Influences on nurses' communications with older people at the end of life: perceptions and experiences of nurses working in palliative care and general medicine.

Aim.  This paper reports an exploratory study investigating nurses' perceptions and experiences regarding listening and talking to dying older people about issues relating to the end of life. Background.  At the end of life, nurses need to be able to communicate with older people in an open and sensitive manner. Although studies highlight that many nurses feel ill-prepared to respond when patients express their concerns and needs about the end of life, few consider nurses' views of caring specifically for dying older people in acute medical settings. Methods.  Focus groups and interviews were undertaken with a purposive sample of nurses, including students and support workers, on general medical and palliative care units (24 participants). These were recorded on mini-disc, transcribed verbatim and offered to participants for comment and clarification. Guided by the principles of the constant comparative technique, transcripts were analysed for broad similarities and differences in the data and participants given the opportunity to comment on the findings. Following the study, a workshop comprising participants and experts in the field reviewed and discussed the implications of the findings for practice. Results.  Factors influencing nurses' communication with older people at the end of life, included: nurses' perceptions and experiences of talking and listening to older people; learning from other members of the multi-professional team; environmental and organizational constraints such as time, privacy and the culture of care; and perceived differences between the values of nurses and those of doctors and patients' families. All participants recognized the importance of communicating with older people at the end of life, but general medical nurses expressed the need for further support. Relevance to clinical practice.  Fostering a palliative care approach, through education and organizational culture that focuses on person-centred care and multi-professional teamwork in a supportive environment, is essential. This should ensure that nurses engage with older people in a meaningful way as they face the end of their lives.