Claire Henry explains how training can help nurses overcome their unease about talking to patients in a constructive way on quality end of life care
As a society we are about as comfortable talking about death and dying as the Victorians allegedly were in the presence of an uncovered piano leg.
This awkwardness is so deeply imbued in our ‘live forever’, botox culture that nurses and their care colleagues can find it difficult to shake it off when faced with a person clearly nearing the end of life. Then they discover that some of these patients and their families actually want to talk about planning for death.
At the recent Nursing Times Primary Care Live conference, a senior palliative care nurse suggested that this inhibition about talking about death and the dying process was well-established in nursing. Community matron for supportive and palliative care Liz Clements suggested that even some nurses with good communication skills felt a reluctance to broach the issue.
Communication skills in end of life care must include the confidence to both raise the issue of planning for future care and death - when appropriate - and respond to patients or families who raise these issues themselves.
True, communications skills training can sometimes be a theoretical exercise. To be effective rather than a tick box exercise, quality training often needs to involve role play and be adapted to the work setting of those being trained.
Elements of training such as these can help provide the confidence to go with the skill – spotting opportunities for such discussions and responding to them is a key communications skill in itself.
However accessing communications skills training in end of life care can be difficult.
An on-going programme seeking to identify both the need for such training and the most effective way of delivering it published its interim report recently.
Co-ordinated by the National End of Life Care Programme and Connected (the NHS provider of advanced communication skills in cancer services), the initial phase, involving the 12 pilots conducting a training needs analysis (TNA), reported that most staff felt they could benefit from additional communications skills training around end of life care.
The report concluded that while most health staff have some involvement in end of life care, few had received more than basic level training in this sensitive and challenging area. Interestingly, several pilots reported that merely conducting the TNA across local health and social care organisations raised awareness of end of life care – which could itself be the first step to making staff more comfortable in discussing death and dying.
What’s more, they also disclosed there was much misunderstanding about the term end of life care. Many staff do not appreciate they are actually involved in delivering it. This might be why it comes as a shock to many when they find patients or families wishing to talk about death and end of life care. If it achieves nothing else, communication skills training in this area would remind nurses that many of the people they encounter have life-limiting conditions or are in or near the last months or year of their life.
This training can be reinforced by individual mentoring and peer support groups.
As Ms Clements pointed out, conversations with the individual and family lay the foundation for quality end of life care by opening up opportunities for advance care planning and discussions around where they would like to die.
That is why nurses and other care professionals have to be provided with communications training in end of life care that gives them both the skills and the confidence to talk about death and dying.
After all, it is rather more important than a piano leg.
About the author
Claire Henry is director of the National End of Life Care Programme