End of Life Conversation
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 conversation 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
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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
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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.