PRACTICE DEVELOPMENT Conversations in end-of-life care: communication tools for critical care practitioners Sarah E. Shannon, Tracy Long-Sutehall and Maureen Coombs ABSTRACT Background: Communication skills are the key for quality end-of-life care including in the critical care setting. While learning general, transferable communication skills, such as therapeutic listening, has been common in nursing education, learning specific communication tools, such as breaking bad news, has been the norm for medical education. Critical care nurses may also benefit from learning communication tools that are more specific to end-of-life care. Strategy: We conducted a 90-min interactive workshop at a national conference for a group of 78 experienced critical care nurses where we presented three communication tools using short didactics. We utilized theatre style and paired role play simulation. The Ask-Tell-Ask, Tell Me More and Situation-Background-Assessment-Recommendation (SBAR) tools were demonstrated or practiced using a case of a family member who feels that treatment is being withdrawn prematurely for the patient. The audience actively participated in debriefing the role play to maximize learning. The final communication tool, SBAR, was practiced using an approach of pairing with another member of the audience. At the end of the session, a brief evaluation was completed by 59 nurses (80%) of the audience. Summary: These communication tools offer nurses new strategies for approaching potentially difficult and emotionally charged conversations. A case example illustrated strategies for applying these skills to clinical situations. The three tools assist critical care nurses to move beyond compassionate listening to knowing what to say. Ask-Tell-Ask reminds nurses to carefully assess concerns before imparting information. Tell Me More provides a tool for encouraging dialogue in challenging situations. Finally, SBAR can assist nurses to distill complex and often long conversations into concise and informative reports for colleagues. Key words: Communication in critical care • Critical care nursing • Family care in critical care • Nurse – patient communication INTRODUCTION End-of-life care continues to hold an important focus for health care practitioners and health policy makers alike. The key goal of any end-of-life initiative is to improve choice and quality of care for dying patients and their families (Mularski et al., 2006; Department of Health, 2008). One of the most challenging aspects of end-of-life care for nurses and physicians is managing difficult conversations (Back et al., 2005; Reinke et al., 2010a). This article introduces three communication Authors: SE Shannon, PhD, RN, Associate Professor, Biobehavioral Nursing & Health Systems, Box 357266, University of Washington, Seattle, WA 98195-7266, USA; T Long-Sutehall, C. Psychol, PhD, NIHR Post Doctoral Fellow, Faculty of Health Sciences, University of Southampton, Southampton, UK; M Coombs, MBE, PhD, RN, Consultant Nurse Critical Care, Senior Lecturer, Southampton University Hospitals Trust, Southampton, UK Address for correspondence: SE Shannon, Associate Professor, Biobehavioral Nursing & Health Systems, Box 357266, University of Washington, Seattle, WA 98195-7266, USA E-mail: sshannon@uw.edu tools to critical care nursing practice to facilitate effec- tive communication that have been applied in other arenas. To demonstrate how these tools may be use- ful for nurses’ end-of-life conversations, excerpts from an interactive workshop are shared. Evaluation data drawn from this event are presented to illustrate what attendees at the workshop found applicable to their critical care practice. BACKGROUND Effective communication around end-of-life care is one of the most important skills needed by any critical care practitioner (Molter, 1979; Nelson et al., 2006). Demon- strating care and concern for seriously ill patients and their families is an intrinsic part of critical care nursing philosophy (Beckstrand and Kirchhoff, 2005). There is clear evidence of the importance of informa- tional and communication needs for ICU patients and their family members (Molter, 1979; Paul and Rattray, 2008). While nurses have a key role in meeting such 124  2011 The Authors. Nursing in Critical Care  2011 British Association of Critical Care Nurses • Vol 16 No 3