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El Ali M. Truth-telling to the seriously ill child - Nurses' experiences, attitudes, and beliefs. Nurs Ethics 2024; 31:930-950. [PMID: 38128903 PMCID: PMC11370149 DOI: 10.1177/09697330231215952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child's bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children is worth exploring. METHODS A systematic academic database and grey literature search strategy was conducted using CINAHL, Medline Psych Info, and Google Scholar. Keywords used included truth, children, nurse, disclosure, serious illness, and communication. A total of 17 publications of varying types were included in the final data set. ETHICAL CONSIDERATIONS As this was a review of the literature, there were no direct human participants. Empirical studies included in the review had received ethics approval. RESULTS Of the 17 articles included in the review, only one directly reported on the experiences of nurses asked to withhold the truth from patients. Empirical studies were limited to HIV-positive children and children diagnosed with cancer and the dying child. CONCLUSION A paucity of literature exploring the experiences, attitudes, and beliefs of nurses with regard to truth-telling to seriously ill children is evident. Little consideration has been given to the role nurses play in communicating medical information to children in a hospital setting. The 17 articles included in the review focused on cancer, and HIV, diagnosis, and end-of-life care. Further research should be undertaken to explore the experiences and attitudes of nurses to clinical information sharing to children hospitalised with a wide range of serious illnesses and in diverse clinical scenarios.
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Affiliation(s)
- Mandy El Ali
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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2
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Wahyuni S, Gautama MSN, Simamora TY. A Literature Review of Nurses Challenges and Barriers in Assisting Patients and Families Facing Breaking Bad News. Indian J Palliat Care 2023; 29:243-249. [PMID: 37700890 PMCID: PMC10493690 DOI: 10.25259/ijpc_128_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/22/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives Breaking bad news (BBN) is a challenging task for healthcare professionals, including nurses. The manner in which bad news is delivered can have a significant impact on patients and their families, either positive or negative. Understanding the roles, methods, obstacles, and challenges that nurses face in the process of delivering bad news is crucial for improving the quality of the delivery process. Material and Methods This narrative review synthesises related studies. The search was conducted through PubMed, Scopus, ScienceDirect and Sage, with no restriction on publication year. The main keywords were 'nurse's challenge', 'nurse's barrier', 'bad news', 'breaking bad news', and 'communicating bad news.' A total of 12 articles were selected from 1075 articles. Results Nurses play a key role in BBN before, during and after the process. Their activities include preparing patients to receive bad news, supporting patients and families when doctors deliver bad news and clarifying information obtained by patients and families regarding the prognosis of their illness. Nurses should possess skills such as building interpersonal relationships, therapeutic communication and providing emotional care for patients and their families. The main challenges and barriers for nurses in implementing BBN are due to a lack of skills and unpreparedness for patient and family reactions. After BBN, the most reported roles of nurses were supporting patients and families and helping them understand the information received from doctors. It is essential for nurses to have the necessary skills and preparedness to effectively deliver bad news to patients and their families. Conclusion Nurses play a crucial role in delivering bad news to patients and their families. They should be equipped with the necessary skills to effectively communicate with patients and their families during this difficult time. Further training for nurses in therapeutic communication, emotional care for patients and their families, and building interpersonal relationships could help to improve the quality of the delivery process.
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Affiliation(s)
- Surya Wahyuni
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Made Satya Nugraha Gautama
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tiur Yulianta Simamora
- Master of Nursing Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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3
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Anestis E, Eccles FJR, Fletcher I, Triliva S, Simpson J. Healthcare professionals' involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study. Disabil Rehabil 2022; 44:7877-7890. [PMID: 34783624 DOI: 10.1080/09638288.2021.2002436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical1 healthcare professionals' involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK. MATERIALS AND METHODS 19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson's disease or Huntington's disease took part in individual, semi-structured interviews which were analysed using thematic analysis. RESULTS Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised. CONCLUSIONS BBN was a critical and challenging aspect of healthcare professionals' clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future.Implications for rehabilitationBreaking bad news is a potentially under-recognised but significant aspect in the neurorehabilitation of neurodegenerative conditions.Listening to patients' stories about a long and occasionally unsatisfactory diagnostic journey and allowing them to express their frustration can be critical in regaining patients' trust and building a relationship with them.Newly diagnosed patients have not always received adequate information about their condition at diagnosis or they might have not understood or retained that information. It is, therefore, essential that patients' understanding of their condition is assessed, misconceptions are cleared and appropriate information about the nature and impact of the diagnosis is provided.Irrespective of the length of experience, breaking bad news was perceived as a multi-faceted, challenging, stressful and emotionally demanding task.Formal support and specialised training on breaking the bad news that addresses the incurable, unpredictable and progressive nature of motor neurodegenerative conditions could help professionals with this challenging task.
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Affiliation(s)
- Eleftherios Anestis
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian Fletcher
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sofia Triliva
- Department of Psychology, School of Social Sciences, University of Crete, Rethymnon, Greece
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Cogley C, D'Alton P, Nolan M, Smith E. "You were lying in limbo and you knew nothing": a thematic analysis of the information needs of spinal cord injured patients and family members in acute care. Disabil Rehabil 2022; 44:6804-6814. [PMID: 34465272 DOI: 10.1080/09638288.2021.1970259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To address the lack of research on the information needs of spinal cord injured (SCI) patients and family members in acute care, in order to inform the provision of appropriate information supports. MATERIALS AND METHODS Semi-structured interviews were conducted with seven traumatic SCI patients and six family members. Reflexive thematic analysis was used to analyse and interpret the data. RESULTS Five themes were generated: (1) "You were lying in limbo and you knew nothing" describes how being situated in non-specialist acute care limited participants' access to information; (2) "You'll never walk again" is not enough describes the need for information about the effects of SCI and the management of secondary conditions; (3) "The delivery was awful" demonstrates the importance of information being explained clearly and empathically; (4) "It was going in one ear and out the other" highlights the need for ongoing conversations with healthcare professionals, as retaining information provided in the early stages post-injury is often difficult; and (5) "Hope" not "false hope" discusses the importance of giving patients and family members hope while simultaneously being realistic about potential recovery. CONCLUSIONS SCI patients and family members had significant unmet information needs in acute care.IMPLICATIONS FOR REHABILITATIONSCI patients and family members had significant unmet information needs while in acute care. Being in non-specialist acute care significantly limited most participants' access to information.During the acute phase of care, most patients and family members would like to know the patient's recovery prognosis, the impact of SCI on the patient's functional independence, how to manage secondary complications, and what to expect in rehabilitation.As patients and family members often had difficulty absorbing information in the early stages post-injury, information should be continuously repeated, reinforced and clarified.HCPs should promote realistic hope for SCI patients and family members even in the absence of neurological recovery, by focusing on what the patient is still capable of while being honest about their prognosis.
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Affiliation(s)
- Clodagh Cogley
- University College Dublin, Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | - Paul D'Alton
- University College Dublin, Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | - Maeve Nolan
- National Rehabilitation Hospital, Dublin, Ireland
| | - Eimear Smith
- National Rehabilitation Hospital, Dublin, Ireland
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Rayan A, Hussni Al-Ghabeesh S, Qarallah I. Critical Care Nurses’ Attitudes, Roles, and Barriers Regarding Breaking Bad News. SAGE Open Nurs 2022; 8:23779608221089999. [PMID: 35434304 PMCID: PMC9008854 DOI: 10.1177/23779608221089999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
This study examines critical care nurses’ attitudes, roles, experience, education, and barriers regarding breaking the bad news. A descriptive, cross-sectional design was used in this study. A convenience sample of 210 critical care nurses completed the study. Most of the critical care nurses contributed to breaking bad news and they were involved in different roles in this process and they had a positive attitude regarding breaking bad news. In this study, (75.2%) of the participants reported that they did not receive any specific training regarding breaking bad news. In addition, nurses face various barriers when breaking bad news. Critical care nurses’ involvement in breaking bad news should be encouraged. Most barriers to BBN were negatively associated with nurses’ roles, attitudes, and experiences during BBN. Administrators should promote the involvement of critical care nurses in breaking bad news and strengthen them through addressing the challenges they face in the process of BBN.
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Affiliation(s)
- Ahmad Rayan
- Zarqa University, Faculty of Nursing. Zarqa, Jordan
| | | | - Islam Qarallah
- Master program in Faculty of Nursing, Al-Zaytoonah University of Jordan and work as critical care nurse in Royal medical services. Amman, Jordan
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Burton LJ, Forster A, Johnson J, Crocker TF, Tyson SF, Wray F, Clarke DJ. Experiences and views of receiving and delivering information about recovery in acquired neurological conditions: a systematic review of qualitative literature. BMJ Open 2021; 11:e045297. [PMID: 33906841 PMCID: PMC8088240 DOI: 10.1136/bmjopen-2020-045297] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To review and synthesise qualitative literature relating to the views, perceptions and experiences of patients with acquired neurological conditions and their caregivers about the process of receiving information about recovery; as well as the views and experiences of healthcare professionals involved in delivering this information. DESIGN Systematic review of qualitative studies. DATA SOURCES MEDLINE, Embase, AMED, CINAHL, PsycINFO, Web of Science and the Cochrane library were searched from their inception to July 2019. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data from the included studies and assessed quality using an established tool. Thematic synthesis was used to synthesise the findings of included studies. RESULTS Searches yielded 9105 titles, with 145 retained for full-text screening. Twenty-eight studies (30 papers) from eight countries were included. Inductive analysis resulted in 11 descriptive themes, from which 5 analytical themes were generated: the right information at the right time; managing expectations; it's not what you say, it's how you say it; learning how to talk about recovery and manage emotions; the context of uncertainty. CONCLUSIONS Our findings highlight the inherent challenges in talking about recovery in an emotional context, where breaking bad news is a key feature. Future interventions should focus on preparing staff to meet patients' and families' information needs, as well as ensuring they have the skills to discuss potential recovery and break bad news compassionately and share the uncertain trajectory characteristic of acquired neurological conditions. An agreed team-based approach to talking about recovery is recommended to ensure consistency and improve the experiences of patients and their families.
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Affiliation(s)
- Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Johnson
- School of Psychology, University of Leeds Faculty of Biological Sciences, Leeds, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Newman AR, Callahan MF, Lerret SM, Oswald DL, Weiss ME. Pediatric Oncology Nurses' Experiences With Prognosis-Related Communication. Oncol Nurs Forum 2019; 45:327-337. [PMID: 29683123 DOI: 10.1188/18.onf.327-337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine nurses' experiences of prognosis-related communication (PRC) with parents of children with cancer. SAMPLE & SETTING Cross-sectional, correlational study in the pediatric oncology setting involving 316 members of the Association of Pediatric Hematology/Oncology Nurses. METHODS & VARIABLES Online survey regarding individual nurse factors, PRC, interprofessional collaboration, moral distress, and perceived quality of care. RESULTS Nurses strongly agreed that prognostic disclosure is critical for decision making, but they are challenged in determining their role. Nurses with more years of experience and training in PRC, those working in an outpatient setting, and those with higher levels of nurse-physician collaboration reported more positive experiences with PRC. Positive experiences with PRC and collaboration were significantly associated with higher nurse-perceived quality of care and reduced nurse moral distress. IMPLICATIONS FOR NURSING Nurses should work to be active participants in the process of PRC by collaborating with physician colleagues. When nurses sense that prognostic discussions have been absent or unclear, they should feel confident in approaching physician colleagues to ensure parent understanding and satisfaction with communication.
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8
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Klint K, Sjöland H, Axelsson ÅB. Revealed by degrees: Patients' experience of receiving information after in-hospital cardiac arrest. J Clin Nurs 2018; 28:1517-1527. [PMID: 30589946 DOI: 10.1111/jocn.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/16/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experience of receiving information about the event after having a cardiac arrest in hospital. BACKGROUND In Sweden, approximately 2,600 people per year experience cardiac arrest in hospital. After a cardiac arrest, the patient is entitled to receive information about what has occurred. This information must be provided in a way that does not do the patient more harm than good. In order to provide information to patients in a satisfactory manner for them, knowledge about how patients react to information in this situation is valuable. DESIGN We used a qualitative approach with interviews and content analysis. METHODS Twenty patients participated in face-to-face interviews analysed by content analysis. Consolidated criteria for reporting qualitative studies were used. RESULTS The analysis resulted in three categories: Getting the information gradually, Understanding information received and Seeking clarity. The subcategories that emerged were as follows: Indirect information, Short and direct information, Explanatory information, Lack of information, Unsatisfactory information, Hard-to-understand information, Insight, Unanswered questions, Hard-to-formulate questions, Requesting information and Searching independently for knowledge. CONCLUSIONS The patients needed gradual and repeated information during their hospitalisation, and repeated information was continually required after their discharge from hospital. Whether or how the information was given varied. The patients' experience was that they sometimes lacked opportunities for conversation and asking questions, while they also found it hard to formulate questions. Patients who have a cardiac arrest in hospital appear to have similar information needs to patients whose cardiac arrest takes place outside the hospital context. RELEVANCE TO CLINICAL PRACTICE Information on the patient's cardiac arrest should be given in gradual stages, according to the patient's needs. The information needs to be repeated during the hospital stay and after discharge. Healthcare professional should gain insight into patients' responses and create information that is adapted to the individual.
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Affiliation(s)
- Kjell Klint
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Helen Sjöland
- Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Åsa B Axelsson
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ozyemisci-Taskiran O, Coskun O, Budakoglu II, Demirsoy N. Breaking bad news in spinal cord injury; a qualitative study assessing the perspective of spinal cord injury survivors in Turkey. J Spinal Cord Med 2018; 41:347-354. [PMID: 28387153 PMCID: PMC6055950 DOI: 10.1080/10790268.2017.1311463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
UNLABELLED Prior abstract publication: 2nd Medical Rehabilitation Congress; Nov 4-7, 2010; Ankara, Turkey Objective: This study aims to investigate the process of breaking bad news from the perspective of spinal cord injury survivors. DESIGN A cross sectional, qualitative study. SETTING Community. PARTICIPANTS Fourteen spinal cord injury survivors. INTERVENTIONS Subjects participated in a semi-structured interview about 'when', 'where' 'by whom' and 'how' they received and 'would' prefer to receive bad news. OUTCOME MEASURES Answers to 'how' questions were coded according to SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathizing, Summary). RESULTS Eight participants (57%) reported that they received bad news from a physician, mostly during rehabilitation. All would prefer to be informed by a physician and majority preferred to be gradually informed during rehabilitation. Half were not satisfied with the content of information. Only half felt that his/her physiatrist understood his/her emotional distress. Majority of participants who received bad news from physicians reported that the setting was private and their family members accompanied them. CONCLUSION Most spinal cord injury survivors were unsatisfied with knowledge and emotional support provided by rehabilitation physicians. Participants would prefer to receive bad news by a senior physiatrist in a planned meeting during rehabilitation.
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Affiliation(s)
- Ozden Ozyemisci-Taskiran
- Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey,Correspondence to: Ozden Ozyemisci-Taskiran, Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Maltepe Mah, Davutpasa Cad, No:4, Topkapı 34010, Zeytinburnu, Istanbul, Turkey.
| | - Ozlem Coskun
- Department of Medical Education, Gazi University School of Medicine, Ankara, Turkey
| | - Isil Irem Budakoglu
- Department of Medical Education, Gazi University School of Medicine, Ankara, Turkey
| | - Nesrin Demirsoy
- Department of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Ankara, Turkey
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10
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Chircop D, Scerri J. Being diagnosed with cancer: The experiences of patients with non-Hodgkin's lymphoma. J Clin Nurs 2017; 26:4899-4904. [DOI: 10.1111/jocn.13967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Daren Chircop
- Department of Nursing; Faculty of Health Sciences; University of Malta; Msida Malta
| | - Josianne Scerri
- Department of Mental Health; Faculty of Health Sciences; University of Malta; Msida Malta
- Kingston University and St George's, University of London; London UK
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11
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Nurses' Perceptions of Diagnosis and Prognosis-Related Communication: An Integrative Review. Cancer Nurs 2017; 39:E48-60. [PMID: 27035358 DOI: 10.1097/ncc.0000000000000365] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Disclosure of diagnostic and prognostic information has become the standard in the United States and increasingly around the world. Disclosure is generally identified as the responsibility of the physician. However, nurses are active participants in the process both intentionally and inadvertently. If not included in initial discussions regarding diagnosis and prognosis, the nurse may find it challenging to openly support the patient and family. OBJECTIVE The aim of this study is to synthesize published literature regarding nurses' perceptions and experiences with diagnosis and prognosis-related communication. METHODS The Whittemore and Knafl method guided the integrative review process. Electronic databases including Cumulative Index to Nursing and Allied Health Literature, Health Sciences in ProQuest, PubMed, and Web of Science were used to review the literature from 2000 to 2015. Constant comparison methods were used to analyze the data and develop themes. RESULTS Thirty articles met all of the inclusion criteria and were included in this review. Several themes emerged from the data, including the nurse's role in the process of diagnosis and prognosis-related communication, barriers and difficulties related to communication, and positive and negative outcomes. CONCLUSIONS Nurses play an integral role in the process of diagnostic and prognostic disclosure. Further exploration of both physician and patient perceptions of the nurse's role are needed. Interprofessional training regarding diagnosis and prognosis-related communication is essential to promote collaboration and better empower nurses in this process. IMPLICATIONS FOR PRACTICE Nurses should aim to purposefully partner with physician colleagues to plan and participate in diagnostic and prognostic discussions. Nurses should identify opportunities to improve their knowledge, understanding, and comfort with challenging conversations.
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12
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Warnock C, Buchanan J, Tod AM. The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news. J Adv Nurs 2017; 73:1632-1645. [PMID: 28072478 DOI: 10.1111/jan.13252] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
Abstract
AIMS The aim of this study was to explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news. BACKGROUND The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or participants. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. DESIGN The study used a descriptive survey design involving self-reported written accounts and framework analysis. METHODS Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 and April 2014. FINDINGS Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarizes the factors that contribute to creating difficult experiences for staff when breaking bad news. CONCLUSION The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice.
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Affiliation(s)
- Clare Warnock
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jean Buchanan
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angela Mary Tod
- School of Nursing and Midwifery, The University of Sheffield, UK
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13
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Quality of Life in Portuguese Patients with Diabetic Foot Ulcer Before and After an Amputation Surgery. Int J Behav Med 2016; 23:714-721. [DOI: 10.1007/s12529-016-9567-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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14
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Kirshblum SC, Botticello AL, DeSipio GB, Fichtenbaum J, Shah A, Scelza W. Breaking the news: A pilot study on patient perspectives of discussing prognosis after traumatic spinal cord injury. J Spinal Cord Med 2016; 39:155-61. [PMID: 25897890 PMCID: PMC5072497 DOI: 10.1179/2045772315y.0000000013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE/BACKGROUND In spinal cord injury (SCI) medicine, informing a patient with a neurologically complete SCI of the poor prognosis ("bad news") for significant neurological recovery (e.g. ambulation) is difficult. Few guidelines exist for clinicians and the wishes of patients in receiving this information are currently not known. The goal of this pilot study was to determine when, by whom, and in what setting persons with neurologically complete traumatic SCI want to hear of their prognosis. METHODS Subjects with a >3 months motor complete SCI above T10 were recruited to complete an online survey, from three geographically different acute rehabilitation centers, to obtain retrospective information on their experiences of receiving poor prognosis. A mixed methods approach was used to obtain data on individual experiences and a combination of quantitative and qualitative analyses was used to assess patterns in individual responses. RESULTS 60 individuals were recruited for the study and 56 participants completed the survey. Most heard their prognosis from a physician, in the acute care hospital (61%), with the patient initiating the conversation (64%). Patient recommendations reveal that most individuals with traumatic SCI prefer to be given the poor prognosis for neurological recovery by a physician and early after injury. There were no differences in patient experience nor recommendations based on demographic background (i.e. sex, age, race, or education level). CONCLUSION The majority of patients surveyed report wanting to know their prognosis early after injury and to hear the information by a physician in a clear and sensitive manner. This study marks the first step towards defining how and when to break the news regarding poor prognosis for neurological recovery including ambulation after severe (neurological complete) traumatic SCI from the patients' perspective.
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Affiliation(s)
- Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA,Correspondence to: Steven C. Kirshblum, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
| | - Amanda L. Botticello
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA,Kessler Foundation Research Center, West Orange, NJ, USA
| | - Gina Benaquista DeSipio
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Joyce Fichtenbaum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Akshat Shah
- Santa Clara Valley Medical Center, San Jose, CA, USA
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15
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Role, perspective and knowledge of Iranian critical care nurses about breaking bad news. Aust Crit Care 2015; 29:77-82. [PMID: 26256781 DOI: 10.1016/j.aucc.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 05/24/2015] [Accepted: 07/20/2015] [Indexed: 11/23/2022] Open
Abstract
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.
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Teaching midwife students how to break bad news using the cinema: An Italian qualitative study. Nurse Educ Pract 2015; 15:141-7. [DOI: 10.1016/j.nepr.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 11/06/2014] [Accepted: 01/15/2015] [Indexed: 12/30/2022]
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Griffiths J, Ewing G, Wilson C, Connolly M, Grande G. Breaking bad news about transitions to dying: a qualitative exploration of the role of the District Nurse. Palliat Med 2015; 29:138-46. [PMID: 25249242 DOI: 10.1177/0269216314551813] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND UK District Nurses have an important role in enabling a good death. Patients and families need to know the patient is approaching the dying phase, yet evidence suggests breaking bad news about the patient's transition to dying rarely happens. District Nurses spend a lot of time with patients and families during the dying phase and are ideally placed to recognise and discuss the transition to dying. AIM To explore the role of District Nurses in breaking bad news of transition to dying. DESIGN Qualitative focus groups. SETTING Primary care (District Nurse service); Four National Health Service Trusts, North West England. PARTICIPANTS A total of 40 District Nurses across the Trusts, all Registered General Nurse qualified. Median number of years as a District Nurse was 12.5. All had palliative cancer patients on their caseloads. RESULTS District Nurses' role in breaking bad news of transition to dying was challenging, but the conversation was described as essential preparation for a good death. Four main challenges with the conversations were patients' responses to the prognosis (unawareness, denial and anger), timing the conversation, complexities of the home environment and limited preparation in this aspect of their work. CONCLUSIONS District Nurses are with patients during their last weeks of life. While other colleagues can avoid breaking bad news of transition to dying, District Nurses have no choice if they are to provide optimal end of life care. While ideally placed to carry out this work, it is complex and they are unprepared for it. They urgently need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care.
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Affiliation(s)
- Jane Griffiths
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Charlotte Wilson
- Barts & The London School of Medicine Centre for Primarly care and Public Health, London, UK
| | - Michael Connolly
- Supportive and Palliative Care, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Gunn Grande
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Newman AR, Helft PR. Reliability and Validity of a Tool to Assess Oncology Nurses' Experiences With Prognosis-Related Communication. Oncol Nurs Forum 2014; 42:64-73. [DOI: 10.1188/15.onf.64-73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Valizadeh L, Zamanzadeh V, Sayadi L, Taleghani F, Howard AF, Jeddian A. Truth-telling and hematopoietic stem cell transplantation. Nurs Ethics 2014; 21:518-29. [DOI: 10.1177/0969733013511359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Hematopoietic stem cell transplantation is a potential cure for a range of life-threatening diseases, but is also associated with a high mortality rate. Nurses encounter a variety of situations wherein they are faced with discussing bad news with hematopoietic stem cell transplantation patients. Research objective: The aim of this study was to explore the experiences and strategies used by Iranian nurses related to truth-telling and communicating bad news to hematopoietic stem cell transplantation patients. Research design: A qualitative approach using content analysis of interview data was conducted. Participants and research context: A total of 18 nurses from the main hematopoietic stem cell transplantation center in Iran participated in semi-structured interviews. Ethical considerations: The Institutional Review Board of the Tabriz University of Medical Sciences and the Hematology-Oncology and Stem Cell Transplantation Research Center affiliated with the Tehran University of Medical Sciences approved the study. Findings: In the first main category, not talking about the disease and potential negative outcomes, the nurses described the strategies of not naming the disease, talking about the truth in indirect ways and telling gradually. In the second main category, not disclosing the sad truth, the nurses described the strategies of protecting patients from upsetting information, secrecy, denying the truth and minimizing the importance of the problem. The nurses used these strategies to minimize psychological harm, avoid patient demoralization, and improve the patient’s likelihood of a fast and full recovery. Discussion: The priority for Iranian hematopoietic stem cell transplantation nurses is to first do no harm and to help patients maintain hope. This reflects the Iranian healthcare environment wherein communicating the truth to hematopoietic stem cell transplantation patients is commonly considered inappropriate and avoided. Conclusion: Iranian nurses require education and support to engage in therapeutic, culturally appropriate communication that emphasizes effective techniques for telling the truth and breaking bad news, thereby potentially improving patient outcomes and protecting patient rights.
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Cordesse V, Jametal T, Guy C, Lefebvre S, Roussel M, Ruggeri J, Schimmel P, Holstein J, Meininger V. [Analysis of clinical pathway in changing and disabling neurological diseases]. Rev Neurol (Paris) 2013; 169:476-84. [PMID: 23623808 DOI: 10.1016/j.neurol.2012.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/12/2012] [Accepted: 12/05/2012] [Indexed: 12/13/2022]
Abstract
Neurological diseases are characterized by the complexity of care and by a constant and changing disability. More and more frequently, their impact on the clinical pathway remains unknown. Seven postgraduate rehabilitation students (Master coordination du handicap, université Pierre-et-Marie-Curie, Paris) reconstructed the clinical pathway of 123 patients with various neurological diseases: multiple sclerosis, Alzheimer disease, amyotrophic lateral sclerosis, spinal trauma, Parkinson disease and brain tumors. There was a significant correlation between disease duration and the number of specialists involved in care, the number of prescribed drugs and the number of short-term hospitalizations; there was no correlation with age. This result suggests that with time an increasing number of complications related to the initial neurological disease developed. Hospitalization in rehabilitation units was highly correlated with the degree of disability and also with the help received by the patients during the course of their disease. This result suggests that these hospitalizations were a direct consequence of burn out among relatives. General practitioners (GP) were highly involved only during the initial part of the pathway, and their involvement rapidly declined thereafter, suggesting a probable relation with the specificities and the complexity of care for neurological diseases which induces a progressive transfer of responsibilities from the GP to the hospital. Social care was always incomplete and occurred too late during the course of the disease. The feeling by the patients that their care pathway was chaotic was highly correlated with the quality of the information given to the patient at the time of the announcement of their disease. This study confirms that cares for neurological diseases is highly specific and that expert centers and coordination networks are in a key position to ensure an efficient care pathway.
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Affiliation(s)
- V Cordesse
- Réseau SLA Île-de-France, bâtiment clinique médicale, hôpital de la Salpêtrière, 47/83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Warnock C, Tod A, Foster J, Soreny C. Breaking bad news in inpatient clinical settings: role of the nurse. J Adv Nurs 2010; 66:1543-55. [PMID: 20492016 DOI: 10.1111/j.1365-2648.2010.05325.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of an exploration of the role of the nurse in the process of breaking bad news in the inpatient clinical setting and the provision of education and support for nurses carrying out this role. BACKGROUND The term 'breaking bad news' is mostly associated with the moment when negative medical information is shared with a patient or relative. However, it can also be seen as a process of interactions that take place before, during and after bad news is broken. Little research has been conducted exploring the role of the nurse in the process of breaking bad news in the inpatient clinical setting. METHODS A questionnaire was developed using Likert scales and open text questions. Data collection took place in 2007. Fifty-nine inpatient areas took part in the study; 335 questionnaires were distributed in total and 236 were completed (response rate 70%). RESULTS Nurses engaged in diverse breaking bad news activities at many points in care pathways. Relationships with patients and relatives and uncontrolled and unplanned events shaped the context in which they provided this care. Little formal education or support for this work had been received. CONCLUSION Guidance for breaking bad news should encompass the whole process of doing this and acknowledge the challenges nurses face in the inpatient clinical area. Developments in education and support are required that reflect the challenges that nurses encounter in the inpatient care setting.
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Affiliation(s)
- Clare Warnock
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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The experience of spinal cord injury: using Frank's narrative types to enhance physiotherapy undergraduates' understanding. Physiotherapy 2009; 96:52-8. [PMID: 20113763 DOI: 10.1016/j.physio.2009.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 06/07/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To consider physiotherapy students' responses to three illness narratives common in rugby players who have suffered a spinal cord injury (SCI). DESIGN A narrative vignette was provided to first and third year students reading for a Batchelor of Science degree in physiotherapy. SETTING A university in the West Midlands during a year cohort meeting. PARTICIPANTS Seventy-seven first year students and 45 third year students took part in the study. All students were attending the university at the time of the study. None of the first year students had completed any clinical placement hours, and all of the third year students had completed the required number of clinical hours for a physiotherapy degree. MAIN OUTCOME MEASURES The narrative vignette consisted of nine questions relating to the vignette. Thematic content analysis was applied to the results. RESULTS The role of experience appeared to influence students' responses. The third year students' reactions to each narrative appeared more consistent and unified as a medical voice. This appeared to support their preference for an ideal type of story and patient. Problems with each narrative were identified, although often not critiqued. CONCLUSIONS Students need more time to consider different illness narratives in order to accept and understand them.
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Natan MB, Shahar I, Garfinkel D. Disclosing bad news to patients with life-threatening illness: Differences in attitude between physicians and nurses in Israel. Int J Palliat Nurs 2009; 15:276-81. [DOI: 10.12968/ijpn.2009.15.6.42984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera
| | - Irit Shahar
- Shoham Geriatric Medical Center, Pardes Hana, Israel
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Abstract
Breaking the bad news in terms of prognosis for significant motor recovery following a neurologically complete spinal cord injury (SCI) is one of the most difficult tasks for the spinal cord medicine specialist. Learning the skills to facilitate this communication is extremely important to better assist patients to understand their prognosis as well as foster hope for their future. If bad news is delivered poorly it can cause confusion and long-lasting distress and resentment; if done well, it may assist understanding, adjustment, and acceptance. This article provides the physician who cares for patients with SCI with some concepts to consider when discussing prognosis with patients and their families.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA.
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Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2008; 31:403-79. [PMID: 18959359 PMCID: PMC2582434 DOI: 10.1043/1079-0268-31.4.408] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Barclay JS, Blackhall LJ, Tulsky JA. Communication Strategies and Cultural Issues in the Delivery of Bad News. J Palliat Med 2007; 10:958-77. [PMID: 17803420 DOI: 10.1089/jpm.2007.9929] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Good communication is a fundamental skill for all palliative care clinicians. Patients present with varied desires, beliefs, and cultural practices, and navigating these issues presents clinicians with unique challenges. This article provides an overview of the evidence for communication strategies in delivering bad news and discussing advance care planning. In addition, it reviews the literature regarding cultural aspects of care for terminally ill patients and their families and offers strategies for engaging them. Through good communication practices, clinicians can help to avoid conflict and understand patients' desires for end of life care.
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Affiliation(s)
- Joshua S Barclay
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27705-3860, USA.
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Whalley Hammell K. Quality of life after spinal cord injury: a meta-synthesis of qualitative findings. Spinal Cord 2006; 45:124-39. [PMID: 17091119 DOI: 10.1038/sj.sc.3101992] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Meta-synthesis of qualitative research. OBJECTIVES To identify, compare and synthesize the factors found to contribute to, or detract from the experience of a life worth living following spinal cord injury (SCI). METHODS Published articles were identified from the Medline, CINAHL and Sociological Abstracts databases, a hand search through selected journals published since 1990, and from reference lists. These were assessed for their relevance to the focus of interest and appraised for rigour and quality. The key themes that emerged from the data were summarized, compared and synthesized. RESULTS The search located 64 papers and four books, of which seven papers met the review criteria for relevance and rigour, and in which 10 main concepts were identified: (1) body problems, (2) loss, (3) relationships, (4) responsibility for, and control of one's life, (5) occupation, and ability to contribute, (6) environmental context, (7) new values/perspective transformation, (8) good and bad days, (9) self-worth, (10) self-continuity. CONCLUSIONS This study demonstrates the utility of synthesizing qualitative research to provide a greater depth of insight into the factors that contribute to, and detract from, quality of life (QOL) after SCI. It also provides a more nuanced understanding of the experience of QOL following SCI than is achievable by quantitative methods. Future qualitative research is required to probe further the concepts and connections identified in this study, and to identify how rehabilitation services might best address these issues.
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Abstract
The aim of the research was to identify the caregivers' response patterns when breaking bad news at the first time of cancer diagnosis and their affect on the patient. These issues were examined from 3 points of view: patients, doctors, and nurses. A total of 152 Israelis subjects participated in the research: 51 patients with cancer, 51 nurses, and 50 doctors. They filled out a questionnaire developed for the research that included 35 items. Support patterns identified as effective were as follows: allowing for the expression of emotions, empathetic silence, support through touch, and the use of participatory, commendation, and encouragement statements. The research findings indicate the crucial need in the involvement of a family member and a nurse in the process and in supplying written information for the receiver of the news. Significant differences (P < .05) between patients and caregivers were found in the type of information given, in the timing and quantity, and in the support and communication patterns. The principal emotions professional caregivers experienced were identification and helplessness. Most of them were not trained in this field. The research findings could bridge the gap between what patients want and what caregivers do and would benefit in designing guidelines for breaking bad news and formulating a workshop program for furthering the team skills.
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Affiliation(s)
- Michal Rassin
- Nursing Research Unit, Assaf Harofeh Medical Center, Zrifinn, Israel.
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Chen HY, Boore JRP. Considering the physiological and psychological consequences of spinal cord injury. ACTA ACUST UNITED AC 2005. [DOI: 10.12968/bjnn.2005.1.5.20269] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hsiao-Yu Chen
- Department of Nursing, Central Taiwan University of Science and Technology, Taiwan, Republic of China, and
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Lohne V, Severinsson E. Hope and despair: the awakening of hope following acute spinal cord injury—an interpretative study. Int J Nurs Stud 2004; 41:881-90. [PMID: 15476761 DOI: 10.1016/j.ijnurstu.2004.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2003] [Revised: 01/07/2004] [Accepted: 04/06/2004] [Indexed: 11/29/2022]
Abstract
The aim of this paper was to explore the patients' experiences of hope during the first months following acute spinal cord injury. This qualitative study has a descriptive and explorative design. Data were collected by personal interviews (N = 10) at a rehabilitation centre in Norway. A phenomenological-hermeneutic approach inspired by Ricoeur was used to extract the meaning content of the patients' experiences. The findings revealed one main interpretation; the awakening of hope, expressed by two themes: hope and despair, and uncertainty. Awakening hopes, even sometimes silent hopes, constituted a contextual background in the immediate aftermath of spinal cord injury.
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Affiliation(s)
- Vibeke Lohne
- Institute of Nursing Science, University of Oslo, Norway.
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Mystakidou K, Parpa E, Tsilila E, Katsouda E, Vlahos L. Cancer information disclosure in different cultural contexts. Support Care Cancer 2004; 12:147-54. [PMID: 15074312 DOI: 10.1007/s00520-003-0552-7] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationship between truth telling and culture has been the subject of increasing attention in the literature. The issue of whether, how and how much to tell cancer patients concerning diagnosis is still approached differently depending on country and culture. The majority of physicians tell the truth more often today than in the past, in both developed and developing countries, but most of them prefer to disclose the truth to the next of kin. Nurses in Anglo-Saxon countries are considered to be the most suitable health-care professionals for the patients to share their thoughts and feelings with. Nevertheless, in most other cultures the final decision on information disclosure lies with the treating physician. Regardless of cultural origin, the diagnosis of cancer affects both family structure and family dynamics. In most cases patients' families, in an effort to protect them from despair and a feeling of hopelessness, exclude the patient from the process of information exchange. The health-care team-patient relationship is a triangle consisting of the health-care professional, the patient and the family. Each part supports the other two and is affected by the cultural background of each of the others as well as the changes that occur within the triangle.
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Affiliation(s)
- Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Areteion Hospital, and Department of Radiology, University of Athens School of Medicine, Greece.
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Abstract
BACKGROUND According to the general literature on hope, individuals who are hopeful live more positive lives than those who experience hopelessness. Hope has been defined as a positive orientation toward future improvements, and is associated with health and well-being. AIM This paper reports a study that explored patients' experiences of hope following spinal cord injury. METHOD Data were collected by personal interviews (n = 10) at a rehabilitation institution in Norway. A phenomenological-hermeneutic approach was used to extract the meaningful content of patients' experiences. The analysis was performed as a spiral process that included a reading to gain a sense of the whole, followed by identification of meaningful parts and a comprehensive and understandable interpretation of the whole. FINDINGS Two themes emerged: 'images of the past and future', and 'balancing between inner emotional dichotomies' that were, mainly, related to experiences of courage/uncertainty and patience/restlessness. DISCUSSION All participants experienced hope. The substance of hope--being able to walk again and hoping for recovery--was a universal experience among participants and was comprehended in terms of positive expectations. The process of hope involved continuous 'ups and downs'. Patients were in need of skilled nursing care to enable and foster hope during the first months following acute spinal cord injury. CONCLUSION In conclusion, patients hoped for recovery and every improvement stimulated hope. The process of hope was future-oriented, characterized by dichotomies. Nurses need the skills to foster hope and enable recently injured patients to look beyond the immediate situation and direct their energies appropriately.
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Affiliation(s)
- Vibeke Lohne
- Institute of Nursing Science, University of Oslo, Norway.
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