How do you approach conversations about end-of-life care with patients and their families?
I used to manage ER/Trauma centers and intensive care units. Hospice was brand new. In fact KublerRoss book was less than 10 years old. There was no guidance
I was scarred as an orderly - I was in my late teens- when i witnessed a general surgeon forbid the family and the staff from telling the grandmother that she had terminal breast cancer.
The pateint was no dummy and she was fully aware she was dying and noticed the changes in the staff and her family. She had NO ONE to discuss her impending demise.
That single even set the rest of my career in motion. I did everything I could to assist patients and families.
Our Senior “Issues in Nursing” project was based on death with dignity. I was husband/father, one of the women was my wife who was post MVC brain injury, terminal coma. We had a a full team and full presentation.
There was not a dry eye in the place — A’s all around for us.
There are many any incidents when you are ER Trauma ICU like the fictional story we did.
Lots of education A minor in philosophy (mostly ethics) with my BSN, lots of ethics con Ed and even helped create the ethics committee for the hospital.
How do you approach the dying patient … just like the pateint taught me…honesty, and forthright approach. You may want to start by asking them what they konw about their condition, and the prospects to meet any future life goals in their condition. Ask beleif systems, family beleif systems then provide the medical facts in small but honest bites. Provide alternatives to hospice, maybe even consider the family needs too.
Honest, caring, pleasant. Sometime even humor can be used to recognize they are human and have a life that they are not dead yet.
First I explain that death is a part of life. Family and comfort efforts help the patient transition into the next chapter. Hospice care has people who can guide all the decisions.
By being honest and transparent with them. I always ask them. What is their goals in expectations for their care. As they list them, we address them. Sometimes they need closure, and we will explore their medical records together to see if closure is there if not, I would suggest to them to follow up with their care provider for that closure. If you don’t, they will most likely end up revoking, hospice, and seeking aggressive measures.
Be honest and be straight forward with them. Tell them all the options and what each decision entails with the results of the options. I tend to interject — if this was my mother—- what I would do but also say— this should no way mean this is what I’m telling you to do! Ask them what they are thinking and support their option. If they are making bad decisions or decisions I wouldn’t recommend, i tend to go over the pros and cons again and maybe explaining things a little more but it’s ultimately their decision. be supportive and you can’t screw it up!
