Along with the control of pain
and symptoms, and interdisciplinary teamwork, the adequate use of communication
skills and interpersonal relationships constitutes the triad foundation that
sustains palliative care. In situations of uncertainty, pain and suffering,
relationships are re-signified and contact with people, either with relatives
or healthcare professionals, starts to represent the essence of care that
sustains faith and hope, supporting the experience of difficult moments.

First of all, while assisting
my client, I used active listening strategies which are powerful therapeutic
interventions. It involved ways of listening, giving full attention, expressing
empathy, and responding to another person that improves mutual understanding.
People’s way of thinking, seeing, hearing, and interpreting the world is
influenced by their beliefs, values, fears, and social and cultural
backgrounds. Active listening is best done without interpretation or
evaluation.

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            It
was of paramount significance to involve my client in facilitating
conversations which included open-ended questions that allowed my client the
opportunity to describe and express her feelings, thoughts, and concerns more
fully (examples: “How are you feeling today?”, “What has been worrying you
most?”, “How have you been coping with these experiences?”, “I understand that
you have some questions and concerns about your care. Can you tell me more
about that?”, “How do you see things going from here?”)

Clarifying responses were also
used in order to get a better understanding about the facts and my client’s
feelings, attitudes, beliefs and values (example: “Can you give me an example
of what you are talking about?”, “Tell me more about …”, “As you were talking I
noticed … in your body language. I am wondering if you are feeling/experiencing
…?”)

Besides, while leading a
conversation I used paraphrasing and summarizing. It helped my client understand
that she was being listened to and her experiences are taken into account. It
also provided an opportunity to get further clarification (example: “What I
hear you saying is that you have been experiencing … which has been making you
feel … Have I understood that correctly?”, “What would be most helpful? Is
there anything else you need?”).

As I have noticed, nonverbal
communication played an important role in the context of palliative care. It
goes without saying that how people communicate is rooted in cultural and
social traditions, values and beliefs. Observing my client’s body language,
posture, gestures and facial expressions provided clues to her feelings,
emotions and capacities for coping.

When communicating with
patients and relatives about incurable and life threatening disease, I gave
attention to the environment and the physical comfort of all concerned. For
instance, standing in a corridor or a waiting room is unsatisfactory for
everyone. Taking relatives to a “quiet room” to discuss painful and difficult
issues has the advantage of signaling the importance of the meeting and the
fact that the news may be bad. My client, however, preferred to be in her own
bed space, with the illusion of privacy given by drawn curtains. This is
because the bed and surrounding space is the client’s territory, where she felt
most in control.