Talking about death and dying is something that makes a lot of us uncomfortable, so we tend to avoid it. While we may logically accept that death is a natural life process, I am not sure this makes our experience any easier. We will all encounter death, and some nursing staff will support people through the last stages of their lives more frequently than others.
As nursing staff, we will have to deliver bad news on occasion. It is never easy and requires skill, confidence, compassion and time. Insufficient training in communication doesn’t only negatively impact the people in our care and their families but can also contribute to our own stress and emotional burnout. Talking about dying is a skill that can be learned and improved.
My 50-year-old mum died in hospital a day after her admission for exploratory surgery. Six hours before her death I was told: your mum is dying, we are not going to resuscitate her if she arrests, we are going to withdraw treatment and expect her to die soon afterwards. In addition, we will need to do an autopsy as we are not sure what the cause is. I am a fan of efficiency and frankness, but that was a lot of information for a 30-minute conversation with strangers. And no answer as to why this was happening. Just a knowledge that shortly I wouldn’t have a mum.
My response to the clinical team was not my finest hour. I was vile, telling them they were neglectful and incompetent, my words were designed to hurt them. I needed answers and they had none, which I found inexplicable. Her autopsy was inconclusive, although unknown to her or us, she had cancer. Perhaps my treatment of the clinical team was deplorable as they were faced with a complex situation that was unfathomable even after death. I am sure the clinical team treating my mum could have communicated better, although even if they did, I’m not sure I would have received the news any better. But they didn’t deserve my anger.
Nursing staff also support families after a death, which requires skill. In a previous role, a colleague was surprised at the level of distress displayed by the daughter of a 90-year-old nursing home resident who had died. For the professionals, this was an expected death, the clinical care of the person was exemplary, and their pain was managed well. However, the person’s daughter had lost someone who had been a constant for their entire life, and their grief was raw and real. People and situations are unique, and we need to be cautious about making assumptions and judgements about people’s needs and what we think is an acceptable level of grief.
Talking about dying with those in our care and their significant others is challenging and can trigger emotions in ourselves and prompt memories of personal loss. We need to appropriately limit our personal experience when communicating, these conversations are about the person and their family not about us. We need to be careful not to hijack their grief to manage our own. But we also need to be kind to ourselves and acknowledge our own feelings and seek whatever time or support we need.
We should never force people to have conversations about death and dying if they do not want to have them. But we do need to be prepared for those conversations if and when people are ready. Understanding people’s preferences helps us do the best for them. When planning my mum’s funeral the funeral director asked, ‘What urn would mum like?’ I had no idea; we didn’t spend Saturday nights flicking through urn catalogues marking our favourites! There were a lot of decisions to make which we were ill-prepared for. Perhaps having a greater understanding of desires and wishes would have made this process easier.
Whatever area of nursing we work, we need to understand grief and how to talk about death and dying. Communication is a core nursing skill and compassion is an essential nursing value. There is lots of information and support available to guide us. Hospices and palliative care services provide some fantastic information for professionals and the public. We also need to look after ourselves and acknowledge the impact death and dying can have on us as professionals and people.
