Although nursing can have its joys and sense of accomplishment, it’s not unlikely that you’ll be breaking bad news to patients and their families. Not everything always goes according to plan, and for many people receiving information about a poor diagnosis or prognosis this process can be particularly difficult.
Breaking bad news is much more of a process than a one-time meeting.
The traditional view of this situation involved a nurse and doctor sitting down with the patient and their families to discuss the current state of their loved one’s health. Although this is still common, the breaking of bad news has been widened to encompass the multidisciplinary nature of healthcare that we find today.
What is Bad News?
Generally, bad news is considered to be information that refers to any bad, sad, or difficult communications that alter a patient’s perceptions of their present and future health. Nurses have a particularly important role in this process, working closely with doctors to organize the approach to providing this information.
By understanding the challenges and difficulties that nurses can face when they are involved with patients who have been given bad news, we can learn to approach difficult subjects with the right methods and sensibilities.
Given that there is a range of bad news, the traditional model of a formal sit-down may not be appropriate for every situation. Moving beyond the narrow perspective of diagnosis and treatment, bad news can be characterized as more than just the breaking down of a diagnosis or prognosis, and considered to be a process of providing negative information.
Addressing the Subjective
This becomes more complicated considering that reactions to bad news are likely to vary between patients and their conditions. Just because someone is receiving news about the necessity of a future procedure doesn’t mean that they will react negatively. However it is unlikely that news of a terminal illness will be received with open arms.
Knowing how to deal with the subjective factors that play into a patient’s reaction is important in evaluating the approach to presenting the bad news. Based on individual expectations, values, life experiences, and their social situation in general, each case is bound to be different however there are techniques that can help the process be effective.
Asking open questions can allow the patients to express their own concerns and fears about their present or future health conditions.
Asking the right questions can help the process along positively.
Examples:
- Can you tell me how you are feeling?
- What are your greatest concerns right now?
- Can you tell me what you understand about what the doctor has said?
- What are some questions you have about your diagnosis/prognosis?
When a patient responds, it is important to acknowledge their statements and make sure that they know you are listening. By facilitating an open discussion of the options that are available, it can be possible to help ease some of their apprehensions.
Breaking Bad News isn’t Fun for Anyone
Breaking bad news isn’t just difficult for the patients, but also for the nurses and doctors delivering the information. It may be that you are having issues in managing your own feelings during the discussion, not knowing what to say or how to bring up certain subjects. This process can be easier for some than others, though as long as you are prepared with the right information regarding the patient’s condition, you’ll have the ability to use facts in the face of any confusion or emotional upheaval.
Bad news is an unfortunate part of the job, although delivering this information effectively can serve to increase a patient’s outlook and help them to remain positive about their future treatments or procedures. Remember to reach out to others in your facility if you are overwhelmingly distraught by delivering the news; it’s not easy, but the support of your colleagues can help keep your confidence up to benefit patients and their families.
