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April 2006

Communicating with the Seriously Ill and Dying

“Every time you smile at someone, it is an action of love, a gift to that person, a beautiful thing.”
Mother Teresa

As we visit our patients, we need to take a step back and put ourselves in their shoes. One way of doing this more effectively is to look at some of the fears they are experiencing. For example:

  • Fear of loss of control— if they are a person who is used to being in charge, this is a major change
  • Fear of pain— every person should have the choice of pain control that is adequate for them
  • Fear of becoming a burden— no one wants to be dependent when they were previously an independent person
  • Fear of disease— they ask themselves, “Why me?” or “What did I do to deserve this?”
  • Fear of loss of dignity— there are so many procedures, invasive and
    non-invasive, that are humiliating to many, and they fear being stripped of dignity
  • Fear of death— Many fear the unknown, “How am I going to die?” “What’s going to happen?” “Will it hurt?” 

With the same empathetic glasses, let’s look at the losses your patients are struggling with. They are:

  • Loss of identity— they’ve become a number in a system of other numbers; they’ve now become the colon cancer in room seven
  • Loss of self-image— “I look awful!” “What’s happening to me?”
  • Loss of privacy— we’ve all heard our patients tell us there is no modesty when you get sick
  • Loss of independence— for many patients, it’s the first time they’ve had to rely on someone to help them
  • Loss of faith and stability— many patients struggle with their faith and wonder “What kind of God would do this to me?”—their lives as they knew them will never be the same

Many of our patients have been dealt a sharp blow of bad news, whether it’s a serious illness or a terminal diagnosis. They’re each dealing with many different issues. How we communicate and assist them can help the patient prepare and deal more effectively with serious illness and death.

Let’s set the scene for effectively communicating with our patients. Although we have all learned this before, many caregivers have forgotten or are uncomfortable in these situations. One-on-one is the best way to communicate. Don’t be afraid to sit in a chair at a patient’s  bedside. Remember to use good eye contact and the use of touch—it can be a powerful healing tool. 

As you start your conversation, use open-ended questions that start with “Tell me”, “What” or “How”. Utilize active listening skills and clarify what your patient is saying—“It sounds like you’re concerned about …” or “It sounds like
you feel …” 

Here are some common communication pitfalls:
  • Try not to be judgmental— accept patients where they are and how
    they are
  • Try not to give advice— chances are they are getting enough advise; only give advise when your patient asks for it
  • Try not to minimize their feelings— they are feeling what they’re feeling, and no one can tell someone else what or how to feel
  • Try not to prevent them from expressing their true feelings— if you do, they may never open-up to you or confide in you again

When we don’t know what to say, it can be clumsy and awkward. It is better to sit in silence than to contribute to conversation that can “shut down” your patient. Here are some inappropriate conversations:

  •  “You’ll be fine”— they will not be fine if they have been given a terminal diagnosis
  • “Don’t talk like that, you can beat this”— never give your patients
    false hopes
  • “What do the doctors know anyway?”— don’t discredit the expertise of doctors; your patients rely on them

Be there for your patients. They may be angry, so remember they’re probably not mad at you, but mad at their situation. They may just need to vent. If your patients ask you questions, be honest with them. It’s okay to cry with your patients, let them know you are sad for them and that you care. Remember, your presence is the best gift you can give your patients!

“To listen to another’s soul in a spirit of disclosure, is almost the greatest service another human being will perform for another”
Author unknown

Cyndi Rohret RN, BSN, CHPN, CRNI
Clinical Consultant, Briggs Corporation

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