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Communication vignettes: ‘Should I cancel my holiday nurse?’
  1. Helen Scott and
  2. Vicky Robinson
  1. Helen Scott is Editor, End of Life Care, and Staff Nurse, St Christopher’s Hospice, London, and Vicky Robinson is Consultant Editor, End of Life Care, and Consultant Nurse in Palliative Care, Guy’s and St Thomas’ NHS Foundation Trust, London. Emails: helen@healthcomm-uk.com and vicky. robinson@gstt.nhs.uk

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Introduction

Good communication skills are a key element of end-of-life care (Department of Health, 2008). As nurses, we cannot prevent the distress that families/friends feel when they know their loved one is dying. However, we can support them through the process. This involves ensuring that families are aware of what is happening to their loved one, e.g. the signs and symptoms indicating that the person is in the end stage of their disease and what to expect from thereon. If the dying person and the family are not aware that death is approaching they will be prevented from saying their goodbyes and sorting out their affairs (Ellershaw et al, 2003). Such closures can help ease a patient’s fear of dying and the bereavement process for those left behind (Buchanan et al, 1996). This article is the first in an occasional series of fictitious communication vignettes, whereby conversations that commonly occur within end-of-life care are highlighted. The intention is to provide readers with suggestions of how to conduct difficult conversations. Individual nurses will, of course, bring their own expertise and personalities to such situations.

Case scenario

Gregory Martin is a 74-year-old retired university professor. He was diagnosed with congestive heart failure 7 years previously. He lives with his wife Enid. They have one son Mark and three grandchildren. Gregory has had two recent admissions to hospital for shortness of breath and oedematous legs. In both cases, following treatment, he was able to return home. For the past year he has been having carers every morning to help him with his hygiene needs. However, over the past 3 months, he has become increasingly weak and fatigued and has been losing weight. Gregory has now been admitted onto a medical ward with a 5-day history of shortness of breath on gentle exertion and recurrence of leg …

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