Rethinking The Paradigm

A friend and I sat at a wine bar. Over a glass of Pinot Noir, the topic of blogging came up. I

photo by jparadisi

photo by jparadisi

told her I was writing a post about the need to teach nurses how to talk to patients about dying.

She said, “Oh, you can’t talk about that all in one conversation. You have to talk about things like that in short, repeated conversations. It’s too much for someone to take in all at once.”

My friend is a diabetic educator, and she is better prepared to discuss life-changing illness with her clients than most nurses are to talk to theirs. Talking about the life-threatening aspects of diabetes is in her job description. Therefore, she’s been educated to do it.

Unlike clinical educators, nurses are hired for what we do to patients, not for talking to them. Although documenting patient education is part of our job description, it doesn’t carry the same weight of importance as, for instance, administering chemotherapy. Assuring that nurses and physicians are competent to discuss dying with patients is not a priority in health care delivery.

What if nurses and physicians were taught and supported in the necessary skills to bring the process of dying the same respect given to the process of giving birth?

Envision patients, physicians, nurses, social service workers, and spiritual care, working together, creating the same level of compassion and purpose for dying that parents, midwives, nurses, and obstetricians have created for childbirth.

If education about childbirth empowers expectant mothers in labor, might not education about what to expect at death equip dying patients with a sense of control, lessening their fear and pain? What might these patients plan, given small conversations of education, over an adequate amount of time? Would they create personal soundtrack CDs of music? Choose poetry for loved ones to read? Decorate their rooms with art to view as their vision dims? Lie in beds wide enough so loved ones can hold them?

As it stands, we burden hospice nurses with guiding patients and families, who do not know what to expect, through the entire dying process. When there is not enough time, patients go without the necessary knowledge to find personal meaning in this eventual and unavoidable passage.