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communication, interdisciplinary communication, nursing, nursing home, terminal care



  1. Johnson, Samantha BSN, RN
  2. Bott, Marjorie J. PhD, RN


Communication with residents and their families is important to ensure that the end-of-life experience is in accordance with residents' wishes. A secondary analysis was conducted to determine (a) who should communicate with the resident/family about death and dying; (b) when communication should occur around death and dying, obtaining a "DNR" (do not resuscitate) order, and obtaining a hospice referral; and (c) what differences exist in communication about death and dying between registered nurses, licensed practical nurses, and unlicensed staff.


More than 90% of staff (N = 2191) reported that the physician or social worker should communicate about death and dying with residents/families, but only 53% thought that direct care staff should talk with them. Weighted scores for "when communication should occur about death and dying and obtaining a DNR order" revealed significantly (P < .01) lower scores for unlicensed staff than registered nurses and licensed practical nurses (ie, licensed staff), indicating that licensed staff were more likely to initiate conversations on admission or at the care-planning meeting or when the resident's family requested it. No differences were found between staff on communication about obtaining a hospice referral.


The identified gaps in perception about who should be communicating can assist in developing appropriate interventions that need future testing. The potential for training regarding communication strategies and techniques could lead to higher satisfaction with end-of-life care for residents and their families.