The Reason Behind Two Ears and One Mouth: Listening More Than Talking At End of Life

Nurses who work in Adult Blood and Marrow Transplant Units are frequently faced with end of life situations. Studies show that many nurses have not received adequate training in communication skills at end of life. Lack of preparation may result in nurses being distressed in these situations (Ross, 2000). When nursing staff is uncomfortable caring for patients and their families at the end of life, it is often revealed in their words and actions. From excessive communication, to saying nothing at all when words are necessary, communication can have a significant impact on the way that end of life situations are approached and handled. Appropriate communication when caring for dying patients and their families can make the experience more peaceful for patients, families and staff.

By focusing on communication, both verbally, nonverbally and through use of silence, patients, families and staff can feel more at ease with the dying process. Nurses are taught to build rapport, be advocates for patients and provide information when sometimes all that one needs is a minute to pause and reflect. Silence is a difficult skill to master (Himelstein, 2003). Silence is a form of communication that brings an entire room of strangers together. It allows everyone to listen. Silence makes patients, families and staff aware of surroundings and allows all to focus in on what is truly important. 

A project was designed to raise awareness regarding end of life communication. Included in the education is: education of nursing staff about communication techniques most appropriate in end of life care, pairing inexperienced staff with a mentor caring for a patient at end of life to observe therapeutic end of life communication and providing information about dealing with emotions when communicating at end of life for staff. Data will be gathered from staff to determine the effectiveness of the intervention. This presentation will share the tools used, the data from our facility and future ideas for improvements in this field.  Through education and awareness, improvements are being made to enhance the end of life experience for patients, families, and staff.

Himelstein, B. P., Jackson, N. L., & Pegram, L. (2003). The Power of Silence. J Clin Oncol, 21(9), 41s.

Ross MM, Fisher R,  & Maclean MJ.(2000). End of Life Care for Seniors: The Development of a National Guide. Journal of Palliative Care.16(4):47-53.