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Challenges for nurses when communicating with people who have life-limiting illness and their families: A focus group
Debra Kerr1, Sharyn Milnes2, Jette Ammentorp3
1Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Waterfront Campus, Geelong, Vic., Australia.
Aims And Objectives:
The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness?
Background:
Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession.
Design:
A qualitative descriptive design was used.
Methods:
Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study.
Results:
In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness; (b) interacting with family members adds complexity to care of patients who have life-limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families.
Conclusions:
Caring for individuals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions.
Relevance To Clinical Practice:
Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.
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