The 4 C’s offer a number of ways that nurses can engage in and support communication with family members about serious illness.

Make sure clinicians and families discuss prognosis, goals of care, and palliative care.

  • The bedside nurse advocates with the team to have a meeting to discuss a particular issue or issues regarding a patient’s care.

  • The charge nurse finds a meeting place, makes sure appropriate people are present, and arranges coverage so the bedside nurse can attend.

Identify family needs for information, ensure that clinicians understand family perspectives, and ensure that clinicians clearly convey information that families want.

  • The bedside nurse helps the family identify a list of questions before the meeting, makes sure those questions are asked and answered, helps the family identify what they want the team to know about their loved one (eg, goals, values, treatment preferences), and...

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