The Effect of Training Oncology Nurses to have End-of-Life Conversations at a Teaching Institution End-of-life (EOL) and goals of care (GOC) conversations are important to have with oncology patients. The topic of death and dying, is a hard topic for most patients to talk about and just as hard for members of the healthcare team to initiate with a terminal oncology patient. It is important to train members of the healthcare team to have EOL conversations. Therefore, it is necessary to train the healthcare team on how to initiate, have, and understand the patients’ goals and wishes, while remaining comfortable throughout the conversation to provide the support the patient may need. It is essential for the members of healthcare team to have the tools necessary to have these difficult EOL conversations, so the patients’ goals and wishes can be understood and met.
Problem Statement The problem is the staff is uncomfortable having EOL conversations with terminal cancer patients because the staff is not trained to initiate or conduct EOL conversations. Training would enable nurses to have EOL conversations with patients (Blaževičienė, Newland, Čivinskienė, & Beckstrand, 2017). Nurses tend to keep communication at a superficial level and avoid emotional cues because they are not prepared to have an EOL
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Even in the studies with a pre-/post- survey following a training class, there is no measure of performance after training classes. Although, nurses feel more confident in post surveys, there is no evaluation if the nurses have improved communication skills in clinical practice. The nurses’ transfer of communication skills to the bedside is an important next step that needs to happen to evaluate the effectiveness of the training
Final Gifts, written by hospice care workers, Maggie Callanan and Patricia Kelly, includes various stories detailing each of their life changing experiences that they encountered with their patients. Hospice care allows the patient to feel comfortable in their final days or months before they move on to their next life. This book contains the information considered necessary to understand and deal with the awareness, needs, and interactions of those who are dying. Not only are there stories told throughout the book, there are also tips for one to help cope with knowing someone is dying and how to make their death a peaceful experience for everyone involved. It is important that everyone involved is at as much peace as the person dying in the
Charalambous, A. (2010). Good communication in end of life care. Journal of Community Nursing, 24(6), 12-14. Retrieved from EBSCOhost.
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
End-of-life care in the United States is often fraught with difficult decisions and borne with great expense. Americans are often uncomfortable discussing death and
Granted, textbooks and nursing classes deal with death, but Marks explains that you do not really understand it until it is right in front of you. Overtime it becomes something that nurse’s become accustom to. To clarify the subject of death never becomes easy, it just becomes bearable. After 31 years of experience Marks explained to me that nurses have to learn how to distance themselves, yet still be caring at the same time; a trait that does not come easily to most. In the same way treating someone with a terminal illness is just as hard. In these cases nurses must step into the role of councillors. They must learn how to comfort their patient, yet not become too attached. As well they must learn how to explain to them what is happening, which can become especially hard when dealing with
Not only is professional communication important in the portrayal of a good nursing image and behaviour, it also plays a vital role in patient care and health outcomes. The ANMC standards serve as a good guidance on the need to establish therapeutic relationship through effective communication. As nurses spend relatively more time with patients, they play a significant role in bridging a patient and doctor. Hence, it is would help for nurses to constantly hone their communication skills through experience over time.
It is found that nurses report that their most uncomfortable situations come with prolonging the dying process and some struggle with ethical issues by doing so (Seal, 2007). Studies have shown that implementation of the RPC program and educating nurses have increased the nurses’ confidence in discussing end-of-life plans (Austin, 2006). With confidence, the nurse is able to ask the right questions of the patient and make sure that the patient’s wishes are upheld in the manner that they had wanted, such as to not resuscitate or to make sure their spiritual leader is present when passing (Austin,
Tulsky, J. A. (2005). Interventions to Enhance Communication among Patients, Providers, and Families. JOURNAL OF PALLIATIVE MEDICINE (8), 1. S95 - S102.
The purpose for this research study was to develop a communication strategy for family members of patients dying in the ICU by evaluating a format consisting of a proactive end-of-life conference and brochure to see whether the intervention could minimize the effects of bereavement for the families left behind. This research provided the family members with more opportunities to discuss the patient wishes, to express emotions, to alleviate feelings of guilt, and to understand the goals of care.
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
In nursing practice, communication is essential, and good communication skills are paramount in the development of a therapeutic nurse/patient relationship. This aim of this essay is to discuss the importance of communication in nursing, demonstrating how effective communication facilitates a therapeutic nurse/patient relationship. This will be achieved by providing a definition of communication, making reference to models of communication and explaining how different types of communication skills can be used in practise.
My earliest experiences of observing nursing in action occurred during my last two years of high school. My father was diagnosed with cancer during the spring of my junior year and died right before my senior year. During that short time I watched as the nurses cared for him and I could see compassion and empathy in the way they looked at him. It never occurred to me until after I had raised my children that I wanted to be able to help people in the same way those nurses helped my dad. But now when I tell people that I want to be an oncology nurse, people often respond by saying that they would never choose that type of nursing. They say that they could not stand to watch their patients die so frequently. Their reactions, along with this course in death and dying, have made me question how I might be able to bear the challenges of nursing in an area where death of my patients may be common. I believe that oncology will be a positive specialty to work in because of the consistent advances in prevention, early detection, and treatment of cancer. Furthermore, I believe that William Worden’s four tasks of mourning as presented in our text book is a good framework for the oncology nurse to use in order to cope with the repeated losses inherent in this type of nursing (Leming and Dickinson, 2011).
Kathy Selvaggi states, doctors “are taught that in order to be making a difference in patients’ lives, they have to be operating… giving them a medication…giving chemotherapy.” However, that is not always the best for a patient; listening and understanding how patients want their stories to come to a close is the best way to initiate end-of-life conversations. Dr. Gawande outlines important questions that patients must be asked: what are your fears and worries of the future, what are your priorities if time becomes short, and what are you willing to sacrifice and what are you not willing to sacrifice. This allows patients to be proactive in their plan of care and understand that their comfort and decisions are a priority. Perhaps, terminating chemotherapy is the best option for a patient who desires to spend his or her last days in the comfort of his or her home.
Many people believe it is inappropriate and harmful to discuss someone ’s end of life plan. However, there isn’t any research that shows it is counterproductive to the patient. Zumi (2017) also stated that “Instead, there is increasing evidence supporting the benefits of the process, including a higher rate of patients receiving value-concordant care—in which patients’ end-of-life wishes are more likely to be known and followed—and a reduction in “decisional conflict” and anxiety and depression experienced by family