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Communication vignettes: ‘How seriously ill is she, nurse?’
  1. Helen Scott
  1. Dr Bruno Bubna-Kasteliz is a clinical adviser to the Health Service Ombudsman and a retired consultant geriatrician from the West Country. Email: bruno.bubna-kasteliz@ombudsman.org.uk

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Introduction

When relatives/friends visit a very ill patient in hospital, they may notice a marked clinical deterioration in his/her condition, evoking anxiety and fear that the patient is about to die. This will probably cause them to ask for information. The first person to whom relatives/friends often turn to communicate their concern is a nurse on the ward. The relative may be unaware of the nurse’s level of seniority or experience. The nurse may be junior, or lack the appropriate knowledge to assist. It is vitally important that the attitude and words of the person first approached are sympathetic and truthful. If that nurse is unable to provide the required information, then he/she must exhibit a willingness and openness to refer the relatives/friends to someone who can. Giving appropriate information about someone who is seriously ill to their nearest and dearest is not an easy task. It requires sensitivity, empathy, adequate clinical knowledge and listening skills. The standard advice is that breaking bad news, whether to the patient or relatives/friends, is best done by a senior practitioner (Brewin, 1991). Information of this kind may not be received in the way in which it is intended. During stressful conversations, it is not uncommon for relatives/friends to find it difficult to absorb information. Inappropriate or ‘blocking’ behaviour on the part of the nurse, i.e. not providing the right amount of information, may lessen the chance of patients/relatives/friends understanding and retaining said information (Maguire and Pitceathly, 2002; Table 1). This can lead to misunderstandings, failed communication and even complaints by the family against the nurse concerned (Abraham, 2004). As Buckman (1996) stated: ‘It has been said that if breaking bad news is done well…patients and their relatives… never forget us, but if it is done badly, they will never forgive us.’

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Table 1

Blocking behaviour …

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