Improving Communication Skills for End-of-Life Patients

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Introduction
When the patients are at the end of their life, they deserve a palliative based approach
to take care of their specific needs (Wachterman et al., 2016). This care plan helps the nurse
understand the needs of the patient and provides them with the best care for which they have
been admitted (Kisorio & Langley, 2016). Improvisation of communication between nurses
and patients is crucial for the best outcome of personalized medical care of every patient
(Bello, 2017). In the following essay, the specific learning need that will be discussed is
improving my communication skills when providing care for end-of- life patients. The paper
will also include a critical analysis of two research papers which specifically addresses this
learning need. The model that will be used to critically reflect in the essay will be Gibb’s
reflection model. There is improvement in the quality of care when the doctors derive the
meaning out of the situation and try to comprehend the situation efficiently with the proper
implementation in their practice (Riley, 2015). This implementation will increase the
satisfaction of the patient (Kirca & Bademli, 2019). At the end of the essay it is critically
reflect how you will attempt to change or improve your practice as a result of this learning
Identify ONE specific learning need which you feel you need to develop
your nursing practice
I am now a third-year nursing student. I was facing many problems relating to poor
communication skills such as the inadequate communication with the patient and the nurses.
During my training last year, I was working in a hospital where I was caring for an 80-year-
old patient suffering from the final stages of Parkinson’s disease. He was in the critical care
unit and I was told to provide him with palliative treatment (Kelley & Morrison, 2015). He
was so restless and fidgety that I was not able to communicate with him. I failed to make him
comfortable as I was rarely talking to him. I could not talk to him because I was very
frightened and nervous on seeing his condition. His condition deteriorated gradually, and I

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just stood there like a puppet doing nothing (Kirsebom et al., 2013). That day, I felt very
disturbed and asked myself as to why I chose to nurse as a career. It was after this that my
senior staff nurse made me understand that it was time to gear up and make this my strength.
It was my senior who told me to enrol myself on a training programme for improving my
verbal and non-verbal communication skills. This specific learning need has limited my
practice by not enabling me to provide patients with the best care.
Step one: (150 words suggested per article): analysing the specific article.
The randomized controlled trial conducted by Gillet, O’Neill & Bloomfield (2016) is
a well-researched paper where extrinsic and intrinsic barriers were identified by the nurses
which demonstrated the communication gap in them. These barriers were extrinsic factors
such as the inability to make sense of the experience and intrinsic factors, for example; the
inability to deal with emotional responses. To prevent this, certain facilitators, such as good
role models, have been found to decrease the issue of the communication gap between
patients and nurses. The study was conducted on participants who are second and fourth-year
undergraduate nursing students in UK. The study used randomized control trial because of its
proven advantage in eliminating any sort of bias in the study (Gillet, O’Neill & Bloomfield
2016). Knowledge of the factors that have been identified in this paper that act as barriers
will help to improve the communication of nurses with patients dealing with their end of life
as they help in overcoming the discomfort and lack of confidence among the nurses.
The paper by Ewing et al. (2018) which used convenience sampling employed 40
hospital and community-based practitioners who interviewed 22 care providers about their
experiences in providing care to the patient during hospital discharge. The Carer Support
Needs Assessment Tool (CSNAT) was used by the researchers and was found to address the
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difficulties faced by caregivers in communicating end-of-life care to patients. It was found
that organisational focus on the needs of the patient was more than the needs of the carer that
means that the organisation focuses more on the patient and creates a misbalance between the
carer and the patient. In addition, it was identified that there was a lack of awareness on the
carers’ part about the end of life care situation. The study applied convenience sampling to
select the participants, which has proven to be effective in reducing the time and cost in
conducting the research (Ewing et al., 2018).
Both of the initiatives were proven successful but had some limitations. Both the
research papers included in the critical analysis are taken from trustworthy sources which
meet all the ethical parameters.
Step two:
The paper which used a randomized-controlled trial found that medical students and
nursing students experience difficulty in communicating end-of-life care to patients. Other
researchers previously found this information. The first barrier which was identified in this
research paper was gatekeeping. It was conveyed by the medical students that registered
nurses are the primary reason for blocking access to dying patients by their family. This study
also suggested that nurses get frustrated when they are assigned a non-reciprocating patient,
where the patient is unable to understand their illness and fails to reciprocate their feelings to
the nurses as well as the physician. It was a common emotion of not understanding what to
say, by nurses and medical students, when a dying patient approached them. The nurses were
mostly clueless as to what would have been an appropriate answer in the above situation.
There have been instances where the patient is unaware of their critical situation because the
nursing professional is scared or anxious to share the news with the family and the patient.
According to Norouzinia et al. (2016) nurse-patient communication is what makes the patient
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satisfied with the care that they have received. This study have suggested that training has
been provided to the nurses to utilise the communication skills, however they have not and
the patient has been left unsatisfied. In accordance with this study, other studies have found
that the nursing professionals have not been putting effort into making the patient feel like
home in the hospitals, which has decreased the satisfaction levels in the patient.
In this paper, an extrinsic barrier, uncommunicative patients, have been considered to
create frustration in nurses which increases the communication gap between patients and
nurses. There are patients who cannot reciprocate their feelings to the nurse which makes it
difficult for the nurse to interpret their actual feelings and deduce an action plan for their
care. Previous studies have been conducted which suggested that nurses need to be more
empathetic towards the patient so that the patient feels familiar with the hospital environment
and shares their concerns. If the nurse faces an angry patient, empathy decreases the
frustration in the patient and makes them soften towards the nurse and share their pain. An
instance was recorded in the paper of a nurse handling a dementia patient. The dementia
patient had been unable to communicate his feelings to create a bond with the nurse. Due to
the inability of the nurse to communicate effectively with the patient, it was felt that they
blamed themselves for their inefficiency. Patients with dementia have been popularly
observed to be in their own world regardless of who is present in front of them and what they
are trying to communicate. This gives rise to negative emotional consequences in the nurse
which makes them unable to function properly with the next patient.
There was another instance presented in the paper which was shared by another
nursing student. The student was dealing with a patient who was unable to understand the
English language and thus made it difficult for the nurse to convey the news of their death.
There was no interpreter available to break the news to the patient despite the patient
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