"The future depends on what we do in the present." - Mahatma Gandhi1
As I write this editorial in early April of 2023, I am once again composing an email to friends, family, and colleagues, inviting them to celebrate National Health Care Decisions Day (NHDD). This day was created through a collaboration with the Conversation Project, a public engagement initiative of the Institute for Healthcare Improvement. The goal of this work is both simple and transformative: to help everyone talk about their wishes for care through the end of life (EOL), so those wishes can be understood and respected.2
As intensive care unit nurses, we care for many patients at EOL. We know that families are often confronted with uncertainly about their loved one's wishes. Because many people have not discussed EOL issues, the introduction of terms such as advanced directives, do not resuscitate, or comfort measures only requires thoughtful conversations and deep learning. The annual NHDD forum provides an opportunity to share resources that promote this process by providing clinicians with tools and methods that guide discussion and education.
The Conversation Project offers a way to ease into that discussion. One tool, the What Matters to Me workbook, begins with a simple and gentle question; "What is your understanding of your current health situation?"3 I use this sentence to begin many discussions with patients and families-including my own family members. The workbook is one of many resources that can be used to create a platform for scholarly discussion among families, students, and colleagues!
Intensive care unit nurses often confront difficult conversations about mortality. We help families begin conversations about EOL goals. For us, every day is a health care decision day. These discussions are not easy-and often delayed until time becomes short-when loved ones can no longer speak for themselves.
I have included my annual letter (Supplemental Digital Content 1, http://links.lww.com/DCCN/A129). Please adapt and reuse to help share this day with your community! Furthermore, use the updated tools, resources, templates, and other ideas with your students, colleagues, and family members.4 Happy NHDD!
* Starter kits to help begin the conversation: https://theconversationproject.org/get-started
* Twenty-five potential resources to share for NHDD: https://theconversationproject.org/tcp-blog/25-potential-resources-to-share-for-
* A comprehensive tool kit with sample emails, flyers, and social media posts: https://theconversationproject.org/new-communications-toolkit-for-promoting-nhdd
Books
* Being Mortal by Atul Gawande
* You Can Stop Humming Now by Damiela Lamas
* Every Note Played by Lisa Genova
* When Breath Becomes Air by Paul Kalanithi
* A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death by Dr B.J. Miller & Shoshana Berger
References