Bereavement Part 2: Breaking bad news

Breaking bad news, whether telling a patient about a poor prognosis or informing relatives of the sudden death of a loved one, is one of the most daunting tasks facing nurses. It requires a sensitive approach, based on individuals' right to know the truth.     

Giving patients bad news

Dating violence presents many challenges to pediatric health care providers. It spans an age range from early high school to early adult years. Prevalence of dating violence appears to be greater than for violence among married couples. In addition, both males and females appear to be at risk for perpetration and victimization. Therefore, physicians and other health care providers need to screen all adolescent and young adult patients for dating violence. Primary prevention at the community level is also an important task to stem the tide of dating violence.     

A reply to Taplin: Good news, bad news.

Our reaction to J. R. Taplin's (see record 1981-26926-001) article "Implications of General Systems Theory For Assessment and Intervention" was mixed; a little good news... a little bad news. It is becoming increasingly obvious that the way clinicians think and act with respect to the problems that clients bring to their offices must incorporate the premises of general systems theory. The great majority of the excellent articles translating systems theory into clinical practice do not appear in those American Psychological Association publications that are generally familiar to traditionally trained psychotherapists. So the good news was the appearance of an article attempting to apply general systems theory premises to traditional psychological assessment in a journal widely read by clinicians. The bad news was that Taplin, by attempting to translate systems theory into conventional, linear-causal approaches to treatment, revealed at best a partial and somewhat confused understanding of general systems theory. A translation from a linear-causal to a systems model is theoretically and pragmatically impossible. The systemic, circular model is epistemologically distinct from the linear approach. These two very different ways of thinking and understanding have separate, clear, and divergent implications for the way we understand psychopathology and the approaches available to us for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a breaking bad news course for medical students

This paper presents the evaluation of a Breaking Bad News course run for three groups of medical students (fourth and fifth year from the London Hospital Medical College and fourth year from St Bartholomew's Hospital Medical College). The course, which is student centred, uses group discussion, videotape presentations and role-play including actors. All teachers, clinicians and human science tutors, had been through a staff training programme on teaching methods. At the end of the course, students' knowledge of important principles in giving bad news had increased, particularly in relation to interpersonal communication; they were more confident in their ability to break bad news well; and the course learning methods were highly rated. The course was just as well received by fourth year as by fifth year students and several said they would like more of this training. The evaluation shows that if reservations about role-play can be overcome then this experiential learning is highly valued by students.     

When good news is bad news: Medical wellness as a nonevent in undergraduates.

Study 1 demonstrated that information about healthy functioning can amplify health concerns and erode diagnostic confidence. Undergraduate Ss received a hypothetical test showing some level of cells associated either with pathology or with its absence. The moderate wellness result produced low confidence in one's health estimate and was distressing to receive. Wellness information may represent an ambiguous nonevent when testing for disease. Study 2 tested this thesis by adding Ss who adopted a recovering role to those adopting an illness role. Judgmental uncertainty was greatest and equivalent among recovering Ss given the moderate illness result and among ailing Ss given a moderate wellness result, and both groups were most willing to consider taking a risky treatment for the disease. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast awareness project for women with a learning disability

In 1995/6, while conducting a quality assurance evaluation in a residential group home for adults with a learning disability, the subject of breast screening and the importance of early detection of breast abnormalities was raised by a member of staff. At the time, the Mulberry Trust had a quality standard that women between 50 and 64 years who are supported in continuing care should attend breast screening clinics on a 3-yearly basis if they wish. A pilot scheme was devised based on the premise that breast awareness for service users should be promoted. It was decided that the scheme should include a breast examination, conducted on a monthly basis, ideally by the service users themselves, or by suitably trained staff on their behalf. The pilot scheme was implemented using available research and training was provided for qualified nursing staff within the trust. The training covered breast cancer prevention and breast awareness. After 7 months the scheme was evaluated and changes were made to policy and practice, including consultation with the trust's ethics panel regarding implementation of procedures. Training for staff in breast awareness continues and the scheme is slowly being introduced across the trust to enable all service users to be involved, both in residential homes and community settings. However, in future, the emphasis will be on identifying changes in the breast during normal care routines, such as bathing and dressing, as opposed to formal, clinical examination.     

Offenders who have a learning disability

This article examines aspects of the criminal justice system in relation to offenders with learning disabilities. Questions relating to the vulnerability and responsibility of suspects are explored in the light of recent literature. The legal rights of detainees are considered with reference to the Police and Criminal Evidence Act 1984. The role of the 'appropriate adult' is reviewed and implications for service workers are explored. Future directions are considered with reference to innovative developments in services. Victims and witnesses will be considered in a subsequent article.     

Good news, bad news makes excellent time while being lost.

Contends that M. Bobele and L. Winderman's (1981) criticisms of the present author's (see record 1981-26926-001) application of general systems theory in actual day-to-day clinical service are based on badly drawn inferences and misreading. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why good people do bad things

The very context of organizational decision making tests autonomous moral agency for managers, and the moral price they pay may be great. Misunderstandings, miscommunication, fear and isolation all play a role in why good people do bad things. Self-knowledge, good communication, alternative support systems and management by walking around (MBWA) all help good people (who happen to be managers) avoid doing bad things.     

Some good news about some bad practices.

Investigated 68 American Psychological Association members' perceptions of the frequency, wrongness, and recommended sanctions for the unethical research practices of plagiarism and data fabrication through surveys that contained 2 scenarios, one depicting plagiarism and the other data fabrication by a psychologist, and questions regarding the psychologist's behavior. Results show that Ss believed that researchers infrequently engage in these behaviors and that adjudication procedures would be recommended when the behaviors did occur; action was recommended more often for plagiarism than for data fabrication. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of the Lifestress Inventory for people with a mild intellectual disability

The Subjective Stress Scale (SSS; Bramston & Bostock, 1994) was developed to measure stress in people with a mild intellectual disability. In previous research, the SSS was found to measure two broad dimensions of stress (a) a General Worry factor and (b) a factor that tapped concerns about Negative Interpersonal Relations (Bramston & Fogarty, 1995). The present study sought to continue this line of research by introducing a slightly modified form of the SSS, to be known as the Lifestress Inventory (LI) and examining the psychometric properties of the scale when administered to a new sample of 221 people with mild intellectual disabilities. Confirmatory factor analysis indicated that three underlying factors corresponding to General Worry, Negative Interpersonal Relations, and Coping were sufficient to account for the correlations among the items in the LI. Rasch analysis indicated some improvements to the scoring format for the LI and also showed that the most easily experienced stressors were associated with the Negative Interpersonal Relations dimension. The refinements introduced by the LI and the further demonstration that some of the broad stress dimensions identified in the general population can also be found in people with an intellectual disability represent important milestones for researchers interested in exploring reactions to stress among this population.     

Confirmatory factor analysis of the Job Diagnostic Survey: Good news and bad news.

Conducted confirmatory tests of the factor structure of the Job Diagnostic Survey (JDS), using data obtained from 2,028 National Guard employees. Neither the Hackman-Oldham nor single-factor models provided acceptable fit until construct–irrelevant method variance factors were added. After incorporating method factors, the confirmatory factor analyses supported Hackman and Oldham's a priori structure; however, when a different goodness-of-fit measure was used, a general factor model was more parsimonious. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)