Comfortable dealing with end of life

Sadly, it is not only in the NICU that people want "everything." Our culture is simply not comfortable with death. It is amazing how many people simply do not discuss the topic at all. I had one woman recently tell me that she would rather decide when to pull her father off of a vent than to discuss a DNR or hospice with him. It is really amazing the things we hear and see.

Have you personally been in the position of talking to a close family member of yours about a DNR or hospice? Or is that still out in the future somewhere, so you can easily take theoretical positions? Perhaps you will have a close family member of yours who initiates discussion about these subjects, or wants to discuss them, in which case your situation is much easier. People frequently write on this forum how different it is when they are the patient or the family member, and how much harder it is then. End of life situations can be very difficult, painful (physically and emotionally), and complicated, and fraught with much pain and fear for patients and family members, and many people simply choose not to talk about this subject. Instead of being amazed, put that energy into trying to understand the emotions that people are dealing with, and then you may find yourself more tolerant of these situations and better able to support your patients and their families.

Have you personally been in the position of talking to a close family member of yours about a DNR or hospice? Or is that still out in the future somewhere, so you can easily take theoretical positions? Perhaps you will have a close family member of yours who initiates discussion about these subjects, or wants to discuss them, in which case your situation is much easier. People frequently write on this forum how different it is when they are the patient or the family member, and how much harder it is then. End of life situations can be very difficult, painful (physically and emotionally), and complicated, and fraught with much pain and fear for patients and family members, and many people simply choose not to talk about this subject. Instead of being amazed, put that energy into trying to understand the emotions that people are dealing with, and then you may find yourself more tolerant of these situations and better able to support your patients and their families.

Yes, my family has had all of those discussions. My parents are both DNRs with advanced care plans. My husband's family are the miracle "do everything" people. My husband and I also both have advanced care plans. Our kids already know what we would want. They are 21 down to 14. It's never too early to start talking.

Yes, my family has had all of those discussions. My parents are both DNRs with advanced care plans. My husband's family are the miracle "do everything" people. My husband and I also both have advanced care plans. Our kids already know what we would want. They are 21 down to 14. It's never too early to start talking.

Then keep in mind that people are different, and just because this discussion has worked for you and your family, it doesn't work for everyone. People are individuals, and should be supported as such.

Then keep in mind that people are different, and just because this discussion has worked for you and your family, it doesn't work for everyone. People are individuals, and should be supported as such.

Thanks, I do that everyday. My point is these conversations would make decision making a lot easier in the moment. I realize everyone is different and do meet people where there are. Just as you should realize that we see many people suffer due to their family's guilt and need to do "everything."

Do you feel comfortable helping families and patients ease into palliative?

It completely depends. Is the patient ready? Is the family ready? Do they truly understand palliative/hospice care? Palliative care isn't necessarily end of life, but hospice usually is.

As a hospice nurse, I can tell you that EOL discussions are difficult to have with families and patients. I recently took on the task of writing an article discussing EOL education with families. During my research, I found many caregivers and patients wished providers had been more honest sooner.

When patients and families are on board, it is true magic.

Hi Everyone,

There is a serious gap in education for palliative and end of life care, especially for the undergraduate nurse. A lot of research through The City of Hope and the End of Life Nursing Education Consotium has brought some monumental changes to quality care at the end of life. The curriculum is not just for undergraduate nursing students, but is also for nurses. I recently attended a ELNEC "train the trainer" seminar and now am able to provide this education to others. I think the link can be found on the HPNA website if interested. I agree with the above poster, P.C.DNP in that starting a conversation sooner rather than later is imperative to patients and families! I am hopeful that through health care providers education our culture can begin to view and accept death as more of a natural process rather than something to always try and postpone. It is about providing comfort, easing suffering and still maintaining hope!

Have you personally been in the position of talking to a close family member of yours about a DNR or hospice? Or is that still out in the future somewhere, so you can easily take theoretical positions? Perhaps you will have a close family member of yours who initiates discussion about these subjects, or wants to discuss them, in which case your situation is much easier. People frequently write on this forum how different it is when they are the patient or the family member, and how much harder it is then. End of life situations can be very difficult, painful (physically and emotionally), and complicated, and fraught with much pain and fear for patients and family members, and many people simply choose not to talk about this subject. Instead of being amazed, put that energy into trying to understand the emotions that people are dealing with, and then you may find yourself more tolerant of these situations and better able to support your patients and their families.

This is pretty harsh.

End of life discussions -- especially long before the end of life -- are difficult. But even difficult things are needful, and whether the discussion is uncomfortable or not it is a great kindness to both the patient (or potential patient) and the family. You seem to be advocating not having the discussion because it's difficult and/or painful to have it. I think you're wrong. I, too am amazed that people don't have these conversations while everyone is still able to make their wishes known. And I've had to drag my parents kicking and screaming into the conversation, and my husband who claims that discussing end of life issues will jinx him and the child as well. It's not unreasonable to fear that an active rock climber/sky diver/extreme sports enthusiast would come to an untimely end of life decision.