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End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families

Isaacson, Mary, J., PhD, RN, CHPN; Minton, Mary, E., PhD, RN, CNS, CHPN

doi: 10.1097/ANS.0000000000000186
Evidence Informed Practive

Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter. It is imperative that pre-/postnursing licensure curriculum be expanded to include training in mutual influence communication practices and mentoring in the skill of orchestration.

South Dakota State University, Sioux Falls (Dr Isaacson); and South Dakota State University, Brookings (Dr Minton).

Correspondence: Mary J. Isaacson, PhD, RN, CHPN, 2300 N. Career Ave, Suite 260, Sioux Falls, SD 57107 (

This project was funded by the Hospice and Palliative Nursing Foundation through a restricted gift from the Hospice and Palliative Credentialing Center.

A special thank you to our hospice/palliative nurse participants. They inspired us as they willingly shared their experiences and expertise with candor, humor, and humility. Also, thank you to our musicians and consultants, Lindsey J. Isaacson and Trevor J. Minton. We greatly appreciated your generosity in sharing your time and talents with us. A heartfelt thank you to Dr Roxanne Vandermause. We are grateful for your insightful and scholarly guidance.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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