One of the most vivid memories from my first placement was my first conversation with a patient about dying
I was on an older people’s rehabilitation ward and one afternoon I went to check on Sophie (name changed to protect confidentiality), a patient in a side room. I was helping her to have a sip of drink when she looked up and said ‘the doctor says I’m dying.’
I froze. My stomach turned and my mind started racing, taken aback by a statement I felt totally unprepared to respond to. I had grown fond of Sophie and to see her so distressed was upsetting.
”I knew from the handover earlier that morning that Sophie was dying”
I knew from the handover earlier that morning that Sophie was dying and from what the other nurses had said, she was deteriorating and it was unlikely that she would get any better. I was worried I’d betrayed this knowledge in my facial expression.
Taking a deep breath, I thought back to a recent lecture on communication, which covered how to deal with difficult conversations. Remembering Egan’s S.O.L.E.R technique I drew up a chair next to Sophie’s bed and put down the bed rail so that we could talk more comfortably. Whilst holding her hand I asked some straightforward, open questions that included ’when did you discover that?’ and ‘how does that make you feel?’, desperately trying to mask my own anxiety and appear relaxed.
I think I started off okay, bu then I suddenly panicked; I had no idea what to say next. Almost without thinking, I said: ‘Don’t worry Sophie, we’re all doing everything we can to get you better and back to your normal self.’
”I said it out of a desire to help her stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation”
I immediately felt awful and her face said it all - she knew I was covering. I said it out of a desire to help her stay hopeful, optimistic, but in reality it sounded trite, like I was brushing her off and trying to avoid a deeper conversation. I think that it made her feel worse.
Kicking myself, I spoke to my mentor who reassured me that she also struggled with questions like those, and some research when I got home revealed that I wasn’t alone. Apparently it’s quite common for healthcare professionals to avoid or block difficult questions, particularly about death or dying (Baile et al, 2000). I suppose we like to focus on how we can ‘fix’ things and don’t want our patients to lose hope.
Looking back, I wish I’d spent more time with Sophie, even just to sit quietly by her side. Silence can feel uncomfortable and my instinct is to try and fill it. I’m a classic ‘digger’ -I tie myself up in knots when I should take a moment to listen. Glass (2010) argues that silence is active, that we fill it with body language which continues to communicate a message. Without speaking she would have still known that I cared, and just being present could have offered some comfort.
”Honesty is such an important part of nursing, especially at the end of someone’s life”
Sophie was obviously scared or lonely and I didn’t recognise that, more concerned with my own feelings of discomfort. She may have had more questions that she wanted to ask and as a student nurse, I may not have known the answers but I could have found out on her behalf.
Honesty is such an important part of nursing, especially at the end of someone’s life. I’ve realised that however much we want to protect our patients from painful emotions, sometimes the best thing we can do is to be there; to listen, answer questions and ease fears - or just to hold someone’s hand and let them know that they are not alone.
Catherine Bates is a current first-year adult nursing student at University of Manchester.
Catherine is part of a group of nursing and midwifery students at the University of Manchester writing a blog aimed at supporting first-year students. This student-led project launched last year particularly focuses on sharing experiences about placement
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Baile, W, Beckman, R, Lenzi, R, Glober, G, Beale, E and Kudelka, A.P (2000) SPIKES - A Six Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist. Vol 5 (4), pp. 302-311
Egan, G (2002) The Skilled Helper: A problem-Management and Opportunity-Development Approach for Helping. 9th edition. Pacific Grove, CA: Brooks/Cole publishing
Glass, N (2010) Interpersonal Relating: Health Care Perspectives on Communication, Stress and Crisis. South Yarra, Victoria: Palgrave MacMillan