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Communication vignettes: ‘I want to kill myself nurse!’
  1. Helen Scott, Editor,
  2. Vicky Robinson, Consultant Editor and
  3. Julie O’Neill, Ward Manager
  1. End of Life Care, and Staff Nurse, Nuffield Ward, St Christopher’s Hospice, London
  2. End of Life Care, and Consultant Nurse in Palliative Care, Guy’s and St Thomas’ NHS Foundation Trust, London
  3. Nuffield Ward, St Christopher’s Hospice, London

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Introduction

Nurses are the health professionals most commonly confronted with patients expressing suicidal feelings and a desire for an early death. However, it has been found that nurses often do not know how to respond when a patient expresses such feelings. They instead say nothing, turn the focus of the conversation onto physical issues, or change the topic altogether (Hudson et al, 2006a). Common reasons for patients’ desire for an early death include fear of being a burden to relatives, loss of autonomy, distressing physical symptoms, depression, hopelessness and fear of the future (Seale and Addington-Hall, 1994; Emanuel et al, 2000; Hudson et al, 2006b; Ganzini et al, 2008). Psychological distress is the most persistent symptom experienced by people with incurable disease (Edmonds et al, 1998). It reduces the patient’s ability to cope with the final illness (Hotopf, 2004). This article is the third in a series of fictitious communication vignettes wherein 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. This vignette relates to a patient who divulges to a nurse that he is planning to commit suicide. The case scenario is the same one that is the subject of the ethical and legal discussion on pages 26–30. In that article the patient does eventually go on to commit suicide. This communication vignette will only deal with the initial conversation between the nurse Sally and the patient Jack to examine whether some of the pitfalls encountered by Sally in the extended version could have been avoided.

Case scenario

Jack Thomas is 87 years old. He has a 5-year history of prostate cancer. Unfortunately, all curative treatment has been unsuccessful. He has …

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