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Communication vignettes
  1. Helen Scott
  1. Helen Scott is Editor, End of Life Journal, a palliative care nurse, and is currently undertaking an MSc in Palliative Care, Department of Palliative Care, Policy and Rehabilitation, King’s College London. Email:

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Communicating with dying people means more than just imparting information. It is about being physically and emotionally present with patients. The following communication vignette deals with the issue of ‘being with’ dying patients, as defined by Dame Cicely Saunders, the founder of the modern hospice movement. Dame Cicely Saunders wrote that practitioners should ‘learn not only how to free patients from pain and distress, how to understand them and never let them down, but also to be silent, how to listen and how just to be there’ (Saunders, 2003). ‘Being with’, as defined by Dame Cicely Saunders, means staying with patients as they approach death, providing them with an opportunity to talk openly about their feelings and fears, while actively listening to what they have to say. Such action can help people face the reality of their forthcoming death (Saunders, 1965; Saunders and Baines, 1983). ‘Being with’ can also entail simply sitting with a dying patient, whether or not he/she is able, or wishes, to communicate (Haraldsdottir, 2007b).

Dame Cicely Saunders began her career as a nurse during the Second World War. The lack of resources and pharmacological agents available at that time taught her that nurses sometimes have little to offer dying patients, other than themselves. She wrote that nurses, with their skilled competence and compassion, are uniquely placed to give each person the essential message: ‘You matter because you are you — and you matter to the last moment of your life’ (Saunders, 1976). However, ‘being with’ dying patients is proving difficult in today’s pressurised health environments. Such action is frequently dismissed as a ‘soft’ skill. Nurses are under a great deal of pressure to concentrate purely on physical care provision. The views and culture of employing organisations, in terms of which aspects of care nurses …

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