Comfort Care Conversations

by | Sep 10, 2013 | Patient Care | 0 comments

It’s a tough world out there. We’ve all been dealing with the chaos from COVID-19. Wherever you live, you have to deal with overcrowding, poverty, pollution problems caused by people, and machines that weren’t made for living in a city environment.

Life can be difficult, but it will always get better. Some pressures and responsibilities come along with modern living. You might feel overwhelmed or like there’s no way out of pressure situations sometimes, but you learn how to remain calm when the chaotic winds whip up around you- it’ll help ease your insecurities and find happiness sooner than later.

As a nurse, you must act fast to make loved ones feel like they’re still in control. When it comes time for comfort care conversations with your patient’s family, sometimes these are some of the toughest that you’ll have. Here’s how to do them as painlessly as possible.

Comfort Care Conversations

Comfort Care Conversations. End of life or comfort care conversations are never easy. These tips can help. #FreshRN #nurse #nurses #comfortcare #patientcare #nursetips

How to Have Comfort Care Conversations With Family Members

These can be rough. But these will be good for you in the long run, so don’t worry.

When They Happen The Nurse Should Be in The Room

Being there for someone who is nearing the end of their life can be an emotional experience. It’s important to remember that they will not always be around, and it would mean a lot if you could help them in any way possible.

There is nothing you can say or do to take away the pain, but there are things that will make their last moments a little easier. If they have faith in some God, then praying with them is something you should do; if they don’t, or it makes them feel uncomfortable, then try singing a song that might bring some comfort and peace.

An important part of being on the deathbed of someone close to us is paying attention to how we treat ourselves when around this person. Do your best not to lose control over your emotions and keep an even temper-no matter what. You know yourself better than anyone else does; trust in yourself enough to realize you’ll be okay regardless of whether or not this person passes away.

Take the Palliative Care Step First

Sometimes we need to take the palliative care step before hospice or comfort care. If the patient’s death isn’t imminent but doing q6hr blood sugar checks are of no point anymore, palliative care is now something to look at. It’s the first step of hospice, but it is a thing that needs to be done before comfort care can even begin.

Suppose the patient’s condition continues to worsen, and you realize their time on Earth is coming to an end. In that case, you need to make sure they are comfortable (remembering safety precautions), allow them to spend as much time as possible with loved ones, speak in private about any last wishes or things they want to be said after they’ve passed away – basically just doing what needs to be done for this person at this point. Even though your job may not seem rewarding at times because of all the sad events surrounding those who have lost their battle with diseases and other such illnesses, it is very rewarding.

Educate Family Members About What Can Be Done

Sometimes families will ask if we can not do this or that.  I take that opportunity to  educate them about palliative care, saying something along the lines of, “there is something called palliative care where a doctor comes to see your loved one and looks at what all is important at this point and what things can be stopped that may cause more harm than good.”

Then I list stuff that I think they would address, like SCD pumps, blood sugar checks, lab draws, CT scans, etc. I talk about how our goal of care and if it is quality or quantity.  I try to be careful not to overstep my boundaries though.  I don’t want to get out of my scope of practice.

Respect Religions That Don’t Believe in Hospice Care

Keep in mind; certain religions do not believe at all in hospice or palliative care. I’ve had a few devoted Muslim patients who believe in the longevity of life. They will fight for every day their loved one has on this earth, even if it is in pain and suffering.

Granted, that is not the majority of patients, but I had to keep their beliefs ahead of my own opinions of what I would do in that situation. While the option of palliative and hospice care should still be presented, be aware they may not respond positively. And that’s okay; our opinions don’t matter. Our job is to present the option and do whatever needs to be done to keep the patient safe and comfortable.

It’s important that you not let your personal feelings affect how they view your advice. While there are certain things we’re expected to do, there will always be patients who refuse hospice care. We may not agree with their decisions or opinions, but it’s their right to make that choice for themselves, even if they suffer later on because of it.

Your tone should change a little bit after the goals of care have shifted from recovery to comfort. I don’t know how to describe it, but be more comforting, supportive, and reassuring. These patients (if they’re awake) and families are very emotional, understandably so.

Don’t act differently if they cry. It’s okay to hug them. That took me a while to be comfortable with. But once I watched a nurse that I looked up to go and hug a crying wife, I felt reassured that it was okay. And that wife hugged and cried so hard, but man, she needed to. And she was so thankful that the nurse hugged her first. That was now her go-to person for everything.

It’s OK If You As A Nurse Don’t Have Words

A lot of times we’re at a loss for words when dealing with these patients and families.  We just don’t know how to talk to them all of a sudden.  That’s okay, it’s not a comfortable place to be. But we still need to be there for them.

Something that I have learned that goes a long way is just acknowledging what’s going on.

“Mr. Smith, I just want you to know that I’m really sorry that you’re going through this.”  

That says “I’m here with you, I acknowledge this sucks, but we’re going to walk through this and I’ll be here to support you today.”  It can be a small amount of reassurance during a really rough time.


Support The Family’s Decisions

You’re not going to make them feel better or take the pain away, you just need to be comforting and supporting.  Support their decisions, empower them, tell them that their loved one is lucky to have them be there for them.  I also have told families that, although this is a terrible situation, I have seen patients pass with no one at their side, and that I think it’s wonderful that so many people clearly loved this person.

The Kinds of Questions You Will Experience With Comfort Care News

Once you do it a few times, it’ll get a little easier, but it’s never easy.  You’ll also get a lot of “why would God allow this?” and “why is God taking them away from me?” kind of questions.  Everyone’s comfort level with that situation is different.  A standard, “I don’t know; I’m so sorry” is always okay because, really, how can you even begin to answer that?

Pray With Patients If Everyone is Comfortable With It

Being a Christian, I have prayed with patients and their families multiple times before.  Keep in mind, this was only after I had the green green green light after multiple unprovoked conversations about their beliefs and God’s role in their life.  So if you feel comfortable, and they have given you the green light without you mentioning anything at all first, go for it.  I’ll never forget those patients, they were so thankful for that support and will always, always have a place in my heart.  Some of the sweetest cards came from them.  They made me cry weeks later!  They really get to my nursey heart.

If you’re not comfortable with all that God stuff, which is more than fine, call the chaplain to support them spiritually.  They are awesome.  And if the family doesn’t connect with that particular denomination or person, they’ll know who to contact to get the right one there.

Although, during those really sudden comfort care conversations, I’ve found that patients and families are more comfortable with their nurses than the chaplains.  Mainly because we’re there at their side all day, and in walks some new guy they have to explain everything to.  They know you and are comfortable with you and don’t want to add to the mix.  I get it.  I don’t know if I would want if I were in that situation either.

Nurses Giving Comfort Care News Is Tough

Being there for those patients and families is tough and even if you feel like you haven’t helped at all, that’s okay.  You probably have and had no idea.  They’ll probably never forget you.  They may not remember your name, but they will probably never forget the nurse that was there for them when their loved one died.

So tell them you’re sorry, tell them you’re here for them, grab them some tissues, let them cry on your shoulder, hug them, don’t be afraid of them, and if they want some prayer from you, go for it.  They’ll be forever thankful for your support.

And even if you don’t know what the heck to say to them, just take really really good care of their loved one.  That will always be enough because that’s all they really want.

How To Tell A Family You Are Withdrawing Life Support

If you’re going to withdraw life support, don’t say you’re going to “withdraw care.” This sends a message to the family that can make them think their loved one will receive less care.  We don’t want them to think that.  Often when we switch to comfort care, these patients require more nursing care.  I would use the term “transitioning to comfort care,” or “removing life support,” rather than “withdraw care”.
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Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

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