1. Gould, Kathleen Ahern PhD, RN

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For the past 2 years, in our November/December issues, we have provided editorials that hope to inform and inspire a different type of family conversation during the holidays.1,2 The aim is to encourage readers to take some time during family visits to discuss a topic often left unspoken. End-of-life care or health care choices when the future is uncertain remain difficult topics. These are not easy conversations, and they are not singular events. Often, it is a process-one that improves with time and practice.


As we approach the holiday season again, families will gather, and perhaps, the opportunity will present to talk about health care wishes. Before we can facilitate these sensitive discussions, we must ask ourselves, "Am I conversation ready?"


There are many ways to prepare and tremendous support to assist us in the process. Recently, this discussion has found voice within many facets of health care, and nurses are on the frontline of this effort. As an educator, editor, and author, I often champion this effort, asking colleagues to join me-as we teach students, clinical staff, and each other how to use the "what matters" language in all care discussions. All health care disciplines are united in this effort and share resources, tools, and skills that we can translate into practice.


Editors from the International Academy of Nursing Editors support this effort as they publish editorials and articles on this topic, citing the work of the Institute of Medicine (IOM), the Institute for Healthcare Improvement (IHI), and The Conversation Project. Many articles provide new information about the Centers for Medicare & Medicaid Services reimbursement for these important conversations.


In recent publications, Susan Carroll3 called for neuroscience nurses to become conversation ready and reminds readers that IOM provides a roadmap and guides readers to the Conversation Project Web site ( Carroll reminds us about the 2014 IOM report4 and states, "despite images in media, the facts about death and dying remain constant. Older adults will live with chronic illness for an extended period and usually die without decisional capacity. To ignore these facts, and to avoid discussions about future care and end-of-life, leaves adults, their families, and healthcare providers at a loss as to how to provide care that matches the individual's values and respects his or her wishes."3


Susan Alexander reminds clinical nurse specialists that there is a great need for education in end-of-life care, which may be most perceptible at the bedside, as nurses witness many profoundly intimate moments between patients and their families. Her words remind us to ask patients, "What matters to you?" rather than "What is the matter with you?"5


On the national stage, the American Association of Critical Care Nurses (AACN) President Clareen Wiencek committed to a "It Matters" theme for 2017 to 2018. This theme places the patients' voice at the forefront of our work. Often quoting from the work of Dr Atul Gawande and his recent book, Being Mortal,6 Wiencek reinforces that nurses know exactly how much these things matter. She adds that "nurses are the architects of the memory for the family of every patient who experiences the crisis of acute illness."7


At the AACN National Teaching Institute in May, I was inspired by a presentation delivered by critical care nurses, Deanna Collins and Julie Cooley, from the Central Oregon AACN Chapter. Collins and Cooley8 shared their commitment to helping their community become conversation ready. Their presentation, "Having the Courage to Care and Be Conversation Ready," was a call to action for all critical care nurses. The presentation introduced the work of the Conversation Project and their chapter project within the community. Their talk was captivating and inspired others to ask, "Is my AACN chapter conversation ready?" This presentation inspired me to help my local chapter to become ready and made me think about the many ways we can spread this work. The possibilities are endless-we can teach individuals, chapters, staff on our clinical units, students and faculty in academic settings, and everyone in our own homes. Every place where nurses live and work is a potential site for education.


In my own work, I find joy introducing students and clinicians to the language and tools of this new conversation. I learn more when I listen to the students recount their experiences using the starter kit with family members or playing the "Gift of Grace" card game with each other. They are ready for this-they want to learn how to make discussions about care decisions an integral aspect of care. Asking patients what matters offers a natural transition toward this process.


Guiding students through the online modules, discussion groups, starter kit, and the card game has provided me with new questions and new approaches. Introducing these conversation techniques to a new generation opens a door, really a floodgate, to new insights and understanding.


We have many new ways to share the power of this type of patient-provider dialogue. In a recent Ted Talk, Jason Leitch refers to the phase "What Matters to Me" as a new vital sign as he shares patient stories and lessons learned from Glasgow, Scotland.9


Maureen Bisognano, former IHI President and CEO, who first introduced me to this language, shares a personal story about the death of her brother and how her family listened to what mattered to him at the end of his life.10


Moreover, I am seeing a new trend in patient responses. Often, patients are the first to broach the subject of care choices, as time grows shorter or care options present. "Do not intervene" and "do not resuscitate" are terms no longer spoken in whispers, no longer a sign of surrender or weakness. Simply, it is a choice-after a long life or illness-to bring clarity to the next phase of care.


This year, I have learned more from colleagues, students, and patients and, to my surprise, from my family. It is a process, one that will bring us closer to the people we love and the patients we care for.


How can you become conversation ready?


* Talk with the people you love; ask them what matters.


* Begin and end conversations with your patients using the "what matters to you" language.


* Join the national conversation, inform yourself, and use the many resources provided by the Conversation, the IHI white paper, and the Centers for Medicare & Medicaid Services ruling on reimbursement.11,12


* Attend Webinars and lectures and use tools, such as the starter kits (including new ones for pediatrics and families and loved ones of people with Alzheimer disease), from the Conversation Project toolkit.


* Bring copies of the starter kits to classrooms and clinical sites. Teach others through dialogue and simulation.


* Practice these methods when your family members are well as we know too well that often these conversations take place during times of crisis.





1. Gould KA. A conversation for the holidays: part II "what matters to you". Dimens Crit Care Nurs. 2015;34(6):313-316. [Context Link]


2. Gould KA. Conversations for the holidays: the Conversation Project. Dimens Crit Care Nurs. 2014;33(6):307-308. [Context Link]


3. Carroll VS. Let's talk: the Conversation Project. J Neurosci Nurs. 2016;48(4):175-176. [Context Link]


4. Institute of Medicine of the National Academies. IOM Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press; 2015. Accessed June 22, 2016. [Context Link]


5. Alexander S. Clinical nurse. Specialist. 2016;30(4):200-202. [Context Link]


6. Gawande A. Being Mortal: Medicine and What Matters in the End. New York, NY: McMillan Press; 2014. [Context Link]


7. Wieneck C. It matters. Bold Voices. 2016;8(7). Accessed July 30, 2016. [Context Link]


8. Collins D, Cooley J. Having the courage to care and be conversation ready. Paper presented at: AACN NTI; May 18, 2016. [Context Link]


9. Leitch J. What matters to me-a new vital sign. Accessed June 30, 2016. [Context Link]


10. Bisognano M. Maureen Bisognano, why health care improvement? Personal story: what matters. Accessed June 28, 2016. [Context Link]


11. McCutcheon Adams K, Kabcenell A, Little K, Sokol-Hessner L. "Conversation Ready": A Framework for Improving End-of-Life Care. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2015. Accessed June 30, 2016. [Context Link]


12. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; revisions to payment policies under the physician fee schedule and other revisions to part B for CY 2016. 42 CFR parts 405, 410, 411, 414, 425, 495[CMS-1631-P]RIN 0938-AS40. Accessed August 6, 2016. [Context Link]