Friday, April 12, 2013

The Power of the Conversation

A couple of months ago, I came across The Conversation Project. I was impressed with the power and simplicity of the tools they have created to help people talk about their end-of-life preferences. As I describe in my own story on their site , having these conversations with my dad when he was in the advanced stage of heart failure enabled us to help him live as he wanted to until the end because we were able to help him make  decisions that were consistent with his quality of life. 

One of the hardest things to learn in becoming a professional is how to have difficult conversations. Many practicing nurses have told me that they and the physicians they work with struggle in talking with people about end-of-life issues. Therefore, my recent professional focus has been on empowering people to do this. When I came across The Conversation Project, I realized that it was purposely a very simple tool- easy enough so that anyone could use it. This gave me an idea: could such a simple tool, be used by novice nursing students, so they could learn to communicate with people about end-of-life wishes? 
I had to find out!!

I teach eight junior nursing students in their clinical learning experience, on a medical acute care floor. In this setting they often care for patients with advanced and end-stage illnesses: liver failure, cancer, heart failure, sepsis complicated by endocarditis, respiratory failure- we've seen all of these patients just this week. Ethical dilemmas are common here. Our clinical conference discussions frequently turn to palliative care, hospice and death. With this type of clinical background, I felt confident that my students would be ready and eager to initiate The Conversation themselves at the end of their rotation. 

A month ago, I gave each of these students The Conversation Starter Kit, and asked them to talk with an older adult in a senior community about end-of-life preferences. They had incredible success with this, developing communication skills and confidence in discussing end-of-life issues that will be invaluable in their nursing careers. 

In reflecting on this experience, one student wrote: " I’m grateful that I had a chance to have that kind of discussion before I had to do it for the first time as an RN. Because we were approaching this topic for the first time, it helped tremendously to be able to follow an outline (from TCP) and form questions and conversation starters based off of that outline.  I also think it was a great experience for the residents involved.  Many of them don’t get that kind of opportunity to open up to somebody who isn't a family member and discuss this kind of topic." The staff in this senior community are excited that these conversations are happening, and are already getting more of their residents signed up for my next group of student conversations in a few weeks. And the students are ready, and eager for this challenge!

April 16 is National Healthcare Decision day. The Conversation Starter Kit is a great tool to give to your patients so they can prepare for the worst, while hoping for the best.