Improving Communication Skills in End of Life Care

END OF LIFE CARE

1END OF LIFE CARE
Introduction
End of life care also known as palliative care is provided to patients who are terminally ill
and cannot recover from their condition. Practitioners caring for palliative care patients require
effective communication and compassionate skills due to the sensitive nature of conversations
with families, carers, patients and the emotional side of the matter (Shapiro, 2011). Lack of good
communication between healthcare professionals, patients’ carers and families is the
contributory factor in number of complaints across many National Health Trusts in the United
Kingdom (Parliamentary and Health Service Ombudsman, 2015).
Terminally ill patients receive holistic care which involves spiritual, social and emotional
support to the patient and includes fulfilling the patients’ wishes of patients which helps them to
die peacefully (Deo & Thejus, 2013). Delivering bad news to a patient or a family member at the
end of life care can be challenging for caregivers and requires skills (Arnold & Boggs, 2015). In
my professional practice, I have come across many patients on end of life care whilst on my
clinical placements and I struggled to effectively communicate with the patient or a family
member.
This paper will aim to reflect on one of my special learning needs - “improve my
communication skills and confidence when delivering news to patient at end of life care”.
The author of this essay will use “Gibb’s reflective cycle” to reflect on personal experiences in a
structured way. This model of reflection is preferred over others as it is easy and straightforward.
This essay will also provide a critique of two evidence based research papers in regards to the
importance of communication with the patient and the family at the end of palliative care.

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My Specific learning needs that needs to be developed
Description
In my academic career as a student nurse, all my clinical placements have been in
palliative care wards where I had the opportunity to provide care to patients who are terminally
ill. It came to my realization that I lacked confidence while communicating with palliative care
patients. It is nerve-wracking to disclose bad news to a patient, carer of family member due to
the emotional distress that follows. One such case is when I encountered an 85 year old patient
who was suffering from progressive dementia. I was given the responsibility to inform the
patient and his family, that the pharmacological treatment was not effective hence it was not
possible to cure his illness. Both the patient and his family were in extreme shock and disbelief
and accused me and the entire ward team for not taking care of the patient. The patient also
displayed extreme emotional distress due to the sudden revelation of this adverse news, that there
was no available treatment for his condition.
Feelings
I felt angry at myself for not seeking support of my peers, before I disclosed the news. I
felt pain for the patient and had a strong feeling that I lacked the skills required to disclose bad
news to the patients and hence forth I contacted with my peer nurses to get suggestions. I
challenged my own assumption that I was capable of communication bad news effectively and I
was determined to work on my communication skills. The accusation by the patient family that
we were not taking good care of the patient left me challenging my skills set and competencies
as a general student nurse. I felt that I did let the whole team down and I was worried that my
working relationship will damaged and I was worried that they might fail me. Looking back
now, I feel this episode helped me to understand my personal and professional strengths.

3END OF LIFE CARE
Additionally, my mentor explained that many people learn by experience and this exposure gave
me some insight into the power of effective and compassionate communication.
Evaluation
The incident served to be quite demoralizing for me as it questioned my capability as a
student nurse and I have always tried to give my best, keeping the best interest of the patient, and
providing them with the best possible care. Looking back now, I have come to realisation that it
is normal for such reactions when sad news is delivered. I also acknowledged that I had the
opportunity to evaluate my skills and strengths after the episode and aim to refine my
interpersonal and communication skills in order to practice safely and effectively.
Analysis
I have always believed that effective communication is one of the fundamental
components of nursing while providing an end of life care. Some people might feel comfortable
talking about death but when taking care of the patient who is dying it is important to
communicate clearly and with compassion to open up conversations. Good communication skills
help the staffs to establish patients’ priorities and support them to make informed decisions (Deo
& Thejus, 2013). Effective communication helps the caregivers to explore any gaps in
understanding the situation that can assure the patient, families and alleviate their anxiety and
stresses.
I strongly believe that I have to work extensively to improve my communication skills
while delivering news to the patient in the end of life care. The action plan to improve this
specialization skill will be discussed in the later sections supported by literature. Although the