The challenge of breaking bad news

Role, perspective and knowledge of Iranian critical care nurses about breaking bad news

BACKGROUND

Given the issue of caring critically ill patients, nurses are involved in the process of breaking bad news in critical care units, while little research has been conducted on this challenging issue.

OBJECTIVES

The purpose of this study was to determine the role, perspective and knowledge of Iranian critical care nurses regarding breaking bad news.

METHODS

This descriptive study was conducted on a sample of 160 nurses working in critical care units of hospitals affiliated to Tehran University of Medical Sciences. Stratified and quota sampling methods were used. The data collection tool was a four-part questionnaire with validity and reliability confirmed via content validity and test-retest, respectively.

RESULTS

The study showed that most critical care nurses were involved in breaking bad news, with different roles. The majority of participants (91.2%) had a positive attitude towards involvement of nurses in breaking bad news. In this study, 78.8% of nurses had moderate knowledge about how to break bad news, and only a few had good level of knowledge (16.2%).

CONCLUSION

According to the findings, while critical care nurses took different roles in the process of breaking bad news and they had positive attitude towards participation in this process, yet their knowledge about this process was inadequate. Thus, designing educational programmes to enhance critical care nurses' knowledge and skills in this area seems necessary.

Breaking bad news to parents: the children’s nurse’s role

Breaking bad news is an extremely difficult and challenging process for the health care professional. The National Service Framework for Children in the UK highlights that the manner in which the health care professional delivers bad news impacts upon the way it is received, interpreted, understood and dealt with. The children's nurse, as an instrumental member of the multidisciplinary team caring for the child and family, is central to this complex communication process. This article examines the literature surrounding the breaking of bad news and introduces a new framework that outlines the multifaceted role of the children's nurse within this complex, challenging process.

Increasing awareness of tissue donation: in the non-heart beating donor

Many healthcare professionals (nursing and medical staff) are familiar with asking families to consider organ donation in the brain-stem death patient. In contrast few healthcare professionals raise the subject of tissue donation with the newly bereaved non-heart beating donor (NHBD) families following cardiac death. The failure of healthcare professionals to approach theses families is strongly supported in the literature [Crit. Care Nurs. Clin. N. Am. 4 (1992) 63; William and Calif, 1996; Prof. Nurse 12 (1997) 482]. Coyle [Intensive Crit. Care Nurs. 16 (2000) 45] identified that for many nurses the conflict arises from the ethical principle of beneficence to do good and non-maleficence to do no harm. However, why is requesting organ and/or tissue donation an ethical issue, should it not be part and parcel of the care offered to bereaved families? Are healthcare professionals not making an issue of it? This article critically analyses the issues surrounding tissue donation and the role of healthcare professionals in raising awareness of eligibility for tissue donation. A tool of structured reflection [J. Nurse Manager 1 (1993) 9] will be used to highlight the use of reflective practice following a critical incident. On the basis of analysis of current practice consideration will be given for future theoretical arguments in development, research, and education.

Health professionals' perceptions of breaking bad news

The growth of the "patient-centred" approach to health care has highlighted the importance of quality communication practices. One area that remains problematic, however, is the process of breaking bad new to patients and/or relatives. Hence, there have been calls for more research and training in this domain. Reports the findings of a study that used the critical incident technique to explore the breaking bad news encounter from the perspective of the health care practitioner. In total 33 senior medical and nursing staff reported on situations in which they described specific, vividly recalled, experiences of both "effective" and "ineffective" bad news delivery. These reported incidents were content analysed and a range of key dimensions was identified for both effective and ineffective experiences. Interpersonal communication skills emerged as particularly salient factors and these are discussed in detail, together with implications for future research and training.