End of life conversations
End of life conversations are difficult to initiate to a point where health care practitioners start to actively avoid talking with individuals that are under palliative care. The thought of initiating the conversation fills a clinician with dismay. McRee & Reed (2016) advise that conversations about end of life should be initiated at the time of patient’s admission. Therefore, GPs should monitor the trajectory of patients’ conditions as soon as they have been admitted in hospital.
For instance, they can assess whether the patient is exhibiting a consistent decline instead of improvement or if the patient is complaining of fatigue with the treatment process of frequent hospitalization. These prompts then require a clinician to set up a place and time when those who should be involved can be present.
As a RN nurse, I can promote and support the process of end of life conversations by first asking for permission from the patient to talk about the topic. This is crucial as it assures the patient that I respect and honor his/ her wishes. I can start by a question such as, “I would like us to discuss about how you would like to be cared for in case you become really sick, is that okay with you?”
I will then determine the appropriate time and place where the conversation should be done. During the discussion, I will show empathy and give enough time to the patient and the loved ones for them to absorb what is being said. I will ensure that I am patient in that I do not focus on covering everything at once.
One of the challenges that makes nurses to shun away from end of life conversations is the fear of blame or causing emotional harm to the patient (McRee & Reed, 2016). Similarly, some clinicians spend months or even years with their patients such that they end up developing deeper relationships with the patients, and therefore, it becomes difficult for them to initiate talks about the patient’s death. They treat the patients as their close friends or loved ones, and honestly no one would like to discuss with a beloved one about their death. Dreadful!!! This is how most clinicians describe the thought of initiating the discussion.
Nurses play a central role when it comes to delivering end of life care. Their conversations about end of life should be patient led, honest, gentle, and should not proceed with the conversation in the event that the patient does not want to continue. Therefore, they should be equipped with the right skills, attitude, and knowledge on end of life for them to deliver quality care.
McRee, L., & Reed, P. G. (2016). Nurse Practitioners Knowledge, Skills, and Leadership for the End-of-Life Conversation in Intensive Care. Nursing Science Quarterly, 29(1), 78-81.
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