Critical Care Nurses' Involvement, Feeling, Perception and Barrier for Practice Breaking Bad News in Jordan

Abstract

Background. Breaking bad news (BBN) is one of the most difficult tasks faced by healthcare providers. In addition, breaking bad news is stressful for both; healthcare providers and patient. Nurses can play an important role in the process of BBN. Whereas, effective communication by critical care nurses improves patients' understanding of their health status and decreases their stress level. Furthermore, effective BBN process requires effective communication skills. Aims. To assess critical care nurses' knowledge level regarding breaking bad news process, assess their involvement in the process of BBN, andto determine the barrier of practicing breaking bad news process as perceived by critical care nurses to identify the factors that affect nurses' practice of breaking bad news in the critical care units. Methods. Descriptive cross-sectional design, using self-reported questionnaires. Results. The study showed that most critical care nurses in Jordan are highly involved in BBN process 77% (n=157), Also, nurses are highly perceived themselves as an active part in BBN process 76% (n=155). The major barrier in providing BBN was relatives requesting that a patient is not told bad news 75% (n=152). Conclusion. Current study revealed that Jordanian critical care nurses took different roles in the process of breaking bad news and they are highly involved in BBN news, creating a base of knowledge regarding BBN among critical care nurses in Jordan. Thus, the study recommends the policymakers to empower nurses role in this process through design an educational program regarding practice BBN and clarify nurses' role in this process.

Critical Care Nurses’ Attitudes, Roles, and Barriers Regarding Breaking Bad News

“…The findings of the current study revealed that Jordanian critical care nurses face many barriers when breaking bad news. The highest mean score for barriers was related to training, similar to the findings of Adebayo et al (2013) and Alkhawaldeh et al (2018) ; this might be due to lack of training and knowledge, unavailability of official curricula, and unavailability of standards or an effective protocol about breaking bad news. Based on the barriers faced by Jordanian nurses and the complexity of this task, adequate skills and knowledge are required to break bad news effectively.…”

“…This result was consistent with Warnock and colleagues (2010), who believe that nurses deal with many different cultures and ages, despite their lack of knowledge, while their attention to ethical principles when breaking bad news strengthens their relationships with patients/relatives. However, this finding is not in line with Alkhawaldeh et al (2018), who documented that being involved in this process had strengthened participants' relationships with patients/relatives with the least frequency.…”

“…The lowest item mean score among the top five barriers during work-related communication and the information transfer sub-scale was “use clear language and avoid medical terms.” This only constitutes a minor barrier to delivering bad news, perhaps because some nurses believe it necessary to use simple language with patients in a different culture as there are no specific policies related to the process of breaking bad news ( Alkhawaldeh et al 2018 ). They may also think that breaking bad news to younger patients is a barrier and that it is necessary to use simple language with patients, similar to Mishelmovich et al’s (2016) result that disclosure of a terminal prognosis to younger patients is challenging.…”

“…Regarding the work-related barriers, the lowest mean score was reported for feeling, which might be explained by the fact that nurses hide their sadness regarding the patient’s health state and their anxiety for the patient’s future and that they have the ability to withstand the emotions of patients (Alkhawaldeh et al 2018). Previous research, however, suggests that this barrier is commonly reported among physicians.…”

A Literature Review of Nurses Challenges and Barriers in Assisting Patients and Families Facing Breaking Bad News

“…The role of the nurse before BBN is to prepare the patient, family, and environment before BBN. [ 14 - 16 ] Therefore, the nurse must be able to establish a trusting and meaningful relationship with the patient and find out the patient’s wishes. [ 17 , 18 ] In addition, the nurse also has a role in anticipating the patient’s and family’s reactions to the bad news that will be delivered.…”