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End-of-Life Conversations with Patients: Tips for Nurses

Dealing with a patient’s death never gets easy. And while hospice nurses may witness more patient deaths than nurses working in other specialties, most nurses will come into contact with terminally ill and dying patients at some point in their careers. In fact, most nurses consider patient death and dying as one of the most challenging aspects of their profession. Additionally, grief may become more complex when a nurse experiences the death of a patient who was under their direct care. Sometimes, these compound feelings of sadness and anger can lead to existentialist questions while working as a nurse, such as, “What’s the meaning of life?”

If you are a nurse and are either working directly with a terminally ill patient or currently trying to cope with a patient’s death, know that you are not alone. In fact, every day, nurses from all over the country express their reactions to patient suffering and dying on forums looking for empathy and understanding. 

With that said, every nurse will react to patients’ deaths differently, and having some healthy coping mechanisms when witnessing a patient in pain or dying is a good place to start. Below are a few tips on navigating a patient’s death and managing end-of-life conversations with terminally ill patients. 

What to Say When Your Patient Is Dying

end of life

When it comes to nursing, patient death will remain the toughest stuff to confront. While most nurses (and people in general) would like to believe that everyone has a fair shot of living a long and healthy life, this won’t always be the case. And, if you have been working as a nurse in the field for several years, perhaps you have already made peace with the idea that patient death and suffering are inevitable in your line of work. That said, having end-of-life conversations and answering questions of a patient who is dying are difficult tasks, no matter how long you’ve been in the field of nursing. 

Keep in mind that terminally ill patients will also have their own way of dealing with physical and mental suffering. Therefore, not all patients will ask difficult questions, such as, “Am I dying?” or make statements, such as, “I don’t want to die.” Many patients will have already accepted their prognosis and will cope with their emotions internally or express their feelings to their closest family members. In either case, it’s important to be prepared for the end-of-life conversations that may come up with terminally ill patients. It’s equally important to understand how you can best support your patient as their nurse. 

First, Get to Know Your Patient 

One of the best ways to connect and show compassion for a patient who is suffering and approaching the end of their life is to get to know them on a human level. That is to say, from the moment you are assigned to care for the patient, make sure you introduce yourself. Explain what your role will be in their care and make yourself available as much as possible to answer their questions about their treatment plan. In fact, compassionate care in nursing can lead to better patient outcomes, higher confidence, and even better coping skills for patients in residence. Therefore, if you are caring for a terminally ill patient, set some time aside to pay attention and really listen to your patient’s concerns, including having end-of-life conversations. This interaction will not only help your patient feel more comfortable but will also lend a hand in helping you cope with their medical prognosis. 

Next, Ask How You Can Help 

Depending on your nursing specialty, you may be in frequent or rare contact with dying patients. More often than not, however, registered nurses (RNs), certified nursing assistants (CNAs), and licensed practical nurses (LPNs) will inevitably experience multiple patient losses. Furthermore, nurses may form close relationships with the patients they care for. You may even feel responsible for patient outcomes—including death. Subsequently, you may want to stay “in control” of telling your patient what they need to in order to stay as comfortable as possible. When, in fact, the opposite is true. As nurses, when dealing with sick or dying patients, it’s actually better to ask what a patient feels is best for them at any given moment. In other words, ask your patient open-ended questions. Ask who they want to be involved in their treatment plan, including what family member or friend they prefer that their doctor speaks to. 

Ultimately, making a patient feel like they are in charge of their future (even when they have little time left on this earth) is the goal. Obviously, there will be instances when a dying patient is no longer lucid, and you, as a nurse, will have to collaborate with the medical team to authorize and make important decisions for your patient. However, if your patient is still mentally alert and cooperating, try and let your patient guide you in deciding what is the best treatment for them. 

Aside from End-of-Life Conversations, Bring Up Good Memories

end of life

When a patient is suffering, and they ask you directly whether they are dying, as a nurse, you are allowed to answer as honestly as you would like. Once you answer a patient’s challenging questions about death, however, do your best to divert their attention to “living” memories. One study showed that reminiscing about positive memories can help combat acute stress responses, which is ideal when caring for a patient in deep suffering or nearing the end of their lives. Moreover, hospice nurses, who deal with death and dying all the time, will tell you that many of their patients enjoy talking about memories, including times the patient spent with their own family or pleasant memories they experienced during childhood. Either way, recalling good memories with a terminally ill patient may help buffer anxiety around death and dying—both for you and your patient. 

Finally, Take Care of Yourself 

Coming home from a long nursing shift after losing a patient can be both shocking and devastating. Or, you may find yourself feeling numb. Both reactions are normal after witnessing a patient dying or in an extreme amount of pain. That said, at the beginning and end of a nursing shift, you must take care of yourself too. Some self-care practices can include ensuring you are getting enough restful sleep, exercising before or after your nursing shifts, and providing your body with nourishing meals. Obviously, we understand that a busy nursing schedule and self-care don’t always line up. But, making an effort to engage in self-care practices outside of work can help strengthen your own stress response to traumatic patient outcomes. That said, you can check out some great self-care practices on our blog here. 

Trust Acceptance

Death is a natural part of the human life cycle. If you need extra support after a patient’s death, some employers offer counseling resources for their nurses—so reach out if you need to. In the end, acceptance is the final stage of the grief process and may help with acknowledging that your emotions will inevitably stabilize over time. And while nursing may feel like one of the hardest professions out there in times of patient suffering, give yourself a pat on the back—you are doing the best you can. Likewise, taking the time to personally validate all your hard work can help you remember why you became a nurse in the first place.

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Blog published on:
September 28, 2022

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