Managing conversations with patients about death and dying
Caring for patients who are dying is both a challenging and demanding role. This is further intensified by the expectation that in addition to attending to physical issues, nurses are expected to manage the emotional and psychological aspects of the situation. The inconsistent nature of the care pathways between differing specialist services can often mean that open access to specialist services is not possible. As such, staff may find themselves inadvertently supplementing and often reinforcing interventions offered by specialist (psychological) services with little consideration given to capacity, experience and resources. As the most ‘consistently present’ professionals in such settings, it is important for nursing colleagues to be aware of the emotional and psychological themes common to patients who are dying. Thus, allowing patients access to supportive conversation with professionals as and when required, ameliorating unnecessary distress.
‘At death you break up: the bits that were you Start speeding away from each other for ever With no one to see.’
In recent years, both government guidance and relevant stakeholder organisations have been working to raise awareness around psychological and emotional issues facing people who are dying. The impact of a terminal diagnosis in real bio-psycho-social terms has become an area of focus and both clinical and healthy populations have been encouraged to face the taboo of talking about death (Macmillan, 2017; Marie Curie, 2017).
A survey by Macmillan (2017) found that within the general UK population 15% opted out of talking about death. Furthermore, 64% of the population overall felt that we did not talk enough about death in the UK.
Macmillan (2017) found that 94% of people living with cancer were more open to talk about death, with 23% saying that they had thought about their own death ‘constantly’ or ‘often’, with 35% of this group reporting that they had not shared these feelings with anyone. Only 8% had spoken about this to their healthcare team. A further 28% of the total stated that they found it hard to be honest about how they felt about their illness. Reasons for patients with cancer not sharing included feeling uncomfortable about it (15%), and not wanting to bother anyone (22%).
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