Breaking bad news By Dr Khurshid Khan
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The document provides guidance on how to effectively communicate bad news to patients and their families. It discusses defining bad news, anxieties around delivering it, and outlines a 5-stage process for doing so: 1) Set the scene by preparing the environment and having relevant information; 2) Build alignment by understanding perspectives and experiences; 3) Impart information at an appropriate level and pace while allowing time for emotions; 4) Check understanding and address questions in a supportive manner; 5) Discuss future plans and follow up support. The overall message is to deliver news empathetically and ensure patients and families feel heard, informed and valued throughout the process.
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A family nurse practitioner (FNP) is an advanced practice registered nurse who has completed 500 clinical hours and has a minimum of two years clinical experience as a registered nurse. FNPs assist with all aspects of patient care including diagnosis, treatment, consultations, performing physical exams, and prescribing medications. They educate patients on preventative care and prescribed treatments. FNPs function as primary healthcare providers for patients across the lifespan in settings such as primary care, pediatrics, geriatrics, and other specialties.
Family tools complete
The document discusses the importance of understanding a patient's family context. A physician must consider how a patient's illness will impact and be impacted by their family. It is recommended that family physicians use assessment tools like genograms, family maps, and the APGAR scale to evaluate family structure, function, and resources in order to provide comprehensive patient care. Understanding the family is critical to healing the patient.
Primary health care
1. Health promotion aims to enable people to increase control over their health through interventions like health education, environmental modifications, and lifestyle changes. It differs from disease prevention by focusing on overall health rather than specific illnesses.
2. Primary health care provides essential health services that are accessible to all members of the community through their participation. Its goals are to promote health and prevent disease through interventions like immunizations, maternal/child care, treatment of common illnesses, and ensuring access to essential drugs and sanitation.
3. Nurses play an important role in primary health care by providing health education, immunizations, treating minor ailments, and coordinating with communities and other sectors like agriculture and education to promote health. Research shows
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The violence against doctors and hospitals is highly condemnable. Please see the depth of the problems and understand.
Sharing Bad News powerpoint
This document provides guidance for a training session on effectively sharing bad news with patients. It begins with reminders to turn off electronics and participate in debriefing. The document then defines bad news, outlines challenges and supports to sharing it, and presents the SPIKES model - a 6 step protocol for setting, assessing perception, inviting questions, providing knowledge, addressing emotions, and summarizing a strategy. A video demonstrates the SPIKES model and is followed by a discussion. The document concludes by thanking those involved in its development.
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This document discusses family as the basic unit of healthcare services. It defines family and outlines the aims and principles of family health services, including reducing mortality rates, providing health education, and encouraging self-sufficiency. The document also describes theories of family nursing like structure-function theory and system theory. It presents tools for family assessment like genograms and ecomaps. Finally, it discusses techniques for family nurse contact, including home visits, interpersonal relationships, and contracting with families.
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This document discusses workplace violence against healthcare professionals. It defines workplace violence as physical assaults, threats, or verbal abuse occurring at work. Healthcare workers experience significant workplace violence, with over 11,000 assaults reported in 2010 alone. This violence leads to increased stress, decreased job satisfaction, and medical errors. The document outlines strategies to prevent violence, such as being aware of one's environment and de-escalation techniques. It also identifies warning signs of potentially violent patients and the importance of reporting violence.
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This document discusses best practices for delivering bad news to patients and their families in a compassionate manner. It begins by having attendees reflect on their own experiences delivering bad news. The goal is to educate healthcare providers on how to communicate bad news effectively in order to positively influence patient and family reactions. It then discusses various methods and protocols for delivering bad news, including preparing, sharing the information clearly and slowly, and caring for the patient emotionally. Common patient reactions are explored, as well as tips for handling special situations. The document emphasizes allowing patients to process the news at their own pace and maintaining a supportive presence.
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The document discusses delivering bad news to patients. It notes that delivering bad news is difficult for physicians due to fears around being blamed, evoking strong reactions, and lack of training. There are three main models for disclosure: non-disclosure where information is withheld, full disclosure where all details are shared, and individualized disclosure where details are tailored based on the patient's preferences. The SPIKES protocol is presented as a six step approach to effectively communicating bad news, including setting up the discussion, understanding the patient's perspective, determining how much they want to know, sharing key medical details, acknowledging emotions, and summarizing next steps.
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It is part of the job to regularly break bad news, yet training for doctors and nurses on how to disclose distressing news to patients or relatives is markedly unappreciated, until now.
Most professionals develop their own appropriate techniques for breaking such news
. Studies in the child disability field in USA and other western countries reveal that about 50% of parents are dissatisfied with the way news of their son's or daughter's disability was given to them
How to break bad news
1- Getting started:
a. Get the physical setting right
b. Ensure family support at the time of breaking the news
c. Fire a warning shot
2- Find out how much the patient already knows
3- Find out how much the patient wants to know
4- Decide on your objectives
5- Share the information
a. Give the information in small chunks
b. Use English, not “medispeak”
c. Reinforce and clarify the information frequently
d. Listen for the patient’s feelings
e. Blend your agenda with the patient’s agenda
f. Offer hope
Bad news may be:
Sudden death & unexpected complications and changes in the course of illness.
Hopeless cases & No resuscitation decision (minimal medical interference )
Genetic disorders & congenital anomalies
Brain damage & long term Prognosis
HOW TO DELIVER A BITTER PILL
GENERAL RULES:
Introduce yourself if you have not met the parents
Private room , a curtain drawn around patient if not possible to move to private room
Sit down on the same level as the parents & the patient.
Free from interruptions, checking that pagers & mobile phones are switched off. Doctors are encouraged to allow patients or relatives the feeling that they have their unlimited consultation time & attention.
Good eye contact
Sensitivity and honesty are paramount
Correct names are used.
Note questions or topics avoided.
Respect the patient's right to "denial". They will often "selectively perceive" information they can cope with.
Appreciate that patients can, and do, cope positively with truth about illness.
Tell staff what has been said. They might be involved in future discussions.
Realize that most patients become aware of their situation gradually, rather than during one meeting. Arrange for a second interview between the parents within 24-48 hours
THE MANNER OF TELLING
Honestly -- with uncertainties acknowledged.
Straightforward, without embarrassment.
Explanations should be clear and not overly technical
Invite parents to ask questions
Offer to introduce parents to another parent with a child with similar condition ???????
What If... The parents start crying ??????????You should pause and say soothing statements like :
I am sorry to have to give you this news.
It is not easy for me. I know that this is not what you were expecting to hear this.
I understand and appreciate deeply your feelings……etc
Don’t say “Cheer up. Things could be worse”
What If The patient becomes angry? “I am sorry
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The document outlines six steps for communicating difficult news to patients:
1. Create an environment conducive to effective communication and ensure the right people are present.
2. Establish what the patient already knows about their health condition.
3. Determine how much information the patient wants to know, as people handle information differently.
4. Deliver the information in a sensitive but straightforward manner.
5. Be prepared to respond to strong emotions that are an expected response to receiving difficult information.
6. Reassure the patient and family that support will continue and questions can be answered going forward.
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