“Daring to deal with the difficult and unexpected” registered nurses’ confidential conversations with patients with palliative care needs: a qualitative interview study

Abstract

Abstract Background In palliative care, registered nurses provide advanced nursing care to relieve patients’ symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described. Aim To gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients. Method Secondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content. Results The confidential conversation was considered an important part of palliative care and is the nurse’s responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient’s terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation. Conclusion Nurses’ confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.

Keywords

• Confidential conversations
• Existential issues
• Hospice
• Nurse-patient-relationship
• Palliative care
• Qualitative research