Acute Care Faculty Series: Case Study on Delivering Bad News (S11 Ep. 72)

Welcome to The Peds NP Acute Care Faculty series! This collaborative series was created and peer-reviewed by national experts and leaders in acute care PNP education to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside. 

 

This episode applies the concepts from the prior episode on “Delivering Bad News” (S11 Ep. 71) to a few examples where HIV status was disclosed to a pediatric patient. After reflection and discussion of a few ethical principles important to consent/assent, it’s time to practice delivering bad news in a case study. An unfolding case poses questions to get you thinking about what you might say. Make it interactive by pausing your podcast and answer the question yourself. The case walks you step-by-step through the process of delivering bad news to a child and their family using the SPIKES protocol. There's no perfect answer, but this example helps to prepare you for competency-based learning, so that you’re ready to deliver bad news in practice.

 

Authors (alphabetical): Becky Carson, DNP, APRN, CPNP-PC/AC, Ann Felauer, DNP, APRN, CPNP-PC/AC, Belinda Large, DNP, APRN, CPNP-PC/AC, and Robyn Stamm, DNP, APRN, CPNP-PC/AC

Welcome to The Peds NP Acute Care Faculty series! This series was created and peer-reviewed by national leaders in acute care PNP education collaborating with one another to meet the needs of our current and future colleagues. In the push for competency-based education where faculty verify the skills of what a student can do, rather than their knowledge, our series focuses on the application of didactic content with a practical approach so that you can learn nuances of clinical skills before you reach the bedside. 

 

This episode reviews the features of a patient presentation in the pediatric intensive care unit (PICU) and goes in depth on how learners can incorporate trends, new findings, and summaries into a succinct discussion in family-centered rounds. After an introduction with some general best practices, the guide begins with effective pre-rounding and progresses to the step-by-step components of a PICU patient presentation. The template describes each component’s contents in detail, followed immediately by an example to demonstrate the practical application of each concept… “It might sound something like this:”... This episode is a valuable tool for any pediatric provider seeking to increase their skills in succinct synthesis and patient presentations, regardless of clinical setting.

 

This episode was peer reviewed by The Peds NP faculty series peer review team. You can read about our novel and scholarly approach to peer review, review our faculty lineup, and learn more about the series, competency mapping, references, and show notes at www.thepedsnp.com. There was no financial support or conflicts of interest to report. Follow me on Instagram @thepedsnppodcast.  Email me at thepedsnp@gmail.com.  Remember that this isn’t just a podcast, you’re listening for the kids.

 

Authors (alphabetical): Jackie Calhoun, DNP, CRNP, CPNP-AC, CCRN, Becky Carson, DNP, APRN, CPNP-PC/AC, Lena Oliveros, MSN, CPNP-AC, Priscila Reid, DNP, APRN, FNP-C, CPNP-AC

Peer Review:

This episode was peer reviewed using a modified revised METRIQ (rMETRIQ) Score. Learn more about The Peds NP's formal peer review process at www.thepedsnp.com/peerreview

rMETRIQ Score: 15/15

What does this score mean? This episode underwent a quality assurance process using formal peer review and achieved the top scores based on established quality criteria for podcasts.

Financial disclosures/conflicts of interest: None

Connect with The Peds NP

email: thepedsnp@gmail.com

Instagram: @thepedsnppodcast

References

Brouwer, M. A., Maeckelberghe, E. L. M., van der Heide, A., Hein, I. M., & Verhagen, E. A. A. E. (2021). Breaking bad news: what parents would like you to know. Archives of disease in childhood, 106(3), 276–281. https://doi.org/10.1136/archdischild-2019-318398

 Cassim, S., Kidd, J., Keenan, R., Middleton, K., Rolleston, A., Hokowhitu, B., Firth, M., Aitken, D., Wong, J., & Lawrenson, R. (2021). Indigenous perspectives on breaking bad news: ethical considerations for healthcare providers. Journal of medical ethics, medethics-2020-106916. Advance online publication. https://doi.org/10.1136/medethics-2020-106916

Field, M.J. & Behrman, R.E. (2003). When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Chapter 4 communication, goal setting, and care   planning. Committee on Palliative and End-of-Life Care for Children and Their Families. Institute of Medicine (US)

Holmes, S. N., & Illing, J. (2021). Breaking bad news: tackling cultural dilemmas. BMJ supportive & palliative care, 11(2), 128–132. https://doi.org/10.1136/bmjspcare-2020-002700

Kaplan, M. (2010). SPIKES: A framework for breaking bad news to patients with cancer. Clinical Journal of Oncology Nursing, 14(4), 514-516.                   https://cjon.ons.org/cjon/14/4/spikes-framework-breaking-bad-news-patients-cancer

Kumar, V., & Sarkhel, S. (2023). Clinical Practice Guidelines on Breaking Bad News. Indian journal of psychiatry, 65(2), 238–244. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_498_22

Labaf, A., Jahanshir, A., Baradaran, H., & Shahvaraninasab, A. (2015). Is it appropriate to use Western guidelines for breaking bad news in non-Western emergency departments? A patients’ perspective. Clinical Ethics, 10(1–2), 13–21. https://doi.org/10.1177/1477750915581797

Monden, K. R., Gentry, L., & Cox, T. R. (2016). Delivering bad news to patients. Proceedings (Baylor University. Medical Center), 29(1), 101–102. https://doi.org/10.1080/08998280.2016.11929380

Mostafavian, Z., Shaye, Z. A., & Farajpour, A. (2018). Mothers' preferences toward breaking bad news about their children cancer. Journal of family medicine and primary care, 7(3), 596–600. https://doi.org/10.4103/jfmpc.jfmpc_342_17