Article 1
Kalowes (2019) in her article looks at the role of nurses in talking about unfavorable prognosis with patients and family members. The author notes there is hesitance on the healthcare providers side to disclose unpleasant information to patients and family members. It is the opinion of the author that nurses can play acritical and complementary role to implement ways to make communication more effective to patients and families with such prognosis. The article focuses on the end of life prognosis and provides an outline of effective prognostic systems and the various challenges and opportunities nurses can use to improve communication and the quality of end-of-life care.
The author identifies several common barriers to effective communication of end-of-life prognosis. These include hesitance by the medical team to destroy hope, sudden death, the unwillingness of clients to accept a prognosis, and nurse’s general discomfort with death. The author proceeds to outline three illness trajectories for end-of-life patients. The author identifies evidence-based steps that can be taken in end-of-life discussions to improve the quality of care. Some of the key points include nurses taking leadership roles, understand the patient and family’s preferences, prepare them for discussion, show empathy and care, acknowledge emotions and concerns, and encourage further discussions.
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Article 2
Rising (2017) discusses the cultural element of truth disclosure in the end of life care. She compares and contrasts truth-telling in the United States, and among Chinese and Latin American minorities. Nondisclosure of end of life prognosis can be a source of moral distress to nurses. Nurses may experience less moral distress if they focus more on assumptions and biases that arise from dominant cultures. The author notes that truth disclosure is compelled by the fundamental ethical principle of autonomy, but nurses are not always comfortable to disclose unfavorable end of life prognosis to patients and family members.
Latin Americans and Chinese minority people are healthcare encounters not similar to those of white Americans. Their cultures are non-dominant and some of their contrast American practices. Their families are more collectivistic and bound by duty and respect for the elderly. Their cultures provide a good platform to compare and contrast with the Western ways. Rising (2017) demonstrates the importance of culture in understanding how to handle end of life prognosis patients and families. The author shows how ethical principles should be viewed through the cultural lens and the significance of the cultural competence model. Rising (2017) identifies cultural competence elements like knowledge, awareness, desire, skill, and encounters. It is important to respect the differences that exist within various cultures so as to serve the best interest of the patient.
Article 3
The authors of this article give an overview of how oncology nurses should break bad news using the evidence-based communication model. According to CDC figures in 2017, around 117 million people are diagnosed with chronic health conditions in the U.S (Bumb et al., 2018). The probability of giving end of life prognosis news is very likely. The article approaches the unfavorable truth disclosure from the perspective of cancer patients and nurses. It discusses what ineffective communication can in such cases and provides evidence-based practice examples.
The article describes the nurses and the patient’s experience in events of breaking bad news. A perceived lack of enough training to nurses to adequately handle communicating bad news and the moral distress accompanied is mentioned both in this article and in Rising (2017) article. In the case of the patient, most would want to discuss their diagnosis with their families included but would prefer the news first before their families are informed. Like Kalowes (2019) article, this paper also discusses barriers to effective communication when breaking bad news. It also touches on cultural considerations which are the main topics in Rising article (2017). This article finally offers the Spikes and Pewter evidence-based models of communication.
Diagnosis
A female patient aged 30 years old was unfortunately diagnosed with stage 4 breast cancer. It was already metastasized and spread to other parts of the body. From the diagnosis, it was evident that her cancer will be terminal. The patient’s family made a plea not to inform the 30-year-old patient of her condition. As healthcare providers, ethics are the guidelines, but it is also important to consider the family’s request, which seemed rational enough. In nursing ethics, the principle of autonomy states that the patient has the right to full control over their body. The medical team took time to consider the family’s request and to deliberate on a decision that had to be made. Their plea to us was loaded with emotions making it extremely difficult for a decision to be made.
Ethical principles are very clear on the issue of truth disclosure to the patient. To the nurse, the patient comes first and the family second. The patient is the medical team’s priority. There is an obligation to disclose the full nature of the diagnosis to the patient. To reach this decision, ethical principles were the guide and careful consideration of other factors as well. First, the patient’s condition required additional decisions to be made apart from the one informing her about the diagnosis. Whether the truth was disclosed to her or not, further decisions had to be made regarding her treatment like how best do to alleviate her pain. Secondly, if the patient was not told the truth at this stage, it was likely that the team would be required to lie to her after that. Thirdly, most clients already suspect their diagnosis. The chances are that when the medical team fails to disclose information to the patient, she might find out the true nature of her diagnosis later through another hospital. This is potentially a bad situation for any healthcare provider. It is vital to have a trusting relationship with the client.
After making a decision that the patient was going to be informed about the full nature of her diagnosis, the family was told of the team’s position and assured that everything would be handled as delicately and thoughtfully as possible. The family was informed about why it was essential for the hospital to disclose the diagnosis to the patient. The patient was then asked if she wanted to know her diagnosis or would she like the family to be told instead. She was informed that her diagnosis was not good. The patient informed the hospital that she wanted information on the full diagnosis. She, however, requested that her family be present when news of her diagnosis was conveyed to her. The medical team followed the patient’s wish. Unfortunately, the patient did not live for long after that. She died a few weeks after she was informed about the diagnosis.
References
Bumb, M., Keefe, J., Miller, R., Overcash, J. (2018) An evidence-based review of communication models for oncology nurses. Clinical Journal of Oncology Nursing .
Kalowes, P. (2015) Improving end-of life care prognostic discussion. American Association of Critical Care Nurses .
Rising, M. (2017). Truth Telling as an Element of Culturally Competent Care at End of Life. Journal of Transcultural Nursing .
