Holistic and Palliative Care - Breaking the Bad News - Essay Example

Introduction Communication is all about passing on of a message from one party to another. In this case a meaning of an issue is conveyed to the stakeholders so that there is understanding between the parties. Communication is an art that can be learned. That is why nurses go through rigorous training in relation to the communication topic. Holistic care includes taking care of the emotional, physical and also the spiritual elements in the patient. Healthcare givers do understand that patients have to get a holistic type of care for them to improve. (Annie-mei, 2002) Generally it is normally very easy to communicate some good news to the people one is attached to. On the contrary communicating bad news is a very hard task even to people who are very eloquent in speech. This paper is dealing with the issue of communicating bad news in the nursing profession. It further has specific examples from practice area that show the link between practice and theory. Discussion on literature Nurses are always required to have the essential skills of communicating bad news. Despite the training that they undergo, it still remains to be a very challenging task to many of them. This is highly related to the human nature. This is due to the fact that nobody wishes bad things to happen to their neighbours, friends and relatives. There are various reasons as to why breaking bad news is such a hard task all over the world. (Payne, 2004) Many healthcare givers fear the emotional reactions from patients and relatives One may not know what will follow after breaking the bad news The effects of such information on the patient are highly feared There is normally the fear of how to handle the situation When communicating bad news to patients, assumptions should never be made that the patient knows and understands the situation completely. The load of the situation should not be lessened by telling only some truth about the ailment. When the full truth is not given to the patient, then the medical ethics are violated. (Kleinsmith, 2006) The right environment or setting is very important when delivering bad news to a patient. It is very important that the information be given in an environment that is private. This means that only the people who need to be there will hear the message. It is very wrong for a healthcare giver to deliver bad news when the patient is in the midst of other patients. More so, the patient should be in a sitting position and not standing. The relatives can be present in order to give their support to the patient during such a hard time. (Buckman, 1992) There are various steps that always need to be followed by nurses and other physicians in communicating bad news to the patient. These steps are very essential since years of practice have shown that without using the right channel, bad news may end up causing more harm on the recipient. Bad news in healthcare facilities may include the information concerning a fatal disease or even death itself. It is the right of the patient to have such important information though not good. (Shaun and Richard, 2001) Research shows that the way bad news is conveyed can help make things better in the patient’s life. The way that the message is conveyed can actually make the family or patient come up with goals that are very realistic. Relationships between patients and nurses can be enhanced by delivering the bad message in a compassionate way. (Buckman, 1992) Step one The first step that has to be taken when breaking bad news concerning a patient’s care is the following. First of all, it is important for the nurse to ensure that the medical report is confirmed. This includes ensuring that all the information that the patient, his family and other stakeholders would wish to know is available. This includes all the information that pertains to the ailment. It is also very important to ensure that all the people who need to know the information are available. They may include the patient’s relatives, patient himself, other healthcare givers and also pastors or any spiritual leader in the patient’s religion. This is very essential as it helps not to keep on repeating the same information to the people who may need to know. (Faulkner, 1996) Communication can also be enhanced through removing or minimizing any form of external distractions. As a healthcare giver, it is very important to be prepared from any emotional response from the people. The most important aspect in the first step is to create a very conducive environment for passing on the information. Step two The next step may be a session where the patient and family members or the other people are involved answering questions. In this case, a nurse has to prepare some questions before hand that can be asked. This could include questions that concern when the illness started. In what ways they could describe the illness, what they understand about it and so on. This works very well in preparing the people’s minds and more so the patient’s to hear any news that the nurse has to give. (Field, 1997) There are also cases where the stakeholders may not even respond to these questions. If this happens, the nurse is required to wait until a later time when they feel a bit more relaxed to talk about the issue. If this does not work, then other close relatives can also be included where necessary. It is important for the nurse to know how much information should be told to the patient. All activities carried out in this step are done in order to establish how much the patient and the relatives know about the illness. (Field, 1997) Step three The third step to communicating bad news is to find out from the stakeholders more information. This is concerning what they expect to hear. This is in terms of details. There are instances when the stakeholders can be so learned that they expect an explanation in detailed medical terms. There are some instances when the health issue can be passed on in very simple language. (Annie-mei, 2002) It is also very essential for the nurse or the physician to establish the person that should be given the information. This is essential because in many cases the relatives will request the nurse or the physician not to inform the patient concerning the illness. They usually have their reasons which should be evaluated by the nurse or physician. This more often than not may be a hard task since the patient’s consent is very important. Tact can also be used by the nurses to determine the patient’s desire to know their health status. All this is in relation to preparing the patient and other stakeholders to receive bad news. Generally this step involves getting to know more about what relatives and patients expect to know concerning the illness. (Kleinsmith, 2006) Step four The next step in breaking bad news concerning health is the actual dissemination of the information. The nurse has to pass on this information in a very sensitive manner. The information however has to be passed in a direct way. It is quite important to let the patient know that it is also hard for you to pass on the information. (Smith, 1987) When speaking to the patient, it is important for the nurse or the physician to pause and observe the reactions of the patient and relatives. Was the message well understood? It is also very essential to clearly evaluate whether the patient or the relatives are really ready for the rest of the information to be passed on. Sometimes it could be wise to stop there or pause and wait for a time when the patient is ready. (Smith, 1987) The nurse or the physician should avoid using technical jargon. Research shows that the word ‘I am sorry’ should be avoided by the nurse or the physician. (Smith, 1987) The reason why these words should not be used is because they can give the implication that the nurse is responsible for the situation. It is very important for the healthcare giver to be very observant during this step. This is in relation to the patient’s reactions concerning the news. (Smith, 1987) Step five After giving the patient bad news, expect to see some emotional response from the patient and even relatives. This is very normal. There are usually different reactions to bad news. Look directly into the patient’s eyes since they will always speak a lot. This could include tears, guilt, sadness, remorsefulness, denial and disbelief among others. The nurse should always be prepared before hand for such emotional reactions. This then enables the healthcare giver to handle the situation accordingly. Nurses and other healthcare givers are also required to have excellent listening skills. When a patient gets a listening ear to her feelings, it works well towards improving their condition. This is part and parcel of the holistic care. (Locke, 1997) There are also cases where the reaction can be very dramatic in nature. This is where the patient can even use abusive language to the nurse or even take off from the venue. This is the time when the patient needs so much support from the caregiver. It is very important to encourage the patient to speak out their feelings rather than withdraw. Step six This step is whereby follow up is carried out. This is whereby the options at hand are also evaluated. At this stage, it is very important that the nurse or physician helps the patient to cope with the news by explaining more about the disease. The healthcare giver should generally encourage the patient to talk about the ailment. This is especially in relation to the healthcare that they need to help in easing the pain or treating the disease. The right words should be used so that denial is highly minimised. These words may include death and pain among others. There are instances where a translator may be required in case of language barriers. The healthcare giver can ask the patient some questions to help him or her cope with the situation. (Foster, 1987) They can include whether the patient knows any other people that are suffering from the disease. They can also include what they expect to happen and any wishes that they have in relation to the ailment. This plays a very big role in helping the patient to come to terms with the situation. It is also very important to inform the patient to expect anything. Planning for the worst occurrence can be carried out but at the same time hope that things can get better. It is very important that the caregivers attending to the patient do not contradict each other. This makes the patient to lose confidence in the information. Plans should be made such that the patient is given emergency call phone numbers. Caregivers should always ensure that they inform the patient on the things that they ought to do and those that may worsen their condition. Healthcare givers should always ensure that they put down all the data concerning the patient. In order to make the news be well perceived, the healthcare giver has to uphold sensitivity, accuracy and show compassion to the patient. Holistic and palliative care When breaking bad news to a patient, it is very important to put in mind the holistic and palliative care needs of the patient. Holistic care as earlier on illustrated, involves giving a patient the emotional, physical and also the spiritual care. The spiritual care can be enhanced by allowing a spiritual leader to be present when breaking the bad news. They can help to give spiritual support to the patient. When breaking bad news to a patient, the healthcare giver should also give emotional support. This is through speaking words of encouragement and hope. It is very important for the nurse or the healthcare giver to show the patient that the patient that there is hope but it has to be very realistic. (Shaun and Richard, 2001) It is important to create a good relationship with the patient and give them contacts that they can access when they feel very low and discouraged. More so introduce the patient to other patients that suffer from the same ailments. Education should be given on the coping mechanisms. The physical needs can be enhanced by ensuring that the patient gets drugs that can relieve pain where possible. Sometimes there are patients that may not be in a position to get the diet they require. Introducing such patients to non-governmental organisations that can help them with the physical needs is very important too. (Lugton, 1992) Palliative care is all about reducing the pain that patients go through. As a healthcare giver when breaking bad news to patient, expect to see emotional pain. Healthcare givers normally have to show the patient so much love and compassion even as they share the bad news with them. (MacArthur, 1996) Examples in practice area Working in an elderly medical ward where patients are diagnosed as suffering from cancer has got its on challenges. This is more so in informing the patients that they have cancer. This disease is known to send chills around the spine in patients when they simply get to hear of it. Many at times, patients may walk it into the hospital just to have routine check ups only to realise that they have cancer. There are others that do have minor complications when they visit the healthcare facility. The last thing that is ever in their minds is the issue of cancer in their bodies. This normally makes it very hard to inform the patients of such bad news. In the process of breaking this bad news to patients, they have to understand what cancer is all about. This is normally a group of cells that have growth that is not controlled. There are different types of cancer. They include breast, lung, endometrial, ovarian, pancreatic, colorectal and prostate cancer among others. It is very important to tell the patient which type of cancer they are suffering from. Many patients in this ward always want to know what exactly causes the disease. This is where the nurse explains that some of them are genetically passed on from their parents. Others are caused by viruses and chemicals from substances like tobacco and asbestos. When breaking the news concerning cancer, the patients are made to understand the treatments that are available for cancer. They include surgery, chemotherapy and radiation therapy among others. All these depend on the type of cancer that the patient is suffering from. (Payne, 2004) Patients always have to be informed more about the correct diet that they need to have once they have cancer. Patients are normally encouraged to take more natural foods. Those that are genetically modified always have to be avoided. They also are told to avoid alcohol and tobacco among other things. The patients in this ward are normally advised to take more fruits and vegetables that are fresh and unprocessed. It is known that vitamin D helps to decrease cancer by approximately sixty percent. This knowledge is important to the patients. When breaking the news concerning cancer, the emotional part on the patients is normally handled by the nurses. This is through talking to patients compassionately concerning this ailment. The nurses often refer patients to organisations that can offer support. These organisations provide counselling, and have support groups for cancer patients. Some of them even provide financial assistance. The steps illustrated above are normally followed when breaking the news to the patients. Holistic and palliative care is also carried out in this ward. (Quill, 1991) Conclusion Bad news are a common occurrence in healthcare set ups. It is normally very hard fro healthcare givers to deliver such news to patients. They may include information on confirmation on a deadly disease. Before breaking the bad news, nurses have to prepare before hand. The environment has to be conducive and all information ready. The message has to be spoken out in a sensitive and yet direct way. Patients sometimes have emotional response to the bad news. All this needs to be well taken care of by the healthcare giver. Patients also need to be advised on the do’s and don’ts that pertain to the ailment. It is quite hard to tell patients that they have cancer. This is due to the fact it is a deadly disease. This information is always passed on to patients in a very compassionate way. The medical options are normally explained. They include surgery, and chemotherapy among others. Holistic and palliative care is usually provided so that patients can cope with the ailment. Read More