Role of the Critical Care Nurse in Disclosing Difficult News

Abstract

S usan is a nurse in the medical intensive care unit. For the past 3 days, she has cared for Ms B, a 59-year-old woman admitted with pelvic pain. Ms B was transferred to the medical intensive care unit because of hemodynamic instability after vaginal blood loss. She has undergone diagnostic tests and has a new diagnosis of uterine cancer. Ms B retains decision-making capacity but is critically ill and decisions need to be made about her treatment. Ms B has not yet been told her cancer diagnosis because she speaks Cantonese and the health care team has been working to coordinate a meeting where a certified health care interpreter can help deliver this news. However, in the meantime, a medical intern has inadvertently disclosed Ms B's cancer diagnosis to Ms B's aunt, Mei, while she was visiting the hospital one afternoon. Mei, although devastated by the new cancer diagnosis, is even more distraught at the thought of her niece living with the knowledge that she has cancer. Mei explains, "Doctors in China don't tell patients they have cancer and my niece would lose hope if she learns of her diagnosis, become depressed, and no longer want to live." Yesterday, while talking with Susan through a telephone interpreter, Ms B asked if something was seriously wrong with her. Susan was unsure what to say, so quickly redirected the conversation when the phlebotomist came into the room to collect samples for laboratory tests. Susan feels Ms B has a right to know her health information but also understands the concerns of Ms B's aunt. Today on rounds, Mei implored the health care team to conceal Ms B's new cancer diagnosis. The team explained that because Ms B has the ability to make her own decisions, they need to inform Ms B that they have new information about her health and ask if she wants to know more. Ms B's attending physician has several other patients to see and plans to fit the meeting into his schedule late in the day, so he wants to use a telephone interpreter instead of an in-person interpreter. The family has reluctantly agreed to attend a meeting with the health care team and patient where, through an interpreter,

Communicating bad news in the practice of nursing: an integrative review

“…Thus, only ten met the study criteria; they are presented on table 1. (8,11,18,(19)(20)(21)(22)(23)(24)(25) The analysis of the studies included in this review allowed us to identify three main points addressed in the articles. The first is about the little or no communication skills developed during nurses' training, a situation described in all articles analyzed.…”

“…The second point discussed is about how the disclosure of bad news appears during nurses' practice, from primary to tertiary care. (8,11,19,21,25) Finally, another aspect identified is the creation of the link between patient/ family/nurse for an effective communication of bad news, (22,23) as well as for strengthening the trust between them in difficult moments. (8,(18)(19)(20)(21)(22)(23)(24)(25) Regarding the communication skills of students and nursing professionals in general, the studies showed that, during undergraduate course or technical training, there are no subjects or courses addressing this issue, and, consequently, this produces a deficit in the development of professional skills.…”

COVID‐19 and difficult conversations in critical units: A practical guide for nurses

“…Usually, it is the medical team who disclose difficult news to patients and their families. However, nurses who work at the bedside are fully involved in this activity because they spend more time with the patient and often know the details of the needs of both the patients and the families 7 …”

“…However, nurses who work at the bedside are fully involved in this activity because they spend more time with the patient and often know the details of the needs of both the patients and the families. 7 Nurses help families in many instances during the process of communicating bad news; for example, following up conversations to clarify technical terms and jargon, ensuring understanding of difficult information or clarifying the implications of the diagnosis or potential treatments. In addition, families may have a preference for conversations with nurses because of their proximity in the nurse-familypatient relationship and the fragility of the relationship with other professionals from the team.…”

“…In addition, families may have a preference for conversations with nurses because of their proximity in the nurse-familypatient relationship and the fragility of the relationship with other professionals from the team. [7][8][9] The task of communicating bad news is a complex skill that requires empathy, appropriate body language, and a welcoming voice tone, among other measures that are impaired in the context of the COVID-19 pandemic. 10 Physical distancing prevents touching or hugging, impedes face-to-face conversations regarding the side effects or symptom evolution, and often makes family farewells unfeasible when the patient dies.…”