Date of Award

1-14-2024

Degree Type

Thesis

Degree Name

Master of Science in Nursing (MScN)

First Advisor

Ms. Arusa Lakhani

Second Advisor

Dr. Rubina Barolia

Third Advisor

Ms. Laila Cassum

Department

School of Nursing and Midwifery, Pakistan

Abstract

Background: Breaking bad news (BBN) is an essential component of healthcare, particularly in critical care settings, where physicians are responsible for communicating the bad news, however, nurses play a vital role in the BBN process. The role of nurses includes providing emotional support, explaining the medical words in simple language, assisting in making treatment choices, and preparing patients and families for the bad news and helping them cope with it. The process of BBN in Pakistan, especially in Peshawar is complicated due to cultural norms, patriarchal family structures, and emotional stress, as well as a lack of formal training and insufficient institutional support. Nurses working in critical care areas encounter significant safety risks and emotional burdens while navigating these challenges. Despite the significance of this role, training on how to effectively deliver bad news is largely overlooked in nursing education.
Purpose: The study evaluated the critical care nurses' role and experiences regarding BBN at public tertiary care hospitals in Peshawar, Pakistan.
Methodology: An exploratory descriptive qualitative (EDQ) study design was used, the study was conducted in the critical care units of two public tertiary care hospitals in Peshawar. Through purposive sampling, 14 participants were recruited. In-depth interviews using a semi-structured interview guide were conducted and data was manually analyzed using Braun and Clark (2013) thematic analysis approach.
Results: Four key themes emerged from the study: Extended family dynamics and diverse sociocultural practices, Strengthening the framework for sensitive health disclosure, Compassionate communication: empowering through support and counseling, and improving sensitive health disclosures through standards, training, and curriculum. These themes reflect challenges faced by critical care nurses, including family involvement, patriarchal decision[1]making, and aggressive reactions during bad news delivery. Confidentiality, safety, and inadequate training further stressed the need for stronger disclosure frameworks. Nurses emphasized the importance of compassionate communication, psychological support, and clearly defined roles. The study also highlighted the significant influence of patriarchal culture on the BBN process, alongside the lack of formal training and guidelines, emphasizing the need for improved standards protocols, and curriculum in health disclosures.
Conclusion: The study concludes that critical care nurses in Peshawar face significant challenges in delivering bad news, including a lack of training, unclear roles, emotional strain, patriarchal influences, and safety concerns. There is an urgent need for BBN education, curriculum integration, and policy reforms to improve communication and safety, enhancing patient care and nurses' resilience.

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1

Last Page

128

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