Reflection: Managing a Challenging Family Meeting

Submitted by: Rachel - Adult Nurse with 8 years experience, Acute Medical Ward

What was the nature of the CPD activity and what did you hope to learn from it?

I was caring for Mr. Thompson (pseudonym), a 78-year-old gentleman with advanced heart failure on our acute medical ward. His condition had deteriorated significantly, and the medical team felt it was time to discuss end-of-life care options with his family. I was asked to attend the family meeting alongside the consultant and specialist nurse to provide nursing input and support.

The meeting involved Mr. Thompson's three adult children, who had very different views about their father's care. One daughter wanted 'everything possible' done, including ICU admission if needed. His son felt we should focus on comfort care, and the other daughter was unsure and became very emotional during the discussion.

I hoped to develop my skills in facilitating difficult conversations, supporting families through complex decision-making, and advocating for patient-centred care when family members have conflicting views.

What did you learn from the CPD activity?

I learned the critical importance of creating a safe, private space for these conversations. We ensured the family had a quiet room, tissues were available, and we weren't interrupted. I also learned to actively listen to each family member's concerns without rushing to provide solutions.

The consultant demonstrated excellent communication by acknowledging the difficulty of the situation and validating each person's feelings before presenting medical information. I learned that it's essential to check understanding regularly and avoid medical jargon that might confuse or alienate family members.

Most importantly, I learned to gently redirect the conversation back to what Mr. Thompson himself had expressed about his wishes. When I mentioned that he had told me he 'didn't want to be kept alive by machines' and 'wanted to be comfortable,' this helped the family focus on his values rather than their own fears and disagreements.

I also learned the value of offering follow-up support. We didn't expect the family to make immediate decisions, and I arranged for them to return the next day after they'd had time to process the information together.

How did you change or improve your practice as a result?

Following this experience, I now ensure I document patients' expressed wishes about their care much more thoroughly, particularly for those with life-limiting conditions. This documentation proved invaluable during the family meeting and helped centre the discussion on the patient's values.

I've also become more confident in my role during family meetings. Rather than staying silent, I now actively contribute nursing observations about the patient's quality of life, comfort levels, and what they've shared with me during care. Nurses often have insights that doctors don't because we spend more time with patients.

I've improved my approach to supporting families with conflicting views by acknowledging that disagreement is normal and doesn't mean they don't care. I now use phrases like 'It's clear you all love your father very much, and it's natural to have different perspectives on what's best for him.'

I also now follow up with families after difficult meetings to check how they're coping and answer any questions that have arisen since. This continuity of support has been really valued by families.

How is this relevant to the Code?

This reflection relates directly to several aspects of the NMC Code:

Prioritise people (1): By ensuring Mr. Thompson's own wishes were central to the discussion, I put his needs and preferences first, even when family members had different views.

Practise effectively (6): I used my communication skills to facilitate a difficult conversation and shared my nursing knowledge about the patient's condition and expressed wishes.

Preserve safety (13): By advocating for a care plan that aligned with Mr. Thompson's wishes rather than pursuing aggressive treatment he didn't want, I helped protect him from potentially harmful interventions.

Promote professionalism and trust (20): I maintained professional boundaries while showing compassion and empathy to a family in distress, upholding the reputation of the nursing profession.

Do you have any further comments?

This experience reinforced for me that end-of-life care isn't just about clinical skills—it's about communication, advocacy, and supporting families through one of the most difficult times of their lives. The family later thanked me for helping them understand what their father truly wanted, and Mr. Thompson died peacefully two days later with his family present, receiving comfort-focused care.

I plan to undertake further training in advance care planning and end-of-life communication to continue developing these essential skills.