Identification of the problem
Mr. Edward, a 42-year-old parent and business owner, observed a significant increase of the testicles. At first, he decided to disregard it, mistaking it for a football injury, and then, subsequently, because he was ashamed to share it with a doctor. After months, he was admitted to the urgent care unit because he was experiencing breathlessness far beyond usual, and had a continuous pain at his back. The symptoms mentioned above have been revealed to be induced by discomfort transmitted from para-aortic lymph node metastases, and also lung metastases. He had a poor prognosis, as a result, his relatives were called to be available as he got the news and to offer support. In a private room, the doctor presented the prognosis to Mr. Edward and his relatives, along with a fellow nursing assistant and myself inside there. Mr. Edward and his relatives, obviously, were saddened.
This situation has left an indelible impression on me. I was understandably nervous before the occurrence, because it was the first time I had seen a situation where the patient and family had to hear such bad news. I was caught off guard by the intensity of my own feelings when I saw Mr. Edward and his wife’s emotions towards the information. It was tough to keep a straight face and refrain from crying. These emotions vanished quickly, superseded by a determination to enhance Mr. Edward’s end-of-life care in every way I could and I tried to help the patient as well as the family members as much as I could. I was motivated to reflect on this scenario in order to improve practice and learning in the healthcare context.
Learning points from the incident
Since this was my first time dealing with a situation like this, I played the role of observer. Nevertheless, it was an amazing training environment in which I was able to improve my communication and interaction skills by observing. On reflection, I guess I could have kept my emotions in check, though I was not ready for Mr. and Mrs. Edward’s response to the revelation on an emotional level. The doctor was the driving force behind the operation, with assistance from another nursing assistant, who both had extensive palliative care knowledge. During prior discussions, it was obvious that they had already earned Mr. Edward’s trust. A fundamental aspect in developing strong partnerships between medical personnel, patients, and caregivers has been recognized as trust, which has facilitated more efficient, transparent, and genuine communication (Pfeifer and Head, 2018).
Connecting with patients on a professional and a personal level is critical in end-of-life care. As a requirement for a medical provider to be regarded as trustworthy, there must be uniformity in both verbal and nonverbal communication. Non-verbal communication has been found to be more effective compared to verbal communication, with attentiveness and gestures being two of the most important traits of non-verbal communication. In other cases, touching has also been suggested as a crucial factor for nurses to consider. Seeing the other nursing assistant utilize hands to console Mrs. Edward, helped the entire family feel relaxed in the room, disintegrating the ‘boundary’ between both the medical practitioners and the patient/family. The doctor mostly communicated through words, which could indicate communication gaps between men and women, with males favoring verbal ways of communication, whereas females prefer nonverbal methods. I noticed that the family tended to consider the nursing assistant as a comforter and someone who could be reached more easily than the doctor, and that this attitude remained unchanged throughout Mr. Edward’s care.
It is also vital to realize the value of effective communication among members of the multifunctional end-of-life care team. For instance, it can be difficult if team members have different perspectives on care. Implementing strategies to facilitate successful inter-personal communication among interdisciplinary teams and other healthcare professionals is one of the core requirements of the NICE guidelines for end-of-life care (NICE, 2019). I used to have to join forces with other care workers throughout Mr. Edward’s end-of-life care, and there were instances when I had to consider the perspectives of other team members in order to interact with them effectively. Staff meetings helped to create a platform where concerns could be addressed and solutions established.
Reactions to receiving unpleasant news in end-of-life care
When giving bad news to a patient, medical professionals may have to deal with a variety of emotions, involving denial and collaboration, as well as emotional outbursts like rage, embarrassment, and regret (Brouwer et al., 2021). Denial is a strategy used by people who are unable to accept that they have a serious illness as a way of coping, however, as their health declines; they will frequently come to terms with the truth. Caregivers and family may encourage the patient to continue to deny his or her illness in order to postpone the need to confront and address tough matters. Most of the time, cooperation between medical practitioners and families/caregivers to keep information hidden from the patient is considered as a way of keeping the patient safe. However, having an open and honest conversation with the patient can play a role in determining their degree of knowledge and awareness, in addition to assuring them of their condition and assisting them in accepting the truth.
When patients, their families, and caregivers are told something they do not want to hear, they often express strong feelings and emotions. Anger aimed at the medical expert who delivered the bad news can often be misdirected, so it is critical to identify and treat the source of the rage. Patients may feel guilty and as if they are being reprimanded for something, they have committed. Similarly, the afflicted may accuse others of their illness. Whereas healthcare professionals are unable to eliminate thoughts of blame and guilt, ensuring that the patient is able to express his or her feelings and addressing relevant topics can help individuals come to grips with their feelings. Mr. Edward’s first response to the information was one of self-blame and regret, as he despised himself for not getting medical care earlier, and he felt bad about causing so much suffering to his relatives. He seemed to embrace his terrible diagnosis and asked a series of questions that showed he was well aware of his condition.
Cultural and spiritual values can affect a person’s perspective on illness, and patients’ and their relatives’ or caregivers’ fears may need to be dealt with either when the bad news is presented or later throughout end-of-life care when someone is on the verge of passing away. As a result, spiritual care is extremely important in end-of-life care. However, because neither Mr. Edward nor his family was quite pious, this was not a significant issue during the episode or in his later treatment.
End-of-life care ethical and legal issues
There are several ethical and legal problems to consider while providing end-of-life care, encompassing death and the capacity to refuse or withdraw life-supporting treatment. One of the most significant aspects of this scenario is the patient’s right to know about their illness. According to research, the majority of cancer victims want to know their condition and how their illness will proceed. This might be difficult for professionals and medics who want to take care of patients and give a positive attitude even if the prognosis is bleak. For example, Mr. Edward needed to ask more questions than he could about his care and prognosis, and the nurse as well as the doctor shared quite so much details with him as they possibly.
End-of-life care is a sensitive matter; however, I feel that if each patient is treated as a unique individual and his or her needs and goals are given close attention, you may achieve a great result. Successful nursing practice emphasizes communication and strong interpersonal relationships once more. When dealing with patients who are approaching the end of their lives, I must be able to communicate well and be capable of providing exceptional service at all times. I must maintain my abilities and expertise up-to-date. I was supposed to take command of circumstances and be capable of communicating and coping with what was thrown at me throughout my placement. To become a nurse practitioner, you must be capable of standing on your own two feet, and this will be crucial in my journey.
This scenario taught me an important lesson, and in the future, I will be very prepared to deal with a similar problem. Critical thinking in nursing is an essential part of successful responsibility and high-quality healthcare services. I have realized how important it is to plan, such as selecting a suitable location for breaking the news and ensuring that the room’s seats are correctly positioned. If it was acceptable, I would pay more attention to the significance of non-verbal approaches, especially touching, instead of depending exclusively on verbal communication. In addition, I have become more aware of ethical problems accompanying negative information in end-of-life care and wherever possible, be honest and transparent with the patient and their family.
Brouwer, M., Maeckelberghe, E., Van Der Heide, A., Hein, I. and Verhagen, E., 2021. Breaking bad news: what parents would like you to know. [online] Available at: <https://adc.bmj.com/content/106/3/276> [Accessed 22 February 2022].
NICE, 2019. Overview | End of life care for adults: service delivery | Guidance | NICE. [online] Nice.org.uk. Available at: <https://www.nice.org.uk/guidance/ng142> [Accessed 22 February 2022].
Pfeifer, M. and Head, B., 2018. Which Critical Communication Skills Are Essential for Interdisciplinary End-of-Life Discussions?. [online] Journal of Ethics | American Medical Association. Available at: <https://journalofethics.ama-assn.org/article/which-critical-communication-skills-are-essential-interdisciplinary-end-life-discussions/2018-08> [Accessed 22 February 2022].