Breaking ‘bad news’

Oxford Handbook of Adult Nursing ◽

10.1093/med/9780198743477.003.0011 ◽

2018 ◽

pp. 133-136

Author(s):

Maria Flynn ◽

Dave Mercer

Keyword(s):

Bad News ◽

Emotional Impact ◽

Breaking Bad News ◽

Breaking Bad ◽

Specialist Nurses ◽

Everyday Realities

The communication of sensitive or upsetting information is now routinely undertaken by specialist nurses. This is typically spoken about as ‘breaking bad news’ and often involves disclosing a life-changing diagnosis. However, an understanding of what constitutes ‘bad news’ will very much depend on the culture and context of an interaction, and general adult nurses will often find themselves in everyday situations where they have to break bad news. Whilst this may not be life-changing information, in the context of everyday healthcare, bad news may be telling an inpatient they are unable to go home or that their routine surgery has been cancelled. These everyday realities can be very upsetting for people and mean that nurses need to be skilled in assessing when information is likely to have an emotional impact. This chapter locates the concept of ‘breaking bad news’ in the context of contemporary nursing and discusses one recognized model of managing the process.

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Training for difficult conversations and breaking bad news over the phone in the emergency department

Emergency Medicine Journal ◽

10.1136/emermed-2020-210141 ◽

2020 ◽

pp. emermed-2020-210141

Author(s):

Anna Collini ◽

Helen Parker ◽

Amy Oliver

Keyword(s):

Emergency Department ◽

Educational Interventions ◽

Bad News ◽

Emotional Impact ◽

Breaking Bad News ◽

Specific Training ◽

Face To Face ◽

Breaking Bad ◽

Difficult Conversations ◽

Stressful Task

Due to the COVID-19 pandemic, there have been strict limits on visitors to hospitals. This has led to clinicians having an increasing number of difficult conversations with patients and their relatives over the phone. There is a lack of published literature examining how to do this well, but it is recognised that phone communication does differ from face to face interactions, and requires specific training. What is most important to patients and their families when receiving bad news is privacy, adequate time without interruptions, clarity and honesty when delivering the information, and an empathetic and caring attitude. Much of the work done on breaking bad news has been done in oncology and focusses on face to face interaction; there has been an assumption that this is transferrable to the emergency department, and more recently that this is applicable to conversations over the phone. Multiple educational interventions to improve the delivery of bad news have been developed, with differing frameworks to help clinicians carry out this stressful task. Simulation is widely used to train clinicians to break bad news, and has solid theoretical foundations for its use. The psychological safety of participants must be considered, especially with emotive subjects such as breaking bad news. We believe there is a need for specific training in breaking bad news over the phone, and developed an innovative simulation-based session to address this. The training has been well received, and has also highlighted the need for a space where clinicians feel able to discuss the emotional impact of the difficult conversations they are having.

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