Communicating about health current issues and perspectives pdf download

How was it for them? Is there anything about what happened to them that worries you? DS 1,8. Explain that energy levels are likely to fluctuate eg, may have good days and bad days , but that overall there is likely to be a gradual deterioration over time. Therefore, it is important to do the things that you need or want to do now while you are still well enough. If things go well for you — well, you can just do them again. If relevant, reassure that dyspnoea may be alleviated.

However, be careful not to promise that dyspnoea will be controlled at all times as it is a difficult symptom to completely contain. DS 8,25,49, The health care professional should weigh up the benefits versus the harm of such information. These issues may be better covered in detail closer to the time they may actually occur.

DS 8,20,53,88, Describe simply and clearly what advance care planning is. Give a rationale for why having these conversations can be helpful for families and the health care team. That is the purpose of advance care planning, to ensure that you are cared for the way you would want to be, even when communication may be impossible. Is this the right person? Would you like to include them in these discussions, so they know what is happening and what might happen in future?

Do you have an advance care directive? Would you like to complete one? I could get you some more information if you like, or refer you to someone who could explore this further with you. Have you talked to your family or general medical practitioner about what you want? CG 45,, Who would make decisions for you if you were unable to do this for yourself? If the person can identify a substitute decisionmaker:.

Document specific details such as timing or circumstances in which to cease blood tests, antibiotics, deactivation of implantable defibrillators, no attempt at cardiopulmonary resuscitation.

Limited care includes comfort care : use of antibiotics and intravenous medications where appropriate, but no surgery or other more invasive measures. Surgical care: surgery and palliative chemotherapy where appropriate, but no ventilation or resuscitation except during and after surgery.

Intensive care: includes all possible treatments, including invasive measures, to maintain life it may not be appropriate to offer this level of care for this patient population. I would like to find out your goals regarding your health and your health care and the things you most value in life. For some people, the goal may be to prolong life; for others, relief of suffering, optimising quality of life; and for others, a comfortable and peaceful death. I suggest we go through examples of possible situations that may arise to help you decide your goals of care.

CG , EO , CG ,, Give a simple explanation of CPR, making it clear that it was designed for previously well people with acute cardiopulmonary events.

It is not necessary to give a detailed description of CPR unless the patient or caregiver requests clarification. It is used to keep people alive temporarily until they can receive emergency treatment in hospital or until an ambulance arrives. If more detail required:. In a hospital setting or if an ambulance is called , it will also involve needles in a vein, tubes down the throat and potentially an electric shock to the chest.

When the clinician judges CPR to have no therapeutic benefit, explain that in your judgement CPR would have no chance of changing the course of their illness.

There are no invasive measures that are going to change the course of the illness now and we need to focus clearly on your comfort. No measures are going to change the course of your cancer. Consider reinforcing this by explaining that most people think CPR in hospitalised patients is successful. However, the success rate of CPR in previously healthy people is low. The outcome of CPR in people with a serious illness is universally poor. I would recommend that we do not attempt it in your case, but I can reassure you that we will continue all treatments that are potentially effective for your comfort.

What do you think about that? Trying to reverse that process and prolong life with CPR at that time is almost certainly going to fail and we would not recommend we try and do so. Is that in keeping with your thoughts and wishes? On the contrary, we will continue to be extremely active and supportive in our care for you. It simply means that when death does eventually come, our focus will be on keeping you comfortable and supported rather than prolonging the dying period.

DS 40, From what we have already spoken about this would seem in keeping with your wishes. Is this so? While some of the treatments have made small differences, it seems clear at this point that [patient] will probably not recover. How do you feel about this? Are there particular fears or issues concerning you about dying?

Is this something on your mind? Recognise that the situation may change eg, person may not wish to die at home, but to be at home as long as possible. Some want to die at home, others in a hospice and others in hospital. Do you have any particular wishes?

Consider explaining the likelihood of decreasing consciousness levels as death approaches. Explain that they will gradually become weaker, needing longer rest periods and eventually become less conscious. Promote understanding of the decreased need for fluid and foods, non-essential medications, routine observations, tests and investigations in the final days.

As far as we can tell, this is not distressing or frightening at all. If you do become distressed, however, we will do our best to ease this as quickly as possible. We will also be there for your family at this time to help support them if necessary. Regarding an unconscious patient:. However, sometimes it takes longer, even up to a week or so. So it is important for you to look after yourself at this time, maybe take shifts with other family members.

Show respect for the family and the fact that they may have different views from your own about truth telling and patient autonomy.

Clarify the reasons why the family wants to withhold information from the patient and explore their concerns with telling the patient. Explain that patients are often aware that they have a terminal prognosis even if it has not been openly acknowledged, and that it can be very frightening and isolating for the patient to not be able to talk about it.

Sometimes it is a huge relief to all concerned if it is brought into the open. EO 73, Explain that you will not give more information than desired by the patient.

However, you are ethically obliged to give the patient the opportunity to ask questions about the illness and to respond honestly. Allow the patient and family time to come to terms with the impending death of the patient. Explore and acknowledge the emotional issues and concerns of the patient or caregiver that are not always expressed and that may result in frustrating communication barriers. If possible, negotiate a family spokesperson, preferably one nominated by the patient if feasible, who can be involved in medical decisions when the patient is too sick to be involved and who can communicate with the rest of the family.

Preferably have someone with you another health care professional or patient liaison officer and document all discussions clearly in the notes. Openly negotiate with patients and family members to try to reach a mutually acceptable solution. Recognise limitations ie, you are unlikely to resolve longstanding family dysfunction. Use a hypothetical question to explore goals and important things that need to be done while well enough.

If we cannot make that happen, what other shorter-term things would you like to achieve? Sometimes having a plan that prepares you for the worst makes it easier to focus on what you hope for most. Can you tell me what is on your mind during those times? Do not force confrontation about denial, otherwise it may lead to psychological distress, further denial or alienation from the health care professionals. Allow patients to fantasise about unlikely possibilities if they otherwise seem fairly realistic and prepared, especially if it is not blocking them from doing important end-of-life work administrative, conversations with family.

Would you like to talk about that? Referral for second opinion may be offered if the patient or caregiver will not accept that the treatment is medically futile. Would you like me or your GP to ask for a second opinion? DS 29, These recommendations can also be applied to those in Box 6. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.

Basic Search Advanced search search. Use the Advanced search for more specific terms. Title contains. Body contains. Date range from. Date range to.

Article type. Author's surname. First page. Issues by year. Article types. Research letters. Guidelines and statements. Narrative reviews. Ethics and law. Medical education. Volume Issue 12 Suppl. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers.

Med J Aust ; 12 : S Topics Palliative care. Contents Contributors Summary Guideline development and use Methods of guideline development Literature review Expert advisory panel Target audience How to use the guidelines Grading of recommendations Limitations of the guidelines The guidelines Timing of prognostic and end-of-life discussions Preparation for the discussion Physical and social setting How to discuss prognosis and end-of-life issues General strategies to facilitate hope and coping when discussing prognosis and end-of-life issues Additional background information about specific content areas and issues Role of self-care Endorsing organisations References.

Summary Prognostic and end-of-life communication is a vital skill for health care professionals caring for patients with progressive life-limiting illnesses, and their families. The guidelines were developed through the following methods: Systematic literature review of the best available evidence on discussion of prognosis and end-of-life issues; Review of previous relevant guidelines and expert opinions in the literature; and Refining of draft guidelines by an expert advisory panel.

Prepare for the discussion , where possible: Confirm pathological diagnosis and investigation results before initiating discussion. Try to ensure privacy and uninterrupted time for discussion. Negotiate who should be present during the discussion. Relate to the person : Develop rapport. Show empathy, care and compassion during the entire consultation. Consider cultural and contextual factors influencing information preferences.

Provide information , tailored to the individual needs of both patients and their families: Offer to discuss what to expect, in a sensitive manner, giving the patient the option not to discuss it. Use clear, jargon-free, understandable language. Avoid being too exact with timeframes unless in the last few days. Foster Realistic hope : Be honest without being blunt or giving more detailed information than desired by the patient.

Encourage questions and further discussions: Encourage questions and information clarification; be prepared to repeat explanations. Leave the door open for topics to be discussed again in the future. Document : Write a summary of what has been discussed in the medical record. Guideline development and use Discussing prognosis and end-of-life issues has been identified as an important component of care by patients with progressive life-limiting illnesses, and their families. Methods of guideline development The guidelines were developed using the following process: Literature review: systematic review of the best available evidence regarding discussion of prognosis and end-of-life issues with patients with a progressive life-limiting illness, and their caregivers; and review of previous related guidelines and expert opinions.

Refining of guidelines with an expert advisory panel. Literature review Systematic review The systematic review 3 was conducted in conjunction with personnel of the systematic review section of the National Health and Medical Research Council NHMRC Clinical Trials Centre, in accordance with the principles and processes recommended by the Cochrane Review.

Review of consensus guidelines and expert opinion Relevant consensus guidelines and expert opinion were incorporated into the guidelines because of the lack of evidence for some topics. Expert advisory panel An expert panel was convened, comprising 35 Australian and New Zealand health care professionals and consumers nine palliative care medical specialists, three medical oncologists, three palliative care nurses, three consumers [including two cancer patients and one caregiver], two general practitioners, two psychosocial experts, two ethicists, two linguists, one oncology nurse, one cardiology nurse, one aged care nurse, one research nurse, one geriatrician, one respiratory physician, one radiation oncologist, one intensive care specialist, and one lawyer.

Target audience These guidelines were developed for use by all members of the health care team involved in the care of patients with progressive life-limiting illnesses, and their families, including GPs, specialist doctors and trainees including palliative care, medical and radiation oncology, surgical oncology, geriatrics, haematology, respiratory medicine, cardiology, and neurology , junior medical staff, nurses, social workers, psychologists, psychiatrists, physiotherapists and occupational therapists.

How to use the guidelines Discussions about prognosis and end-of-life issues can be conceptualised as a process of ongoing conversation over time, rather than a single discussion. The guidelines Discussing prognosis and end-of-life issues is difficult. Preparation for the discussion Box 2 If the consultation is planned, it is important to provide consistent, accurate information by reading clinical records, speaking with health care professionals, and researching the literature to obtain up-to-date knowledge.

Physical and social setting Box 3 Relationship between the health care professional and patient or caregiver Good interaction between the patient and health care professional is fundamental to effective communication, 43 and patients facing a progressive life-limiting illness place great emphasis on the relationship with their health care professional.

Who else should be present during the discussion Although it may be beneficial to provide support and ensure continuity of care by having another health care professional present, 37 , 44 , 46 some patients are not in favour of this approach. How to discuss prognosis and end-of-life issues Box 4 Importance of generic communication skills Trust can be built by using an empathic, patient-centred style.

Additional background information about specific content areas and issues Commencing or changing disease-specific treatments eg, chemotherapy Box 6 In the setting of an advanced progressive life-limiting illness, the main goals of disease-specific treatments are to improve the length and quality of life.

Cessation of disease-specific treatments eg, chemotherapy Box 7 When patients hear news of lack of treatment response, clinicians should be prepared for a wide range of emotions such as sadness, anger or despair. Introducing specialist palliative care services Box 8 The World Health Organization defines palliative care as: an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Discussing future symptoms and symptom management Box 10 The possibility of uncontrolled pain in the future concerns many people, so it is important to offer reassurance that pain can be controlled in the vast majority.

Difficult scenarios such as requests by family members to withhold information, family conflicts and unrealistic requests by patients Box 14 , Box 15 and Box 16 The information preferences and autonomy of the patient are paramount, yet it is vital to include family members in discussions surrounding the transition from curative to palliative care. Role of self-care At the end of the discussion, it is important to reflect on how the discussion went and how it could be improved next time, as well as recognising the emotional impact of the discussion on oneself and the need for self-care.

Give the patient the option not to discuss it or defer the discussion to a later time. DS 17,28, Find out what the patient has been told by other health care professionals in order to provide consistent information where appropriate. RGP Mentally prepare. DS 15 Allow yourself time to confer with a colleague if the ensuing discussion is troubling you.

DS 2,37 Ask the patient if he or she would like any family members or caregivers to be present during the discussion, especially if planned eg, follow-up appointment after test results.

DS 1,25,35, RGP EO 41 Check that the patient is comfortable with additional health care professionals being present for the discussion if it is feasible and important for provision of ongoing care eg, nurse, registrar.

DS 2,8,39,47 Engage in active listening eg, attend to the patient fully, reflect what you think he or she has said. DS 15,31,39,48 Show compassion and use a warm, caring, respectful and empathic manner. Broach the topic in a culturally appropriate and sensitive manner.

Clarify with the patient and family their cultural background or norms. DS 53,57 Regardless of the content of the prognostic or end-of-life discussion, explain the uncertainty and unreliability of prognostic predictions.

DS 15 The discussion may involve correcting misunderstandings regarding information obtained from other sources eg, media or Internet. Check that the patient or caregiver has fully understood what has just been said.

DS 2,25,31,42, Avoid being blunt or giving more detailed information than desired by patients or caregivers. DS 62,64 Recognise the impact of the information on the patient and caregiver and communicate with empathy and understanding.

DS 2,25,62,63 Do not make promises that cannot be delivered or that are inconsistent with clinical evidence. DS 27,35,62 Try to foster openness and consistency of information given to the patient and the family regarding discussions of prognosis and end-of-life issues. DS 49,53,65 To explore and address differing information needs, consider having joint as well as separate discussions with caregivers when appropriate if the patient has given consent to discuss his or her illness.

RGP Where appropriate, discuss ways of coping on a day-to-day basis eg, taking one day at a time, using strategies that allow an ongoing relationship with the family, such as writing letters or recording thoughts, focusing on important relationships.

State whether or not survival may be improved by the treatment. DS 8,20,26,53,88, Ensure that full supportive care will be provided whether or not any disease-specific treatment is given, and provide reassurance to this effect. CG Refer to the palliative care health care professionals as part of the multidisciplinary team.

Consider using clinical scenarios to structure the discussion. DS 53 Clarify the reasons why the family wants to withhold information from the patient and explore their concerns with telling the patient. Use an official interpreter if one is needed.

Consider speaking with the patient both with and without the family present. EO Allow the patient and family time to come to terms with the impending death of the patient. EO If possible, negotiate a family spokesperson, preferably one nominated by the patient if feasible, who can be involved in medical decisions when the patient is too sick to be involved and who can communicate with the rest of the family.

DS 53 Preferably have someone with you another health care professional or patient liaison officer and document all discussions clearly in the notes. RGP Openly negotiate with patients and family members to try to reach a mutually acceptable solution.

DS 35 Recognise limitations ie, you are unlikely to resolve longstanding family dysfunction. View this article on Wiley Online Library. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA ; Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death. Arch Intern Med ; Communication of prognosis and issues surrounding end of life EOL in adults in the advanced stages of a life-limiting illness: a systematic review.

Cochrane handbook for systematic reviews of interventions 4. In: The Cochrane Library, Issue 3, National Health and Medical Research Council. Guidelines for the development and implementation of clinical practice guidelines. Canberra: AGPS, A guide to the development, implementation and evaluation of clinical practice guidelines.

Developing clinical guidelines: a challenge to current methods. BMJ ; Discussing end-of-life issues with terminally ill cancer patients and their carers: a qualitative study. Support Care Cancer ; Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness. VandeKieft GK. Breaking bad news. Am Fam Physician ; Mueller PS. Postgrad Med ; , J Clin Oncol ; Attitude and self-reported practice regarding prognostication in a national sample of internists.

When and how to initiate discussion about prognosis and end-of-life issues. J Pain Symptom Manage ; Desire for death in the terminally ill. Am J Psychiatry ; Communication about the ending of anticancer treatment and transition to palliative care. Ann Oncol ; Prognostic awareness and the terminally ill.

Psychosomatics ; Psychological responses of patients receiving a diagnosis of cancer. Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med ; When the treatment goal is not cure: are patients informed adequately? Collusion in doctor—patient communication about imminent death: an ethnographic study. West J Med ; Talking with terminally ill patients and their caregivers about death, dying, and bereavement: is it stressful?

Is it helpful? What do patients receiving palliative care for cancer and their families want to be told? A Canadian and Australian qualitative study. Cancer patient preferences for communication of prognosis in the metastatic setting. Bioethics ; Facilitating end-of-life decision-making: strategies for communicating and assessing.

J Gerontol Nurs ; 26 9 : Res Nurs Health ; The attitudes of cancer patients and their families toward the disclosure of terminal illness. Family perspectives on end-of-life care at the last place of care. When the diagnosis is cancer: patient communication experiences and preferences. Cancer ; Communicating prognosis to patients with metastatic disease: what do they really want to know?

Patient—physician communication about end-of-life care for patients with severe COPD. Eur Respir J ; Is there consensus between breast cancer patients and providers on guidelines for breaking bad news? Behav Med ; Friedrichsen M.

Support Care Cancer ; 8: J Gen Intern Med ; Discussion of the do-not-resuscitate order: a pilot study of perceptions of patients with refractory cancer. Tulsky JA. Beyond advance directives: importance of communication skills at the end of life.

Discussing life expectancy with terminally ill cancer patients and their carers: a qualitative study. Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement.

Acad Med ; Breaking bad news: consensus guidelines for medical practitioners. Palliative Care Expert Group. Therapeutic guidelines: palliative care. Melbourne: Therapeutic Guidelines Limited, Clinical practice guidelines for the management of advanced breast cancer. Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service.

In search of a good death: observations of patients, families, and providers. Ann Intern Med ; Rose KE. A qualitative analysis of the information needs of informal carers of terminally ill cancer patients. J Clin Nurs ; 8: Communicating bad news. Ann Oncol ; 8: The needs of terminally ill cancer patients versus those of caregivers for information regarding prognosis and end-of-life issues.

Communicating in a multicultural society. II: Greek community attitudes towards cancer in Australia. Intern Med J ; Cultural aspects of nondisclosure. Camb Q Healthc Ethics. Attitudes and information needs of Chinese migrant cancer patients and their relatives. Aust N Z J Med ; Terminally ill cancer patients: their most important concerns. Cancer Pract ; 5: Information needs in terminal illness.

Soc Sci Med ; Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Communication and information needs of care-givers of adult family members at diagnosis and during treatment of terminal cancer.

Prog Palliat Care ; 8: J Adv Nurs ; Friedrichsen MJ. Justification for information and knowledge: perceptions of family members in palliative home care in Sweden. Palliat Support Care ; 1: Heaven CM, Maguire P. Disclosure of concerns by hospice patients and their identification by nurses. Health Expect ; 4: Barnett MM. J R Soc Med ; Documentation of discussions about prognosis with terminally ill patients.

Am J Med ; Responding to the active and passive patient: flexibility is the key. Health Expect ; 5: Psychiatric interviewing techniques VI. Experimental study: eliciting feelings.

Br J Psychiatry ; Discussing palliative care with patients. Maguire P, Piceathly C. Learning counselling. Oxford textbook of palliative medicine. New York: Oxford University Press, Optimism and survival in lung carcinoma patients. Information needs and decisional preferences in women with breast cancer. Outcomes, preferences for resuscitation, and physician-patient communication among patients with metastatic colorectal cancer.

Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. J Am Geriatr Soc ; Chan A, Woodruff RK. Communicating with patients with advanced cancer. J Palliat Care ; Br J Cancer ; Misunderstanding in cancer patients: why shoot the messenger?

Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians. Ley P. Towards better doctor—patient communications. In: Bennett AE, editor.

Communications between doctors and patients. Oxford: Oxford University Press, Communicating prognosis in early breast cancer: do women understand the language used?

Med J Aust ; Lay understanding of terms used in cancer consultations. Psychooncology ; Hargie O, Marshall P. Interpersonal communication: a theoretical framework. In: Hargie O, editor.

A handbook of communication skills. London: Routledge, J Cancer Educ ; 7: Fallowfield L. Participation of patients in decisions about treatment for cancer. When the treatment goal is not cure: are cancer patients equipped to make informed decisions?

Lofmark R, Nilstun T. Not if, but how: one way to talk with patients about forgoing life support. Postgrad Med J ; Information needs and awareness of diagnosis in patients with cancer receiving chemotherapy: a report from Greece. Johnston G, Abraham C. Managing awareness: negotiating and coping with a terminal prognosis. Int J Palliat Nurs ; 6: Communication between patients and physicians about terminal care: a survey in Japan.

Dying from cancer: results of a national population-based investigation. Palliat Med ; 9: Communication of preferences for care among human immunodeficiency virus-infected patients. Barriers to informed decisions? Arch Fam Med ; 6: Health Commun ; Dignity in the terminally ill: a cross-sectional, cohort study. Lancet ; American oncology and the discourse on hope.

Cult Med Psychiatry ; Carter PA. A not-so-silent cry for help. J Holist Nurs ; Cutcliffe JR. How do nurses inspire and instil hope in terminally ill HIV patients? Flemming K. The meaning of hope to palliative care cancer patients. Int J Palliat Nurs ; 3: Oncologist ; 5: Approaching difficult communication tasks in oncology.

CA Cancer J Clin ; Patient approaches to clinical conversations in the palliative care setting. Communication styles in the cancer consultation: preferences for a patient-centred approach.

Psychooncology ; 9: Sharing decisions in cancer care. Communicating a poor prognosis. Topics in palliative care. Giving bad news to cancer patients: matching process and content.

Palliative Care Australia. A guide to palliative care service development: a population approach. Canberra: Palliative Care Australia, Weissman DE, Griffie J. The palliative care consultation service of the medical college of Wisconsin.

J Pain Symptom Manage ; 9: World Health Organization. National cancer control guidelines: policies and managerial guidelines. Geneva: WHO, Standards for providing quality palliative care for all Australians. Hearn J, Higginson I. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review.

Disarming the guarded prognosis: predicting survival in newly referred patients with incurable cancer. Christakis N. Death foretold: prophecy and prognosis in medical care. Chicago: University of Chicago Press, Glare P. Prognosis in palliative care: ten common questions. Prog Palliat Care ; Fukui S. Information needs and the related variables of Japanese family caregivers of terminally ill cancer patients.

Nurs Health Sci ; 6: Advance care planning. Experts practice what they preach: a descriptive study of best and normative practices in end-of-life discussions. NSW Health. Using advance care directives: New South Wales.

Sydney: NSW Health, See one, do one, teach one? House staff experience discussing do-not-resuscitate orders. Molloy W. Butch Sampson. Eugene Shaw. Jenny Brown. V Framework. D Framework. Patrick and Gloria Lake. Mary Lou and Rob Brady. D Essential Nursing Actions. D Knowledge Domains. Communicating with Persons with Disabilities. Assessing a Patient with a Disability.

Overview and Introduction to Disability. Aging with a Disability. Assessment of a Person with Disability. Communicating with People with Disabilities. Pregnancy in Women with Disabilities. Damon McAdam. Thomas Sykes. Mia Jones. P Framework. P Teaching Strategies.

Adolescent Substance Use Disorder. Anxiety, Depression, and Suicide in the Adolescent Population. Children with Chronic Conditions: Impact on Families. Immunization Challenges with Migrant Children. P Additional Resources. Positive Aspects of Family Caregiving. Bridget Nelson Hardy and Peggy Nelson. Eileen Suzuki and Angela Foster. Phil and Lois Gardner. C Framework. Coaching for Excellence in Nursing. Interprofessional Education IPE. Practical Nursing. Informatics Teaching. Getting Started.

Computer Literacy. Information Literacy. Codes for Curricular Threads. Advocacy Teaching. Toolkit Home. Toolkit Introduction. Government and Who's in Charge. Engaging the Policy-Making Systems. Meeting with Congress. Media Relations. Advocacy Skills for Strategy Development.

Advocacy in Action: How to. Other Advocacy Resources and Tools. Public Policy Toolkit Feedback and Comments. Curriculum Design. Instructions on using the toolkit for other than personal reading. Faculty Resources.

Addressing Student Fears. Reliable Reporting. Infection Control Guidelines. Global Community. Competencies for Nursing Education. Nurse Educator Core Competencies. Grants and Scholarships. Edmund J. Priorities for Research in Nursing Education.

Leadership Institute. Research Priorities in Nursing Education. Tools and Instruments. Descriptions of Available Instruments. Research Participant Recruitment. International Council of Nurses Education Network.

Continuing Education Provider Program. Scholarly Writing Retreats. Critical Conversations PDF. General Recommendations for Communicating with All Persons with Disabilities: Talk to persons with disabilities in the same way and with a normal tone of voice not shouting as you would talk to anyone else. Talk to people with disabilities as adults and talk to them directly rather than to an accompanying person.

Ask the person with a disability if assistance is needed; do not assume that help is needed until you ask. When communicating with a person with a disability, it is important to take steps to ensure that effective communication strategies are used. This includes sitting or standing at eye level with the patient and making appropriate eye contact.

When speaking to a person seated in a wheelchair or scooter, sit so that you and the person are at the same eye level. When giving directions to people with mobility limitations, consider distance, weather conditions, and physical obstacles such as stairs, curbs, and steep hills. Shake hands when introduced to a person with a disability.

People who have limited hand use or who wear an artificial limb do shake hands. Recommendations for Communicating with Patients with Vision Loss Identify yourself when you approach a person who has low vision or blindness. Introduce anyone with you to the person with vision loss. If the person uses glasses, ensure that they are readily available to the person and that he or she uses them.

Touch the person's arm lightly when you speak so that he or she knows to whom you are speaking before you begin. Face the person and speak directly to him or her. Use a normal tone of voice avoid shouting. Explain when you are leaving the environment. When offering directions, be as specific, i.

When assistance the person to a chair, place the person's hand on the back or arm of the seat. Never pet or otherwise distract a canine companion or service animal unless the owner has given you permission to do so. Recommendations for Communicating with Patients with Hearing Loss Ask the person who is hard of hearing, deaf, or deaf-blind how he or she prefers to communicate and eliminate or minimize background noise and distractions. If the person uses an assistive hearing device hearing aid , ensure that it is readily available to the person and in working order and that he or she uses it.

If you are speaking through a sign language interpreter, pause occasionally to allow the interpreter time to translate completely and accurately. Talk directly to the person who is assisted by a sign interpreter, not to the interpreter, even if the person is looking at the interpreter and does not make eye contact with you. Before you start to speak, get the attention of the person you are addressing.

Visual wave or tactile signals light touch can be used to get the person's attention. Speak without exaggerating your words. Do not raise your voice, unless you are specifically requested to do so. Speak in a normal tone without shouting. If the person lip reads speech reads , face the person and keep your hands and other objects away from your mouth. Maintain eye contact.