.
It was suggested that Managers should replay video vignettes and emphasise
communication at Ward Meetings.
Sustaining the Project
Nearly all participants greatly appreciated the opportunity to develop their skills and
confidence for handling ‘awkward’ communication situations in the workplace. A need for
further training/refreshers in communication was also identified by many participants. With a
view to responding to this need, Managers in the Unit made specific decisions on follow-up
the project. (Full details are in Appendix 7).
The first objective of the project was, ‘To enrich and increase interpersonal communication
between staff, residents and relatives’. Phase 1 was the provision of the current training
project within the Unit. This objective will be further developed by the Unit in Phase2,
through A Key to Me (new HSE Documentation requirement) and the Life Story Project which
will be carried out by Ward Staff. Phase 3 will involve further development of a Person-
Centred Culture in the Unit. Practical measures for keeping communication high on the
agenda were also agreed.
The second objective of the project was, ‘Dealing with awkward communication situations’.
To remind staff about the skills they have learned during the course a 10-minute slot in a
number of Ward Meetings will be allocated by Managers to reviewing key skills learnt in the
course. Materials will be provided for the Managers by the project including a poster on key
themes. The Clinical Practice Coordinator will show the video vignettes developed for and
used within the project featuring staff from the Unit and also extracts from the HFH DVD, ‘
Hard to Say’, to small groups in her office. Discussion will follow. This approach will also be
used for Induction of new staff.
Conclusions
The Success of the Project
The Committee which co-designed this project opted for a radical approach to End-of-Life
Care Communication Training; ‘on the job’ audio recordings, interviews with relatives and
residents and video-recorded role plays all of which were potentially very threatening to
participants. However, it was felt that it was worth risking a different approach because the
learning from these activities would be integrated at a deeper level and lasting behaviour
change was more likely to result.
Proposal to HSNPF
This higher-risk strategy delivered excellent results. Feedback from evaluations, follow-up
interviews and informal feedback from managers indicates that participants perceived a
significant increase in their own skill levels and confidence in relation to ‘awkward’
communication situations identified in the Staff Questionnaire.
It is more difficult to evaluate the success of the other project objective which was ‘to enrich
and increase communication between staff and residents and staff and residents’ families’. It
is not within the scope of this project to do an in-depth evaluation of medium to long-term
outcomes. However, we can say that qualitative feedback in Follow-Up Interviews contains
numerous examples of new insights gained and changes in practice resulting from interviews
with residents, ‘on the job’ audio recordings and video-recorded role plays. A number of
managers have reported that some staff members have become more proactive and aware in
relation to communication with residents since the programme. Insights from this programme
will be built upon by other initiatives such as A Key to Me (a new HSE documentation
requirement) and the Life Story Project and the development of a Person-Centred Culture in
the Unit.
The Key Learning by the Participants (from the Key Facilitator’s perspective)
The vast majority of participants reported difficulty with shifting from a task-focus to actively
listening and showing empathy to residents at important moments such as when they receive
bad news or when they have something they need to talk about. Staff said that they feel most
comfortable with doing something for residents who are upset (often making a cup of tea)
and find it difficult to simply be with residents who are sad or frustrated. There was great
participant interest in a video vignette of a staff member actively listening to a
depressed/frustrated resident and to role plays on talking about sad/bad news with residents
and supporting dying residents and their families and friends. All participants were very
interested in specific expressions which might be appropriate for them to use in these
situations.
Many overseas staff were very interested in learning more about how to ‘chat’ with residents
and their families. Many expressed a fear that asking questions would be experienced as
prying or intruding by residents and relatives. The dominant concern of many was not to
offend and this was identified as a major obstacle to initiative-taking in conversation. A lot of
work had done around how to take the lead in conversation, how to make small talk and how
to judge if the person you are speaking to is responding negatively. Some participants
benefitted greatly from the identification of content areas which would help them to keep
conversation going and from reassurances that Irish people would generally not be offended
by ‘small talk’ which involved asking questions.
The Key Learning for the Key Facilitator
Nearly all participants felt that they needed help for the ‘awkward’ communication situations
addressed in the programme which meant that there was a very high level of motivation to
up-skill. A great deal of learning took place because the content and learning activities were
perceived as highly relevant to participants. In particular, work on the skills around
communicating sad/bad news and supporting dying residents and their families provided a
fresh, stimulating context for learning.

Proposal to HSNPF
Role plays and Communication Self-Profiles done in conjunction with the Key Facilitator
revealed that each staff member had particular strengths and weaknesses in relation to
communication. It was very useful for both the participants and the Key Facilitator to have an
opportunity to discuss these in the Individual Feedback Sessions. Cultural background proved
to be a significant factor in predicting the attitudes of many participants to initiating a
conversation with residents or relatives, ‘chatting’ (in particular, what it is appropriate to
talk about) and approaching residents/relatives who are upset and supporting them in their
sadness/difficulties. Explicit discussion of these issues proved very informative for all
participants.
Synopsis of What Worked, What Didn’t Work, and What You Would Do Differently
Despite some teething problems which were ironed out promptly, the programme design and
delivery worked very well overall.
In the first session there were a number of problems with the role play groups. Groups were
given autonomy to propose the content of role plays which they wanted to work on. Because
of lack of familiarity with role plays and a lot of familiarity with specific residents, the role
plays done in this session were not very productive. Afterwards, it was decided to script role
play scenarios for group work. It was also decided after the first session to allocate
participants to role play groups based on their professional function rather than to have cross-
functional groups. Both of these decisions ensured that nearly all role play groups worked
very well afterwards.
Given that the course was on communication and learning activities such as video-recorded
role play and ‘on the job’ audio recordings were potentially threatening, there was a
significant amount of fear and anxiety present in the first group. This anxiety was shared by
the Key Facilitator who feared that the methodology of the project might be rejected by
participants. The Practice Development Coordinator worked hard prior to the programme to
try to create a positive attitude to the more challenging aspects of the programme. She felt
afterwards that she might have ‘pushed too hard’ and that this might have added to the
anxieties of the first group.
In spite of the initial difficulties, the Key Facilitator, Assistant Facilitator, Clinical Nurse
Manager and the Practice Development Coordinator gained the trust of participants for role
play activities. Participants also trusted that the Key Facilitator would safeguard the
confidentiality of the ‘on the job’ audio recordings and the Individual Feedback Sessions.
Without this trust the programme would have achieved very little.
Final Comments and Recommendations
Training on communication around death and dying is an excellent vehicle for effective
intercultural communication training and should be made available to all healthcare staff.
Nearly all staff members come to this training with a feeling of inadequacy and a desire to be
more skilled in end-of-life communication. This desire creates a unique learning opportunity
in which the verbal and non-verbal aspects of communication can be reviewed in a fresh and

Proposal to HSNPF
motivating context. All participants are learning to speak a difficult language together; end-
of-life communication training is a leveller in the intercultural team.
Working together on role plays in small groups of three, participants learn to be much more
aware of differences in each other’s communication styles and gain a greater understanding
of how to communicate effectively with each other. For this reason it is an excellent
teambuilding activity as well as being a great source of learning.
The whole organisation approach adopted by this project was highly effective. Working with
nearly all staff in the Unit created a momentum and lots of internal discussion. Participating
staff learned a lot about communicating with each other as well as with residents and
relatives. The learning from the project needs to be integrated and developed on an ongoing
basis and this can only be done by committed local Managers responsible for continuous
quality improvement. For this reason, it is recommended that a whole organisation approach
be adopted in this type of training.
This project can improve both the quality and quantity of communication in all residential
care settings. Communication training of this type has a vital contribution to make to the
quality of life of residents and staff who live and work in these settings. For this reason it
should be made available to all staff in residential healthcare.

Proposal to HSNPF
Appendices
Appendix 1 – Summary of Feeback from Residents – removed
Appendix 2 - Summary of Feedback from Interviews with Relatives – removed
Appendix 3- Results of Staff Questionnaire – page 20
Appendix 4 - Research Underpinning the Training Methods – page 30
Appendix 5 – Role Plays – page 31
Appendix 6 – Edited Summary of Follow-up Interviews with Participants – page 33
Appendix 7- Managers’ Decisions on Follow-up to the Project – page 37

Proposal to HSNPF
Appendix 1 – Results of Staff Questionnaire
Hospice Friendly Hospitals Programme

Anonymous Staff Questionnaire
Relating well with Residents, their Families and Friends
This questionnaire aims to find out which aspects of communication are challenging for staff
and to provide training and support on difficult/uncomfortable aspects. Please feel free to be
totally honest. Confidentiality is assured. Thank you.
Please tick the appropriate box:

63 respondents out of 72
Section A: Communication with Residents
Tick the appropriate box. If it does not apply to your work, tick N/A (non-applicable).
A1 For each of the following communicative situations, please say if you find it easy, difficult or
very difficult.
Easy Difficult Very N/A

Difficult
A1/1 Making small talk about the weather etc 61 1
A1/2 Starting a social/personal 60 2 1
conversation/just chatting
A1/3 Requesting and explaining the need for 46 13
residents’ co-operation /involvement
A1/4 Interpreting apparently unreasonable 22 27 1 5
requests from residents
A1/5 Being silent/listening to a resident 57 3
A1/6 Holding a resident’s hand 54 2 2
A1/7 Not being able to know what residents 22 26 3 3
want
A1/8 Dealing with anger 21 34 1
A1/9 Dealing with complaints 29 26 1
A1/10 Dealing with residents’ depression and 14 41 1 3
frustration
A1/11 Initiating a conversation about future 11 29 3 7
preferences in care including end of life
care
A1/12 Talking about sad/bad news 23 33 1 2
A1/13 Talking with dying residents 26 21 12 3
A1/3 1 A1/10 10
A1/4 3 A1/11 9
A1/7 4 A1/12 1
Proposal to HSNPF
A1/8 4 A1/13 10
A1/9 2
A2 Do you know what the residents you work with were like before they came to the Unit?
(For example, do you know about their lives/ travels/interests/families?)
I don’t know anything I know a little I know a lot I would like to know more
9 22 + 11* 5
20 + 11*
11 respondents gave two answers – I know a little and would like to know more – marked with
asterisks
A3 Do you sometimes find it hard to start up a social/personal conversation with

residents?
Yes 7 No 55
If yes, why?
• About her reaction, co-operation

• Some residents do not like to talk about their personal aspects
• Social conversation easy but a little difficulty starting a personal conversation
• Some have dementia/cognitive impairment. Afraid of offending them with personal questions
• It’s hard to understand , what they want of their needs
• Lack of interest
• Due to cognitive impairments, dementia, mood swings
A4 Do you sometimes find it hard to find topics to talk about with Yes No
residents? 10 50
Would you like some help with this? Yes No
16 32
Which aspects of Irish life would you like to know more about? (for example sport,
television personalities and programmes etc).
• Sport 8
• Personalities 6
• TV Programmes 6
• Irish Culture 2
• Irish dance and music 2
• Irish history, historical places 2
• I want to know all aspects 2
• Would like more information on old Dublin characters and Dublin stories and
customs
• Celebrities and VIPs when the residents were young
• How life was in the past when they were young
• Residents’ interests

Proposal to HSNPF
• Irish politics
• I am able to make a conversation on all aspects of Irish life and have no problem with
this
• n/a Irish citizen
• Familiar with all aspects of Irish life

Proposal to HSNPF
A5 Can you always understand what residents say? Yes No

18 42
If no, what seems to cause the problem? (You may tick more than one box.)
Accents 14
English Language 3
Hearing problems 23
Speech problems 40
Cognitive Problems 22
Visual Impairment 5
A6 What is the biggest obstacle to better communication with residents?
• Speech problems 10
• Cognitive problems 10
• Hearing problems 7
• Lack of time to chat to residents 3
• Accents 2
• Lack of personal/social/familial information regarding the resident prior to admission 2
• n/a 2
• Being able to listen and understand what is being said. Take time to listen. Speak
slowly. Maintain eye contact
• Always give them a big smile and greet them Hi of Hello before you start a
conversation
• Staff not taking the time to have general chats
• Some staff or even managers couldn’t make themselves clear – vague statements- due
to wrong grammar
• Understand what is going on with residents- possibly family matters or house worries
that you do not know about
• Sometimes they are not in the mood to talk
• Visual impairment
• Overcoming problems in A5
A7 In a training course on communication with residents, which aspect of your

communication skills would you most like to improve?
• Speech problems 5
• Hearing 3
• Cognitive problems 3
• Hints on dealing with different aspects of Dementia and Alzheimer’s 2
• I would like to know more about body language/non-verbal behaviour 2
• N/A 2
• Sign language 2
• How to deal with people with behavioural problems
• Not understanding through illness
• Dealing with anger and challenging behaviour

Proposal to HSNPF
• In general taking the time to figure what the resident is trying to communicate and
listening and hearing what they have to say. Being interested in what they have to say
• I have not got any training courses this year
• If the resident doesn’t co-operate with you
• Would like to be able to communicate better with residents with dementia short
phrases so pleasing to the receiver to hear the effort being made – Chinese, Filipino,
Nigerian, French, Spanish and Sign language
• Stopping myself getting frustrated when I can’t understand what a resident is saying to
me
• Language skills (Good morning, breakfast, how are you etc.)
• To get feedback on what I do well and what I could improve on
• Learn new things and adhere to all communication skills
• How much to tell someone who is dying
• Simple and grammatically correct sentence formulation
• Dealing with end of life discussions, dealing with residents’ frustrations, depression and
anger
• Nothing
• Motivation training for encouraging participation in activities
What support do you need to improve your communication with residents?
• Provide training for all the staff 3

• When a resident arrives, I would like of the staff nurse and Care Attendant could sit
with the resident’s family, to hear all about the resident’s needs etc. More information
needed re their life history/backgrounds etc. 2
• I need more information about a few aspects of communication skills like body
language and sign language
• Get the facts or details or information of the residents and apply to them – example
likes and dislikes, favourite foods, drinks etc.
• Don’t’ need any
• More background information if possible would be helpful
• Studying but maybe in a practical way e.g. study cases
• Good team attitude
• Anything and everything there is to offer. The more we know the more we can do for
the residents
• Support for colleagues
• English course – oral and written
• Need to have better understanding of what the residents want
• At various times throughout the years we have to attend study days on how to improve
communication with residents
• Any course which helps communication with residents
• Motivation and improving activities for the cognitive impaired and dealing with
depression
• Team support , family and carer support

Proposal to HSNPF
Section B: Communication with the Relatives and Friends of Residents

Tick the appropriate box. If it does not apply to your work, tick N/A (non-applicable).
B1 For each of the following communicative situations, please say if you find it easy, difficult
or very difficult.
Easy Difficult Very N/A
Difficult
B1/1 Approaching and welcoming visitors 58 2
B1/2 Making small talk 59 1
B1/3 Keeping families/friends up to date on 40 5 13
residents’ well being
B1/4 Letting visitors know that you are available 38 9 1 9
for questions/clarification
B1/5 Finding out about residents’ lives / 31 18 7
interests / families prior to coming to the
Meath
B1/6 Dealing with anger 14 37 2 2
B1/7 Dealing with complaints 22 32 4 1
B1/8 Responding to difficult questions 19 35 2 1
B1/9 Giving sad/bad news 15 31 4 3
B1/10 Talking with relatives/friends about dying 19 29 7 1
residents
Of the above, which do you find most difficult?
B1/3 1
B1/4 1
B1/6 11
B1/7 7
B1/8 9
B1/9 8
B1/10 13
Dealing with difficult clients/families 1

Dealing with conflict 1
B2 What support do you need to improve your communication with residents’ families and
friends?
• Increased training on communication 8

Hospice Friendly Hospitals Programme Pilot Project: Relating Well to Residents in End-of-Life Care
Final Report
• I don’t feel I need support 2

• You need the support of the staff you are working with and also management
• A questionnaire for family members regarding their resident
• Communicating with friends and relative about complaints, giving sad news
• Not having enough time
• Support on best way to deal with families’ anger and complaints
• Every kind of support
• Relatives and friends may like to become more involved in activities
• That medical staff would understand that the concerns communicated are big and urgent
in the life of the person communicating and not to dismiss it or handle it as casual
• Talk to them (residents and relatives) to enhance your communication. Always start talking
or greeting them just to continue your communication
• n/a
• Basic English course
• More knowledge and awareness of family dynamics. More involvement in family meetings.
• Support when dealing with questions of residents asking about dying. How much to tell!
• Time to build up a care/trust relationship with the friends/family
• Dealing with angry family members
• More knowledge about breaking bad news
• Don’t really know
• Good team, family meeting every 3-4 months
B3 What is the biggest obstacle to better communication with residents’ families and friends?
• Accent. I can understand Dublin accent but there are some people I couldn’t understand
especially if they are from Cork, Galway – the heavy accents
• Language barrier especially dealing with difficult questions
• Having the time during the day to sit and chat with them
• Giving sad/bad news
• Not being able to meet families and friends of residents
• Anger and speech problems
• None
• Dealing with someone’s anger, because I can be inclined to react with anger on impulse.
• Being very careful about what to say
• n/a 2
• Lack of knowledge about how to communicate in some situations
• Trust and support from families. Sometimes I feel the families are looking out for the
smallest thing to complain about rather than supporting us in caring for their loved one
• What to say first, how much information to express
• The fact that I don’t see and talk to them often that much makes me uncomfortable to
talk and open a discussion with them
• Approach, genuine interest and concern, patience and understanding that
questions/requests are not complaints but a cry for help

Final Report
• Smiles and greet them hi and hello and say something nice and beautiful
• Language barrier
• Not knowing them very well
• Not having enough time to sit and chat
• Fear of doing something wrong
• Getting families to listen to what is being said
• Nil of note

Final Report
Section C: General
C1 Do you find it difficult to communicate about some issues through English?
Yes 4 No 50
If yes, which ones?
• When people speak too quickly or have accents

• Accent
• Language. Job description
C2 In a work situation with whom do you work best with/communicate with most naturally?
Children Young people Adults Older people

2 + 8* 2 + 5* 19 + 19* 14 + 18*
11 ticked both adults and older people

5 ticked both children, young people, adults and older people
2 ticked children, adults and older people
1 ticked children and adults
These choices are recorded in the asterisked figures
C3 In your work, which group would you prefer to care for?
Children Young people Adults Older people

1* 1 + 2* 6 +3* 39 + 4*
2 picked adults and older people

1 picked young people, adults and older people
1 picked children, young people and older people
These choices are recorded in the asterisked figures
C4 Did any of your training inform you about communication skills with older people?
Yes 31 No 20
If yes, which training?
• Elder Abuse
• FETAC Caring for the Older Person ( 2)
• Notices around the wards about how to deal with people and deafness

Final Report
• Study days on communication. Dementia mapping

• Nurse training
• LEO Programme. Communication Skills for Managers
• FETAC Level 5 Healthcare Support 7
• Lifting and Manual handling and C.P.R.
• Sign Language
• Communication with deaf people
• Any training that they give us is helping us and residents
• Dementia, Alzheimer’s
• Teambuilding
• All our training and courses will always cover the older person as this is the area we work
in ( you tailor things to suit your environment and the people we work with)
• Elder abuse and communication
• Sheeba gave a lecture regarding communication skills a few months ago
• Hearing impairment. Dementia
• Nursing
• Managing Challenging Behaviour in Dementia Care
• Communication skills on elderly
Any further comments?
• It would be of great benefit for all of us (health workers and residents alike) to understand
one another. Some staff badly need basic English course.
• Team work is very important
• Would welcome a training day for all staff, porter, kitchen staff, carers, nurses etc on how
best to support residents and families, especially when resident is close to death
• I find it hard that nurses don’t back staff when it comes to dealing with relatives
• Confusing communication between staff can cause problems in handovers i.e. agency
workers
• I have observed it is not necessarily cognitive/visual problems or even complaints or
requests- it is usually the attitude of the care-giver to the resident that is the biggest
obstacle to communication
• Have never received formal training
• I enjoy music, mime and dance as a form of communicating with the elderly. I like
spirituality and prayers also.

Final Report
Appendix 4 – Research Underpinning the Training Methods
Research Underpinning this Pilot Project
This Pilot Project is firmly rooted in Peter Maguire’s research on how to teach
communication skills in the health sector. The first article cited below is the most relevant
to the design of this training programme. The second article cited describes an important
study on raising staff awareness around communication with residents by audio recording
their interactions with residents and subsequently analysing them and giving feedback to
staff.
Maguire, P. & Pitceathly, C. (2002). Key communication skills and how to acquire
them. BMJ, 325:697-700
Effective methods of communication skills training consist of cognitive input, modelling

and practising of key skills through simulations. For a simulation exercise to be effective,
feedback must be given by audiotape or videotape to allow the participant to become
aware of their own interpersonal communication style.
Participants should be asked to identify the particular tasks they want help with – breaking
bad news, handling anger and responding to difficult questions.
Limiting the size of the group to four to six participants creates the sense of personal
safety required for participants to explore relevant attitudes and feelings. It also allows
more time to practise key communication tasks.
For the purposes of the Pilot Project we will limit the role play group size to three in order
to ensure that each participant receives quality individualised feedback from an
experienced facilitator in the reduced time-frame of one and a half days training.
Nordie Williams, K. & Bucchorn Ilten, T. & Bower, H. (2005) Meeting

Communication Needs. Journal of Psychosocial Nursing and Mental Health
Services, Vol. 43. Iss 7: 38-46
Nursing home staff who provide 80-90% of communication opportunities for residents may
overlook communication as a therapeutic tool for care giving. Staff who provide the most
communication with residents lack awareness and skills to effectively communicate with
older adults. Analysis of audio recordings of staff interacting with residents reveal that
residents’ limited opportunities for communication with staff are primarily focused on care
tasks. With increased communication awareness gained from analysis of recordings, staff
can learn to reduce Activities of Daily Living talk and increase personal-social topics to
better meet psycho-social needs of residents.
These two approaches to modelling and giving feedback on communication are replicated
in the Pilot Project.

Final Report
Appendix 5 - Role Plays
Role Play situations
Workshop 1 – Sessions 1 and 2 - Dealing with anger, Communicating at a personal level and
Talking about sad/bad news
1 Dealing with anger
A A relative approaches you about clothes belonging to her aunt which have gone missing - a
beautiful pink cardigan and a cream hand-crocheted bed jacket. She is angry because she went to
a lot of trouble to crochet the jacket as a birthday present and the pink cardigan is her aunt’s
favourite one.
Resource 1 – check body language, intonation and words

Acknowledge emotion/difficulty/problem of angry person
Resource 4 – use talk down skills – slightly lower volume, slightly slower speed of delivery and
open body language as shown in video vignette
B Brian, a demanding and long-established resident who is in full possession of his faculties takes
likes and dislikes to staff members, depending on his mood. At times he verbally abuses staff
members whom he does not like, saying things like ‘You don’t look after me properly’, ‘Go back
to your own country’ or ‘Go back to the bog where you came from’. Today he doesn’t like you
and insults you. You are assigned to work with him.
Resource 1 – check body language, intonation and words

Resource 4 – use talk down skills – slightly lower volume, slightly slower speed of delivery and
open body language as shown in vignette
2 Communicating at a personal level and finding out what is really going on with a person.
A male resident, Tom, aged 76, has a number of serious health problems but is in full control of
his faculties. For the second time today he says he doesn’t want to eat any food. He is in bad
form and is hard to get through to. You don’t know him well but you need to find out why he is
not eating and if there is anything you can do to help him.
Resources 1, 3 and 5
Video vignette – body language, intonation, silence, active listening
3 Talking about sad/bad news
One of your residents, Nora, a good-humoured, lucid 82 year old found out two hours ago that her
younger brother, Colm died suddenly in England yesterday. She loved him very much. You know
Nora quite well and relate easily to her.

Final Report
Resources 1, 3 and Step 3 Resource 6. Acknowledge the grief and emotion.
Workshop 2 – Session 1 – Talking with dying residents and their families and dealing with
complaints
4 Talking with dying residents and their families
A Sean Traynor who has lived for four years in the Unit has been very ill recently. You get on well
with him and are with him one evening when he asks you ‘Am I dying?’
B Sean Traynor who has lived for four years in the Unit has been very ill recently and his condition
has rapidly deteriorated in the last few hours. His wife, 74 year-old Peg Traynor, has been
informed that his condition has deteriorated even further and that it is advisable to come in to be
with him. You meet her when she arrives.
5 Dealing with complaints (and anger)
Cecilia Kelly, daughter of a resident becomes very angry when she visits and discovers that her
mother, Margaret Kelly, has a bad bruise on her right hand and right arm. Mrs Kelly has severe
dementia. She immediately concludes that her mother has fallen and that staff have tried to
cover up the fall instead of telling her about it. She attacks the first member of staff she sees.
Resources 1, 3 and 4. Respond to feelings, check assumptions and clarify them, offer solutions to
any aspect of the problem which is in your power to solve and ensure that the rest is dealt with
by someone who can.
All names are fictitious.

Final Report
Appendix 6 – Follow-up Interviews with Participants
• Follow-on interviews lasting 15 minutes each were conducted with 20 course

participants (out of a total of 55) 4 -8 weeks after completion of the programme.
• The purpose of these interviews was to ascertain participants’ perspectives on learning
four to eight weeks after the programme ended.
• Between 3 and 6 representatives were selected from each of the four job categories:
Managers, Staff Nurses, Care Assistants and Household/Porters.
• In order to assess if there were differences of perspective between Irish and overseas
staff, we interviewed 4 overseas Staff Nurses and 3 Irish Staff Nurses and 3
international Care Assistants and 4 Irish Care Assistants. As all Managers were overseas
staff and all Household/Porters were Irish, it was not possible to assess if perspectives
were different for these categories.
• Notes were taken by the Key Facilitator.
• The interview followed the format below.
Interview Format
1 Which elements of the course did you find most useful?
A Video vignettes of MCU staff

B Role plays
C Role plays played back on the television
D On the job audio recordings
E Workbook research between courses
F Feedback Session with HH
Why?
2 What did you learn?
3 How could this course be improved?

Final Report
Summary of Feedback
Question 1
Which elements of the course did you find most useful?
A Video vignettes of Unit staff

B Role plays
C Role plays played back on the television
D On the job audio recordings
E Workbook research between courses
F Feedback Session with HH
From a quantitative perspective the following elements were judged to be most useful:
• Role plays and role plays played back on television 18 out of 20

• Video vignettes made by staff from the Unit 13 out of 20
• ‘On the job’ audio recordings 6 out of 10
Why?
A selection of comments below give a flavour of why participants found a particular element most
useful:
B and C - Role plays played back on the television
• ‘you have to think on the spot, be on the ball… it’s great to learn how to stall [when you
are asked a difficult question] so that you can think about what to say next’
• ‘Different scenarios and how to deal with them like ‘Am I going to die?’ and bad news in
particular because it is not a thing I do every day and it helped me to prepare’
• ‘Great for the body language, asking questions in a way you’re not intruding and reading
the residents’ signals. The ‘Am I dying’ role play I really remember’
• ‘I loved the role play, especially the ones about a resident dying. I now know how to
approach the resident and relatives if someone is dying’
• ‘from a distance you see better’
• ‘very clear, very easy to take in, very , very worthwhile’

Final Report
A - Video vignettes of Unit staff
• ‘You can see how to do things like body language and positioning’
• ‘the bad one highlighted what you could slip into when you are busy… missing signals…it
was funny but serious
’
• ‘makes you think of what you are doing, sometimes we are on auto-pilot’
• ‘modelling of how to approach people’
• ‘able to see what the course expected of us’
D- On the job audio recordings
• ‘Feedback from Helen Harnett on how I sound, how I should communicate, I have more
awareness of areas I need to improve on, my shortcomings, things like intonation’
• ‘when I heard my tone of voice and how loud I speak I got a shock – it makes me think now’
• ‘I got so much information about the residents and it made me very aware of listening to
what they are saying to you. It’s great to get the feedback, the constructive criticism of an
outside person. Positive feedback is very necessary.’
E- Workbook research between courses
• ‘In the one-to-one conversation with the resident you get more used to them, learn their
background, I’m doing it now since with people I don’t know much about, having more in-
depth conversations…talking to the son helped as well’
• ‘The research conversation in the Workbook, it links me forever to that man, he’s got
much worse since but the link is there. He said at the end of the conversation ‘Come back
I’ve lots more to tell you’.’
F- Feedback Session with HH
• ‘ I love getting feedback… I can improve’

Final Report
Question 2
What did you learn?
Comments have been selected to illustrate themes in the feedback:
• ‘How to deal with complaints and End of Life Care which we need at the moment, that
role play helped, we are now more confident in how to deal with the family because of
the role play’
• ‘How important communication is, that our job is not just doing things and problem –
solving. By being in a certain way you can actually solve their problem without any
medical intervention’
• ‘Communication is a very important element in our profession, body language,

intonation…it makes a lot of difference how we convey our message’
• ‘I learnt an awful lot, especially how to answer questions about dying’
• ‘Tone of voice and the dvds make it very understandable, it’s very plain exactly what you
are trying to put across and using the people we work with is very good too’
• ‘How to deal with people. It gives confidence to communicate with people and that’s our
job’
• ‘ It would make a lot more comfortable to speak to a resident when I do get an

opportunity’
• ‘I learnt what not to do. I learnt to talk, listen and to take time out’
• ‘I learnt how you have to get to know residents better and that I need to know more about
residents’ lives and interests’
• ‘That everyone is unique and that I need to be a bit more patient with teamwork
sometimes… I got a better understanding of my colleagues. I also learnt to dig deeper
from different angles with the residents. I now see them as very much alive rather than
just old and that it’s my job to make them comfortable’
Question 3
How could this course be improved?
Suggestions were made by individual but the main theme here was
• ‘Frequent recaps and an ongoing programme’

Final Report
Appendix 7 – Managers’ Decisions on Follow-up to the Project
Decisions on Follow-up to the HfH Communication Project arising out of the Meeting with
Director of Nursing, Clinical Practice Co-Ordinator and Clinical Nurse Managers in the Unit,
June 4th 2009
1 Objective 1: To enrich and increase interpersonal communication between staff, residents and
relatives.
• HfH project to be seen as Phase 1 of objective 1. Now followed up by

Phase 2 which consists of: A Key to Me (new HSE Documentation requirement) and Life
Story Project which will be carried out by Ward Staff. Phase 3 will involve further
development of a Person-Centred Culture in the Unit.
• Managers to keep communication high on the agenda by using the quiet time around 6pm
for staff discussion on approaches which work with residents who present with behaviours
which are challenging to staff
• One person in each unit is to be allocated to check out what each resident would like to
watch on television and to make suggestions on what might be of interest to that person.
TV Times will be available.
• Big matches which might be of interest to residents will be written up on the Menu Board
in the Dining Room
2 Objective 2: Dealing with awkward communication situations
Many staff expressed a wish to have a refresher course/be reminded about skills learnt during the
course.
• 10-minute slot in Ward Meetings will be allocated by Managers to reviewing the following
themes:
Communication Impact
Dealing with residents’ frustration and depression
Dealing with anger
Talking about sad/bad news
Supporting dying residents and their families
Key Facilitator is to provide materials for the Managers for each 10-minute slot. It was also
decided that there should be a format for Ward Meetings.
• A poster on each of the five themes is to be put up in the Staff Room. One poster every
two/three weeks

Final Report
• Refreshers – Clinical Practice Co-Ordinator will show DVD of video vignettes and extracts
from ‘ Hard to Say’ to small groups in her office. Discussion will follow. This approach will
also be used for Induction for new staff.

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Amended Final Report

Anonymised version of report to the

Health Services National Partnership Forum

Helen Harnett & Denise Robinson

Hospice Friendly Hospitals Programme

Pilot Project: Relating Well to Residents in End-of-Life Care

Amendments to original report

Hospice Friendly Hospitals Programme October 2009 Page 2

1. joint responsibility for developing and implementing the training,

2. results-orientated coordination of both organizations’ resources to support the training

Hospice Friendly Hospitals Programme October 2009 Page 3

Hospice Friendly Hospitals Programme October 2009 Page 4

Target Group All staff in the Unit – 72 in total

Group Size 9 participants

Number of Training Days 1.5 days x 8 groups =12 days in total

One Key Facilitator. One Assistant Facilitator and

Project Design and Delivery

Hospice Friendly Hospitals Programme October 2009 Page 5

The outline of the training sessions was as follows:

A one-day workshop exploring how to relate well to

Participants completed active reflection activities

Facilitator provided 30 minute feedback session for

A half-day follow-up session was used to embed the

• Talking about sad/bad news

Hospice Friendly Hospitals Programme October 2009 Page 6

Full Timetable & Participant Activities

Workshop 1 – Awareness & Skills Building (Day 1)

09.00 Welcome & Introductions

14.30 Communicating Across Cultures & Generations

15.30 Presentation of skills building exercises to be completed between

Rationale for Workshop 1

Skills Building Activities (between Workshops) & Rationale

1. Workbook activities were completed on communication across cultures and

Workshop 2 – Awareness & Skills Building (Day 2 - Half-day)

Rationale for Workshop 2

• Group discussion and feedback on active reflection activities. Sharing of increased

Workshop 2 facilitated skills building exercise, feedback by facilitator to each

Resources for Training

Projected Outcomes and Benefits of the Pilot Project

The main projected outcomes and benefits were identified as follows:

• For Participants: Significantly increased awareness in relation to communication,

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Feedback & Evaluation

New knowledge about how to communicate

Average score: 4.63 (Where maximum =5)

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More confident about my communication skills

Average score: 4.47 (Where maximum =5)

Improved skills in talking with dying residents &

Average score: 4.47 (Where maximum =5)

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Usefulness of video role plays

Average score: 3.96 (Where maximum =5)

Usefulness of 'on-the job' audio recordings

Average score: 2.89 (Where maximum =5)

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Satisfaction with trainer

Average: 4.65 (Where maximum =5)

‘Tools in managing communication. My difficulties of separating task-orientated from

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On completion of the training, follow-up interviews were conducted with a sample of 20

‘Communication is a very important element in our profession, body language,