In this day of selivering bad news, I thought that this article that I saved from last year would be a great refresher. Food is food regardless of the source.
The Rules for Delivering Bad News to Patients
August 27, 2019
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I've talked to some colleagues recently who've been a little down about their roles as nurse practitioners. Working in family practice, they have found themselves in the position of delivering bad or upsetting news to their patients. Cancer diagnoses were fortunately made rather than missed, but letting a patient know they've got a serious, life-altering illness or condition is tough, not to mention, this is not something most of us as NPs learn to do in school.
Have you ever found yourself in the position of delivering difficult news to patients? How did you feel? Having such conversations as nurse practitioners can make us anxious or awkward. Some of us approach these discussions emotionally while others appear detached and robotic in their delivery of the news. Delivering bad news is an unavoidable part of our jobs as nurse practitioners but that doesn't mean we get used to it. Fortunately, however, conducting serious conversations is a skill that can be learned and there are many guidelines out there to help healthcare providers hone this skill set.
Rule #1: Know what constitutes bad news
Sometimes I share information with a patient that I perceive as not a big deal. Then, the patient starts to freak out. Or cry. Or to have some other sort of emotional reaction that I didn't anticipate. Bad news doesn't have to be a terminal diagnosis. It can be related to anything surrounding a diagnosis such as timing, personal or professional consequences. Breaking a metatarsal and wearing a boot, for example, may not be too bad in the grand scheme of things, but breaking your foot the day before your wedding is pretty disappointing.
Rule #2: Full disclosure is best
In the past, healthcare providers operated on a more guarded front. In the 1800's, for example, the American Medical Association even encouraged physicians to avoid sharing news that discouraged patients. Today, however, studies (not to mention ethics!) show that most patients prefer full disclosure. It's our duty as nurse practitioners to share up-front, honest information rather than sugar coat our delivery with excessive optimism, withhold details, or give false hope. Share news with the patient directly rather than directing it toward family members. Honest, trustworthy information is empowering!
Rule #3: Prepare yourself
Anticipate the conversation you're about to have with your patient. You may even wish to practice your delivery with a colleague. Prepare yourself to feely badly as you share the news. And, don't forget that silence is OK. Avoid the temptation to fill gaps in your conversation rather let the patient process and take the time to formulate questions.
Rule #4: Frame the conversation
Framing the news you're about to share is essential. Your patient may or may not be expecting to hear something difficult. And, the way you set up your conversation has an impact on the patient's reaction. Using the word "serious" (ex. "I have some serious news to share...") is better than using the word "bad". "Serious" creates a more constructive framework that inspires action and empowerment as opposed to the word "bad" which indicates the situation is helpless. Even if you're delivering a terminal diagnosis, your patient can choose how to react and what steps they wish to take in response.
Rule #5: Think SPIKES
There are a few well-known methods for delivering serious news to patients, my favorite of which is the SPIKES method. This algorithm lays out considerations for nurse practitioners and other healthcare providers in these situations. Here's the SPIKES protocol:
Setup - Think through the conversation you're about to have, anticipating questions the patient might ask beforehand. Prepare for an emotional reaction. Gather any necessary resources that might be helpful for the patient.
Perception - Gauge the patient's understanding and perspective on the news you have shared. This is best accomplished by asking questions like "What did you take away from what I just shared with you?" or "What are your expectations of treatment?". This way you know you are both on the same page as far as understanding the medical outlook, next steps and goals.
Invitation - Encourage the patient to think further about their care going forward. Find out how much information the patient wants about his or her medical condition as well as who he/she would like to be included in decision making such as family members.
Knowledge - This step has to do with how you as a provider deliver information. The best practice is to deliver the headline first, followed by the details. Communicate using language that matches the patient's level of education and medical knowledge. Be direct in your delivery, avoid skirting the main message.
Empathy - Understandably, patients get emotional about serious news. Anticipate such a reaction and display empathy. Naming the patient's emotions can help. Asking "Can you tell me more about what you mean by that?" will also help you determine how the patient feels about the situation.
Summarize and Strategize - Make a plan for the next steps in both treatment and communication with your patient. Express support and encourage the patient to tell friends and family the news to develop a personal support system. Talk about how the patient can act on this news to accomplish his or her treatment and lifestyle goals going forward.
Have you ever delivered bad news to a patient? How did it go?
Hello Everyone new to PA forums- I have some textbooks that I am selling as I graduated and no longer need them. I have pictures, all are in great condition. I am located in Tempe Arizona so if you are looking for AT STILL, MIDWESTERN or NAU PA PROGRAMS, then this is for you.
Prices are whatever the used pride on amazon is minus 20% assuming your in AZ and I don’t have to ship. Bates is currently sold
12- Lead ECG- The art of interpretation by Tomas B Garcia, MD DO NOT BUY THE ECG TEXTBOOK BY DUBIN, that guy is a pedophile and lost his medical license. Don't give him money
Pharmacology 4th, 5th, 6th edition from Lippincott Willams and Wilkins- Bought all three as they have different questions in the back which are good for exam practice
Surgical recall 7th edition by Lorne H Blackbourne- A must have if you have a surgery rotation, seriously this book is a life savor, every chapter has a set of popular pimp questions that Preceptors try to make you miss.
Case Files: Surgery 5th edition LANGE- Recommended if you want to pursue Surgery
Case Files: Emergency Medicine 4th edition LANGE Recommended if you want to pursue Emergency Medicine, this one did come in handy on rotations
Avoiding common Errors in the Emergency Department 2nd edition- Really only recommend if you want Emergency Medicine
LANGE Q&A Physician Assistant 5th edition 225 question practice test with 1100 questions and detailed answers- I counted approximately 25 pages where I circled answers on the questions, after that I just used a separate sheet of paper
Bates Guide to Physical Examination and History Taking 12th edition Hardback by Lynn S Bickley
Tolerances- an orthopaedic reference manual 3rd edition- small pocket book for an ortho rotation- Only recommend if you want ortho surgery
Pocket Medicine 6th edition by Marc S Sabatine- pocket book for general/internal med. A huge help
Manual for Eye Examination and Diagnosis 9th edition by Mark W Leitman- full color
Ophthobook by Timothy Root M.D.- oddly enough my favorite textbook on here. Its a fun break from the grind, funny and extremely informative. I used this over the more expensive option above and did just fine
I wanted to share a conference that I'm helping plan in January 2020: Pediatric Sports Medicine Conference: Managing Pain in Your Young Athletes After Injuries. I attended last year and really enjoyed the content. It sold out last year, so if you're interested in attending, be sure to register before the end of Dec.
UCSF Benioff Sports Medicine faculty will present evidence-based management of acute and chronic pain, including the roles of ice, splints and braces, pain medication, cognitive behavioral therapy and physical therapy.
By the end of this conference, participants will be able to:
Recognize the early signs and symptoms of pain amplification syndrome and chronic regional pain syndrome that could occur after injury
Apply appropriate pain management strategies for young athletes, including ice and other modalities, pain medication, cognitive behavioral therapy, and physical therapy
Discuss the red ‑ flags of pediatric musculoskeletal injuries, including when to get X-rays and when to refer
Describe the proper prescription and fitting of upper- and lower extremity splints, including their duration of use depending on injury diagnosis
Explain the steps needed for proper evaluation and management of concussions to avoid persistent post-concussion symptoms, including chronic headache pain
Identify rheumatological causes of joint and back pain in pediatric patients Here is the link for more information or to register: https://ucsfbch.regfox.com/2020-pediatric-sports-medicine-conference
This course is designed to be a "scan and surf" adventure with the education ending at 2 pm each day so participants have time to enjoy the location. With so much to do in Huntington Beach and the hotel offering a Beach Amenities Program, the SEMPA Ultrasound Course is the perfect balance of education and fun!
The course will provide point-of-care ultrasound training to physician assistants working in emergency medicine. Didactic sessions will focus on concise, useful information, images, and video. Most importantly, participants will have the opportunity to learn the necessary skills through hands-on teaching and practice on models under the guidance of experienced faculty and sonographers.
Upon completion of this program participants should be able to:
List the standard views or “windows” for each of the six primary areas of emergency ultrasound - trauma, aorta, biliary, cardiac, pelvic and procedural applications Accurately interpret point of care ultrasounds Demonstrate the standard views or “windows” for each of the six primary areas of emergency ultrasound - trauma, aorta, biliary, cardiac, pelvic and procedural applications Limited to 50 participants 1:5 faculty to student ratio Hands-on scanning of live models Simulation technology incorporated Lots of practice time Earn CME towards your EM-CAQ Faculty from emergency ultrasound fellowship programs Learn the core applications to emergency ultrasound Meals included Time to enjoy all Huntington Beach has to offer For more information and to register: