Nursing Reflection Assignment: Breaking Bad News in Clinical Setting

This nursing assignment presents a reflective account of a student's experience in a clinical setting, specifically focusing on the challenging task of breaking bad news to a patient diagnosed with bone metastases and their family. The assignment employs Gibbs' reflective cycle to dissect the event, detailing the student's actions, feelings, and thoughts during the communication process. It explores the emotional complexities of the situation, the importance of empathetic communication, and the application of nursing principles in delivering sensitive information. The student evaluates the experience, identifying both strengths and areas for improvement, and proposes an action plan to enhance their communication skills and approach to similar situations in the future. The reflection emphasizes the significance of family involvement and the need for a composed, professional demeanor when dealing with patients facing difficult diagnoses. The assignment also references relevant literature to support the analysis and recommendations for future practice.

Running head: NURSING ASSIGNMENT
NURSING REFLECTION ASSIGNMENY- BREAKING THE BAD NEWS
Name of the student
Name of the university
Author note

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Introduction
While working with terminally and critically ill patients, nursing professionals require
well- developed interpersonal communication skills. As per Bramhall (2014), engaging in
difficult conversations are a crucial part of nursing professionals as with effective
communication skills, nursing professionals are able to develop a positive nurse-patient
relationship. Further, it helps the patient to develop an easy rapport with the nursing
professionals and hence, with empathetic and excellent communication, they are able to connect
to the nursing professionals. However, one of the crucial aspects of nursing repertoire is breaking
the bad news to the patient or associated family members. Gluyas (2015) mentioned that
breaking bad or negative news to the family and patients is completely dependent on the
personality of the nursing professionals. In this paper, I would discuss one of such experiences
where I had to break the bad news to one of my patients and his family members. I would be
using Gibb’s reflective cycle for this aspect and would be using pseudo names for the privacy of
the patients.
Description of the event

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In my clinical placement, I was given the responsibility of AA (42) who was admitted to
the healthcare facility after critical health condition with intense and intermittent pain around his
legs and pelvic areas. The patient was admitted to the healthcare facility by his wife AB (40) and
their 15-year-old son accompanied them in the healthcare facility. They were very much tensed
as the patient was fidgeting on the stretcher with pain and was extremely restless. After
reviewing the healthcare condition of the patient, the healthcare physician asked me to take the
patient for tests such as X-ray, MRI scan, CT scan of the pelvic area so that the complication
could be observed. Hence, upon assessment, it was found that AA is suffering from bone
metastases. As per Griffiths et al. (2015), metastases is the condition, in which the cancerous cell
starts spreading relocating to other regions of the body due to which cancer spreads throughout
the body system. I clearly understood that it is one of the most crucial aspects of my nursing
career as I was about to break the first bad news to my patients. As per Warnock (2014), if the
breaking of bad news is done by someone close to the patient, then the impact does not harm the
patient adversely or the patient can withstand the critical situation. Hence, I first informed the
bad news to AB, and then in her presence, communicated the news to the patient. Therefore, this
was the crucial situation that was a new experience for me and I was provided with the
opportunity to develop my communication with empathy so that I could provide the patient with
bad news (Bumb et al. 2017).
Feelings and thoughts

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Prior to the patient assessment, I was confident and after greeting the patient and his
family members I took the patient for the healthcare assessment process. However, was unable to
understand the reaction of the patient. He was constantly discussing with his wife regarding his
health improvement and was asking her to stay strong and his health would be improved. The
situation was very emotional, however, I was able to control my feelings and as Abbaszadeh and
Ehsani (2014) mentions that nursing professionals should not be emotionally weak and
vulnerable so that they could not provide proper care to the patients. Watching the patient
fidgeting with pain was the most difficult part of the care process as I was unable to help the
patient with medication and therapies prior to the assessment results. However, it was an
emotional situation, where I, being the caregiver for the patient provided my support to the
family members to calm their emotions and help the patient to overcome his sufferings. After
getting the assessment results, when I came to know that the patient is suffering from a
secondary stage cancer, I was feeling sad for the patient and his wife because they were so much
hope that the patient would overcome the healthcare complication very soon, but the disease the
patient was suffering from, usually takes years to be eliminated and require courage and
determination, as Konstantis and Exiara (2015) mentions that cancer affects patients mentally
and financially more than physically. Therefore, I was concerned about the effect it would exert
in the patient. While communicating the bad news to the patient, I maintained a positive behavior
and asked the wife of the patient to stay with him while I make him aware of his health
condition. I hesitated as I thought the patient would break down and would not be able to
withstand the shock, however, the patient took it positively and was very assured that through
our healthcare interventions he would be able to withstand the harmful effects (Griffiths et al.
2015). Hence, this courage and determination filled me with confidence that if the patient

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affected with such disorder could overcome the condition, then I should also help the patient
with best of my practice so that I could decrease his sufferings.
Evaluation and analysis
Upon evaluating the abovementioned section, I would say that the while providing the bad news
to the patient and the family, I was very composed and calm and took care of the patient while
informing about secondary cancer he was suffering from. This was my first experience of
breaking the bad news to the patient and his family my nervousness, confusion, and stigma was
due to the lack of experience I had. Despite this fact, I was able to keep myself calm and
composed and hence, I was able to maintain the nursing code of conduct for the benefit of the
patients. As per Kpanake, Sorum, and Mullet (2016), if the nursing professionals are emotional
or weak while delivering bad news, then it could affect the patient negatively and the patient and
their chances of being affected with depression and stress increases. Hence, by maintaining the
professional behavior with the patient, with empathy and care, I was able to inspire the patient so
that he could overcome his health ailments and could provide the patient with hope and
determination. Further, Warnock (2014) also mentioned that while providing bad or negative
news to the patients, their family members should be present around them so that they could be
provided with mental support. Therefore, it should be mentioned that I was able to maintain the
right practice for the breaking of bad news and hence, in the first attempt I complied with the
correct practice for this aspect. Hence, I was satisfied with the process and the way I handled the
crucial situation. However, I voice, and attitude while providing the bad news to the patient
should have been more clear and concise and hence, this was the aspect in which my care
process lacked.

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Action plan
After evaluation of the care process and the situation of delivering bad news to the
patients, I was able to identify the process, in which I could improve my practice and hence, I
was determined to develop an action plan so that I could evolve as nursing professionals to
connect to my patients with effective and accurate communication strategy. In this aspect, I
would be communicating with my senior nursing professionals so that I could be aware of their
ways and strategies of communicating with the patients while breaking the bad news and then
implementing the strategies in my nursing practice (Abbaszadeh and Ehsani 2014). Further, I
would also discuss this experience with the nursing supervisor so that he could identify more
aspects from my clinical placement. Hence, due to this, I would be able to understand the aspects
which require modification and with the help of senior nursing professionals and personal
experiences would be able to overcome the situation. As () mentions, terminally ill patients are
emotionally and physiologically weak and are unable to overcome the mental shock of critical
illness, my modified practice would help the patient to overcome the mental trauma and focus on
the healthcare intervention, and ultimately, improve the healthcare condition (Konstantis and
Exiara 2015). Further, I would also make sure that in every situation, similar to the one I have
shared here, I include family members of the patients so that they could be provided with
effective support and they could successfully withstand the negative news.
Conclusion

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Effective communication is the most crucial aspect of nursing care as there are several
instances where the nursing professional’s bad behavior, their inability to develop
communication or their inability to help patients mentally creates an adverse condition for them.
Especially, nursing professionals are unaware of the correct strategy which they should use for
the communication regarding the breaking of bad news. Therefore, I presented one of such
experiences I had while providing care to the patients and delivering bad news to one such
patient and his family. I used Gibb’s reflective cycle to comment on the type of strategy I used
and the scope for my improvement.

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References
Abbaszadeh, A. and Ehsani, S.R., 2014. Nurses’ perspectives on breaking bad news to patients
and their families: a qualitative content analysis. Journal of medical ethics and history of
medicine, 7.
Bramhall, E., 2014. Effective communication skills in nursing practice. Nursing Standard
(2014+), 29(14), p.53.
Bumb, M., Keefe, J., Miller, L. and Overcash, J., 2017. Breaking bad news: An evidence-based
review of communication models for oncology nurses. Clinical journal of oncology
nursing, 21(5), pp.573-580.
Gluyas, H., 2015. Effective communication and teamwork promotes patient safety. Nursing
Standard (2014+), 29(49), p.50.
Griffiths, J., Ewing, G., Wilson, C., Connolly, M. and Grande, G., 2015. Breaking bad news
about transitions to dying: a qualitative exploration of the role of the district nurse. Palliative
medicine, 29(2), pp.138-146..
Konstantis, A. and Exiara, T., 2015. Breaking bad news in cancer patients. Indian journal of
palliative care, 21(1), p.35.
Kpanake, L., Sorum, P.C. and Mullet, E., 2016. Breaking bad news to Togolese patients. Health
communication, 31(11), pp.1311-1317.
Warnock, C., 2014. Breaking bad news: issues relating to nursing practice. Nursing Standard
(2014+), 28(45), p.51