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Breaking bad news
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- 1Crawford D et al (2013) Educating children’s nurses for communicating bad newsThe way news is disclosed
can affect the way news is accepted and the level
of support the family will require.
The importance of
clarity, honesty and empathy is emphasised. - 2Crawford et al (2013) Advice for student nurses on delivering bad newsEnhance communication
skills by exposing the children’s nurse to clinical areas
where bad news is given frequently and is not a rare
event. e.g neonatal intensive care, children’s
intensive care, oncology etc. to enable the
student to witness first-hand how clinical experts
deliver difficult information.
Maintain a confidential and anonymous diary, log book
or reflection journal to critically evaluate how their
communication skill sets are developing. - 3What is bad news?Bad news can mean different things to different people
Theorist have defined bad news as:
Buckman (1984) Any news that alters the patients view of his or her future
Arber and Gallagher (2003) Any information which is not welcome - 4Role of a childrens nurse in breaking bad newsThe children’s nurse, as an instrumental member of the multidisciplinary team caring for the child and family, is central to this complex communication process
- 5The NSF and breaking bad newsStates how the manner in which the news is relayed to parents impacts upon the way it is received and accepted. (DH, 2003).
- 66 Styles of BBN (Martins and Carvello, 2013)1. Inexperienced messenger
(Lacks experience & knowledge of pt condition and situation)
2. Emotionally burdened expert
(Kind but cannot cope with own emotions)
3. Rough and Ready Expert
(Information presented in sharp, harsh manner. No regard to pt knowledge or emotional impact)
4.Benevolent but tactless
(Expresses sympathy but little or no empathy)
5. Distanced expert
(Communicates objectively but little emotional understanding of pts perspective)
6. Empathetic Professional
(Balances the nature and pace of communication with the patients physical and psychological response) - 7What style of BBN do pt's prefer? (Martins and Carvello, 2013)There was no one style that suited everyone. No patients preferred the "rough and ready" style, the majority of pts preferred "empathic professional" but just because the majority liked empathic professional approach does not mean it will suit everyone e.g some patients liked distanced expert/emotionally burdened
Highlights importance of individualised care - 8How nurses can be supportive to other professionals during BBN (Working as part of MDT)An open nurse who enquires and responds appropriately to how the clinician feels may contribute to reflective practice, improvement and emotional well-being
(Shaw, 2012) - 9Role of the childrens nurse in BBN (RCN, 1999) Manager/leaderBefore breaking the news
Prepare self/family
Prepare venue and consider privacy
Liaise with doctor
Ensure X-rays, results, & information
leaflets are available
Organize the necessary people to be present
Allocate another member of team to care for the child
After breaking the news
Ensure follow up as required
Document clearly in the nursing notes - 10Role of a Childrens nurse in BBN (RCN, 1999) Facilitator/supporterDuring the meeting
Support the family
Show empathy/be attentive
Take notes for parents if desired/ app
Ensure parents have time to express their emotions
Act as a supportive presence for the doctor during interview
Immediately following meeting
Give choices, do they want to be left alone?
Answer any questions they may have,
clarify any points, use simple language - 11Role of childrens nurse in BBN RCN (1999) Teacher/EducatorProvide family with any further information they require
Provide practical help and written
information to back up verbal information if appropriate
Ongoing evaluation about knowledge of condition - 12The role of the childrens nurse in BBN (1999) Advocate/Team playerCommunicate with other members of the MDT
Document and record in nursing notes
Promote needs of child/support parents regarding how and why to tell their child - 13Rabow and McPhee’s (2000) ABCDE mnemonic of BBNAdvanced planning
Building a therapeutic relationship and environment
Communication
Dealing with reactions
Encouraging and validating emotions
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- University Nursing Fichas sobre Breaking bad news , creado por katherinethelma el 20/02/2014.
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