NURS2006: Clinical Practice Improvement Project on Bad News

This report presents a Clinical Practice Improvement Project (NURS2006) focused on enhancing the delivery of bad news to patients in healthcare settings. The project aims to improve bad news delivery by 30% within four months by utilizing tools like the SPIKES protocol, which includes setting up the interview, assessing patient perception, obtaining the patient's invitation, giving knowledge and information, addressing emotions with empathy, and strategizing and summarizing. The report emphasizes the relevance of clinical governance, outlining pillars such as clinical performance, professional development, clinical risk, and consumer value. It highlights the importance of addressing this issue, citing research indicating adverse patient effects from poor communication. The project also details key stakeholders, including pharmacists, nurse managers, nurses, and doctors, and utilizes the PDSA (Plan, Do, Study, Act) cycle for continuous improvement. The report concludes by addressing potential barriers to implementation, such as lack of experience, poor communication, lack of cooperation, time constraints, and financial limitations, and proposes solutions to overcome these challenges.

NURS2006 PROJECT 5
Clinical Practice Improvement Project Report
Project Title:
Improving bad news delivery
Project Aim:
To improve delivery of bad news to patients regarding their health by 30% in next 4 months.
This targets is specific because delivery of bad news must be in appropriate manner. This helps
to provide proper medication to customers and corrective measures can be taken in order to
console patient. Above stated aim can be measured through reaction and future actions of
consumer. In order to achieve objective there must be use of different tools such as SPIKE. This
aim is realistic through improving communication channel of interaction with consumers
(Hager and et. al., 2013). Time bound is most important component of aim so managers of
hospital set time of 4 months to achieve it.
Relevance of Clinical Governance to your project
Clinical governance is a set policies which are followed by hospitals and other medical
institutions through which patient can be taken care in appropriate manner. This is the path
way through which clinical activities are performed by correct person at right time. This is the
model through which continuous improvement in services is possible in services of
organisation. Clinical governance helps in risk management which is effective for risk
management, creating good culture within hospital, possibilities of mistake gets reduced, etc.
are some benefits arise (What were the lessons learned from implementing clinical audit in
Latin America?, 2018).
Corporate governance is effective because there is requirement of change in working style n
order to improve delivery of bad news. Hence clinical governance is effective for achieving aim
and guiding staff in order to improve performance of workers.
There are pillars of corporate governance which enhance knowledge about it-
Clinical performance and evaluation- There are different activities in health care organisation

such as test, medication, observation of patient, etc. these operations must be performed in
appropriate way through which positive results can be achieved in health of health of patient.
As per clinical governance, there is provision of evaluation of performance. When evaluation is
done, then workers are aware about their job responsibilities and they are accountable to it
(Clinical governance, 2018). As per aim of report, to improve communication of bad news
there are some models which can be used in order to deliver information in ethical way. These
tools are ABCDE model, SPIKES protocol, BREAKS model.
Professional development and management- There are different professionals in hospitals
which works in order to medicate patient. It is their responsibility to communicate bad
information properly (Mechanick and et. al., 2013). As per SPIKES, there are different activities
which has to be managed properly. This helps to deliver information in appropriate manner.
With the help of clinical governance, it is easy to manage activities of delivering bad
information.
Clinical risk- Clinical risk is on of the most affecting pillar in health care sector. When actions
are taken to improve communication of bad news. There are possibilities that models of
delivering information are not implemented in appropriate way. Hence evaluation has t be
done to know area of flaws and improvement can be done.
Consumer value- As aim is to improve communication of bad news to consumer, so analysis of
consumer must be done. This helps to give priority to consumer and use of appropriate model
can be done.
Evidence that the issue / problem is worth solving: (400 words)
Issue arise in organisation is to improve communication of bad information. This issues covers
in clinical risk of clinical governance. This issue can be resolved with the help of different
model such as SPIKES, ABCDE, BREAKS, etc. This helps to create environment through which
information can be delivered to patient. It is important to address this issue, so bad news can
be conveyed properly to patient. This helps to give relevant information to patient, emotions
can be balanced, communicator can provide empathy over it (Reeves and et. al.., 2013). As per
research there are about 90% which gets adversely affected because bad information was
delivered in inappropriate manner. This affects health of patient and they gets scared of
disease. This looses client's hope and results in negative impact on health.
This issue can be resolved effectively with SPIKES model. This model is discussed as under-
S- S stands for standing setting up the interview. This is the first step through which bad news

can be delivered to patient. There is requirement of proper arrangement of meeting.
P- P stands for Assessing patient’s perception
. After setting meeting,n there is requirement of creating good environment which helps in
proper communication with patient. It is essential to listen consumer patiently.
I- I stands for Obtaining the patient’s invitation
. After setting environment, measures are taken to take invite patients and family members. It
is essential to make changes which are important and significant for building good relations
with them. This ease in delivering information (Wolff and et. al., 2013).
K- K means Giving knowledge and information to patient. In this phase actual medical reports
are conveyed to patient. It is important to use language which is understandable by patient, it
must be polite and humble.
it is important to be sure that delivered information may be conveyed and understood by
patient properly.
E- E means addressing the patient’s emotions with
empathetic response
. After delivering information it is essential that medical personnel must provide some
empathy to patient. It is fruitful to give some positive vibes after analysing reaction of patient.
Sources through which disease can be cured must be analysed so emotions of patient can be
balance (SPIKES, a Six-Point Protocol, Helps Physicians ‘Break the Bad News’ to Cancer Patients,
2018).
S- S means Strategy and summary. This is the step in which conversation with patient gets
closed. They may plan next meeting in this [phase and measures for next time can be
conveyed to client. In case of any doubt or issue to family members, this can be resolved.
This model is appropriate because there is proper environment for communicating with client.
As per reaction of patient, doctors are able to deal with situation and they have proper
diagnosis to recover from it.
Key Stakeholders:
Stake-holders are the people who have keen interest in working of organisation. They are the
people who wants that organisation must perform operations in appropriate and ethical
manner. Stake-holders includes Pharmacist, nurse managers, nurses, patients, doctors, etc.

These persons play important role in conveying adverse information to sufferers.
Pharmacist- They are the person who provides medical assistant to sufferer. They plays
important role in providing proper medication. When bad information is convey to client, then
pharmacist provide appropriate medicine, injections to cure disease.
Nurse managers- This is the person above nurse staff. They are responsible to assign different
roles to nurse and take acre of patient. They visit patients and in case of emergency, they
provide treatment too. (Bratzler and et. al., 2013)
Nurses- Nurse work as assistance of doctors. They keep eyes on medication of patient, timely
injections, etc.
Doctors- Doctor is important for maintaining and curing diagnosis. They watch reports of
patient, interpret it. Doctors provide knowledge about different measures through which
disease can be cured.
CPI Tool:
There is always scope of improvement in business activities of health care sector. There is
requirement of change in policies because there is difference in sufferings, mindset of workers.
PSDA tool is used for Clinical Practice improvement. PSDA stands for plan, do, study, act. As
per this tool, there is requirement of planning of activities to convey bad information, then
actions are performed. After performance it is important to analyse that information is
delivered and understood in appropriate manner or not. At last, in case of negative
results,corrective measures are taken.
Plan- In order to convey information to patient, there is requirement of proper planning.
There is requirement of proper environment, so communication can be effective with sufferer
and it can be delivered properly (Anderson and et. al., 2014).
Do- After planning, this is phase in which meeting among doctor and patient is organised. This
phase is effective if planning is appropriate. In this doctor convey about diagnosis to patient.
Study- After delivering information, this is the phase in which actions of customers are
analysed. There are possibilities of shock, cry, silence, etc. as reaction from clients.
Act- While studying there are possibilities of [positive as well as negative results. It is essential
that doctors has to analyse areas of flaws and then correct measure can be taken.
This model works on continuous basis, so this helps to improve business operations in
effective and appropriate manner. For instance, if some mistake is undertook with one patient,

then this can be improved with this model.
Summary of proposed interventions:
Clinical practice improvement (CPI) can be undertaken with the help PSDA plan. It is essential
that organisation has to make changes in working style a per case. This helps in
implementation of policies in appropriate manner. There is requirement of change which is
effective and significant for making changes in working style. It is essential that association
has to make alterations through which they can convey bad information appropriately. For
instance, when bad information has to conveyed to client and they reacted through sadness,
crying then doctors must provide solution to such health issue (Cima and et. al., 2013).
Employees working in health care organisation such as nurse, compounder, etc. must be
trained to act while dealing with patient or sufferer. Through PSDA model, policies roles,
working style improved and improvement is possible in delivering bad information.
Barriers to implementation and sustaining change:
While implementing change in association, it is not essential that positive results can be
achieved. There are possibilities of some barriers which affects delivery of information. Hence
it is important to take measures in order to overcome it. While performing research, there are
some issues which are faced by research team. They are discussed as under-
Lack of experience- There are possibilities that team mates have less experience, so this
affects time work and aims are not accomplished on time. Due to lack of experience quality of
research may also declined.
Poor communication- Communication is one of the important component in delivering
performing research. There are various activities which are required in order to attain aim.
There is poor communication among team so this affects quality of information collected.
Lack of cooperation- Cooperation is important in team while performing research work. There
are various activities in performing this task, so due to lack of cooperation, there are
possibilities of miscommunication and team mates are not ready to work in group. This affects
last results.
Time consuming- Research work is time consuming because there are some personal conflicts
which affects research activities. There are some duplication of activities which shows wastage
of resources.
Lack of financial resource-

Yes, it is possible to overcome barriers. There is requirement of different tools through which
aims are achieved. There are some entertainment activities which are effective and significant
for interaction among team mates. There are some communication measures which helps in
communication among team mates.
In order to sustain project, proper communication techniques are used. This is effective for
getting positive results. Team mates are aware of their roles and responsibilities and hence
they perform operations properly.
Evaluation of the project:
Project evaluation is essential because this is the part through which attainment of aim is
known. There are possibilities that aim of improving bad information is not achieved, then
reasons can be known through evaluation. Data is collected before starting project, this helps
to know actions which helps to deal with issue. From the above discussion it is clear that CPI
(Clinical improvement plan) is helpful in improvement of performance. Some measure which
has to be taken by research are proper communication channel, regular evaluation of
activities, staff engagement in decision making. These are the measures are helpful in
achieving aim of project i.e. improvement in communication of bad information.
REFERENCES
Books and Journals
Anderson, J. L. and et. al., 2014. ACC/AHA statement on cost/value methodology in clinical practice
guidelines and performance measures: a report of the American College of
Cardiology/American Heart Association Task Force on Performance Measures and Task
Force on Practice Guidelines. Journal of the American College of Cardiology. 63(21).
pp.2304-2322.
Bratzler, D. W. and et. al., 2013. Clinical practice guidelines for antimicrobial prophylaxis in surgery.
Surgical infections. 14(1). pp.73-156.
Cima, R. and et. al., 2013. Colorectal surgery surgical site infection reduction program: a national
surgical quality improvement program–driven multidisciplinary single-institution
experience. Journal of the American College of Surgeons. 216(1). pp.23-33.
Hager, D. N. and et. al., 2013. Reducing deep sedation and delirium in acute lung injury patients: a
quality improvement project. Critical care medicine. 41(6). pp.1435-1442.
Mechanick, J. I. and et. al., 2013. Clinical practice guidelines for the perioperative nutritional,
metabolic, and nonsurgical support of the bariatric surgery patient—2013 update:
cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and
American Society for Metabolic & Bariatric Surgery. Obesity. 21(S1). pp.S1-S27.
Reeves, S. and et. al.., 2013. Interprofessional education: Effects on professional practice and
healthcare outcomes. Cochrane Database of systematic reviews, (3).

Wolff, A. C. and et. al., 2013. Recommendations for human epidermal growth factor receptor 2
testing in breast cancer: American Society of Clinical Oncology/College of American
Pathologists clinical practice guideline update. Archives of Pathology and Laboratory
Medicine. 138(2). pp.241-256.
Online
What were the lessons learned from implementing clinical audit in Latin America?. 2018. [Online].
Available through:
<https://www.emeraldinsight.com/doi/abs/10.1108/14777270910976157 >.
Clinical governance. 2018. [Online]. Available through:
<https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2141.2001.02515.x >.
SPIKES, a Six-Point Protocol, Helps Physicians ‘Break the Bad News’ to Cancer Patients. 2018.
[Online]. Available through: <http://www.cancernetwork.com/articles/spikes-six-point-
protocol-helps-physicians-break-bad-news-cancer-patients >.