Learning outcomes:
Develop an understanding of “what matters in the end” and how as nurses and as members of a team we can contribute through this understanding to the care of our patients.
Recognize the worth and the attributes of effective communication on these topics and the courage it takes to have these difficult conversations.
Discussion questions:
Letting go:
Gawande poses the question “what do we want… to do now? Looking at the decisions faced by the women and men in chapter 6, how do we as nurses help people with this question? What is our role?
Why is the question “AM I dying?” so difficult for caregivers to answer?
What is the philosophy of Hospice and how is it different from what you thought it was?
Have you seen in your clinical rotations or in your own lives the kind of struggle between charging forward (sometimes into suffering) when a better course would have been having the permission for “letting go?” What is the argument against it? How do you help patients balance that?
What are the policies and philosophies that must change to allow for that? What happens when these policies change?
Hard Conversations
One of the most famous and recognized surgeons has the humility in this book to tell story after story of his own failure to have the hard conversations that need to be had. Why is this so difficult? Do you think it is as difficult for nurses?
Do nurses have a different relationship (than the classic two presented of medicine) and therefore a different kind of conversation? Why or why not?
What is the gift we give patients by having the hard conversations? Is it a matter of ethics that we do have these conversations, or that we do call for these conversations from our colleagues in medicine?
What did you learn about what these conversations have to encompass. What struck you as the best way these conversations were handled?
Courage
The last chapter is called courage. What does courage have to do with this?
What should we take from the research on the remembering self versus the experiencing self in working with our patients? He makes the point that peak experiences matter and endings matter.
How do nurses have a role in making both possible?
Gawande ends with the most personal story in the book. Why do you think he ends with this?
What about experiencing and understanding your own or someone you loves final decisions is so essential for understanding the care you give others?
