Abstract

Emergency department (ED) staff is responsible for giving bad news regarding death, diagnoses, and other traumatic losses to patients and loved ones. Individuals receiving traumatic and sudden bad news are at increased risk of serious psychological and physiological consequences of disrupted grief. Despite published recommended practices for providers to help prevent maladaptive grief responses, little research is available on actual bad news delivery practices and factors promoting or hindering adherence to recommendations, and no study specifically explored the ED context.

The study used a qualitative design to explore bad news delivery practices, awareness of recommendations, factors perceived to hinder or promote recommended practices, and differences between ED staff and hospital settings. Qualitative data was collected via 42 key informant interviews to saturation at 3 EDs in Southern California served by CEP America, 3 in Central Florida, and a Veteran's Health Administration setting in Florida. Participants were invited to participate based on theoretical sampling of the following relevant perspectives; physicians, nurses, and others involved in bad news delivery. Data was coded and analyzed for emergent themes, and results were compared between hospital types.

Participants reported a lack of structured/formal guidance and protocols and diverse perceptions regarding roles and responsibilities associated with delivering difficult news. Key themes included whether addressing emotional needs of those receiving bad news is part of the medical team's professional responsibility; whether comfort efforts should aim to console or facilitate grief reactions, how personal factors influence adherence to recommended approaches; and benefits of using a team-oriented approach. Results suggest development of a protocol and use of unified team approach in which each member understands his or her responsibilities, values and understands the roles and strengths of other members, and retains appropriate flexibility could maximize effective use of staff members' expertise and strengths in unique and often unpredictable situations. This kind of team approach could also help provide the best care possible for patients and loves ones involved.

School

School of Public Health

First Advisor

Susanne Montgomery

Second Advisor

Brenda Rea

Third Advisor

Jason Owen

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2010

Date (Title Page)

6-2010

Language

English

Library of Congress/MESH Subject Headings

Emergency Medicine; Attitude of Health Personnel; Crisis Intervention; Communication Barriers; Physician-Patient Relations. Truth Disclosure. Bereavement. Self-Help Groups -- organization & administration.

Type

Dissertation

Page Count

xii; 148

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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