Rush hospital nurse: Why providers should revisit how they discuss death with patients

Providers often struggle to have open end-of-life discussions with critically ill patients, prompting a need for hospital leaders to reevaluate how nurses discuss death and dying, a nurse argues in The Hill.

Six insights from the op-ed, written by Colleen Chierici, BSN, RN, nurse at Rush Oak Park (Ill.) Hospital:

1. Ms. Chierici recalled when her mother was critically ill, she listened to an oncologist discuss the 30 percent chance her mother would respond to chemotherapy, but never said her mother was dying.

"Would my family have chosen a different path for my mother, if there had been a more explicit conversation? Resoundingly, yes," Ms. Chierici writes. "If my mother's healthcare providers would have had a deliberate discussion about her impending death, my family would never have chosen chemotherapy and instead chose to initiate hospice care."

2. Nurses have a duty to advocate for patients, Ms. Chierici says. "Advocating can take many forms, but most often, it is helping patients navigate the complexities of the healthcare system as well as explaining the meaning of test results, procedures and diagnoses."

3. But nurses across the globe, including Ms. Chierici, often struggle to have explicit conversations about dying with their patients, she said. A study published in the International Journal of Nursing Studies surveyed acute care and critical care nurses to evaluate how they approach end-of-life discussions and found nurses' own knowledge and participation rates are low when it comes to end-of-life care.

4. On the other side of this issue is patients who may not be making a well-informed decision since they do not understand they are dying, Ms. Chierici says. "When the focus is shifted from 'fighting to live' to 'death is imminent,' other care decisions can be made by these patients. They can choose hospice care."

5. For nurses who struggle to have difficult discussions about death with patients and their families, Ms. Chierici recommends reviewing the End-of-Life Nursing Education Consortium project — a national education initiative for educating nurses on better end-of-life care that includes coursework on effective communication.

6. Hospital leaders may need to reevaluate how nurses are trained to have conversations about death and dying, Ms. Chierici concludes. "Have those who are experts at these discussions share their wisdom and teach nurses how to have these conversations in an empathetic and impactful way so that patients can receive the comfort and dignity of hospice care in a timely manner," she writes. "If we can make these changes in our communication with patients and their families, perhaps one day we will all know when it is our time to die."

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