Comments on: Bearer of Bad News

By: Sean

Sean — Sun, 26 Jul 2009 15:55:52 +0000

I’m guilty of the same cowardice. Unfortunately it’s not our place (the Nurse) to give those results (answers) to the family.
I honestly cannot remember why or where I learned it, but it’s been ingrained in me as a nurse, that resutls.. ANY results are to be given and communicated to the family by the physician and not the nurse.
Maybe I’m using it as a crutch?

I still would have done the same thing.

Tough decision.

By: midwest woman

midwest woman — Fri, 17 Jul 2009 18:29:30 +0000

“what the parents would want from us” struck me. Different people need different things. You have stoic people, emotional people…people process information in their own unique way. That’s why I’m such an advocate of continuity of care so you get to know the people involved and who they are.It’s in these scenarios that the relationship between caregiver and family is so critical. Holisitc medicine gets a bad rap but there something to be said for treating a person and not just the disease.

By: realityrounds

realityrounds — Fri, 17 Jul 2009 15:54:07 +0000

Boston NICU RN
Thanks for your comment. When I think about it, there is a lot that a NICU nurse knows about prognosis etc regarding the babies, that we do not tell the parents. I do not have a crystal ball, but I know, statistically, what the long term outcomes for a 24 weeker is. I do not tell the parents what I know, because I want them to have hope. But maybe, this is the wrong approach. I wonder what the parents would want from us?

By: BostonNICU-RN

BostonNICU-RN — Fri, 17 Jul 2009 15:21:09 +0000

I’ve been a NICU nurse for 15 years. That really is the worst, whent they have such a seemingly great course and then something as devastating as PVL. I’m sorry for you and the family.
I agree that you did the right thing, but it must have felt like a cop-out and a deception to the family. I have been in similar situations and always felt that the mother could see through what I was saying and sense that something was wrong. There have been times I’ve spoken with the parent later after the news had been given by the physician and apologized, but explained to them that I didn’t think over the phone was the right way to do things, and that I wanted them to be able to ask all their questions and get a prognosis in person. We as nurses know a lot, but I personally don’t think that I am the best one to talk about statistics and long-term prognoses. I know what I do well and what my limits are and that is for the good of my patient and his or her family.

By: Joy

Joy — Fri, 17 Jul 2009 03:26:54 +0000

I don’t think it is your job to give the news, ESPECIALLY over the phone! So I think you did the right thing. It’s hard to know what to say in the moment but perhaps something you could say in the future is, “The doctor has the ultrasound results and will most likely talk to you about them when you arrive!” as chipper as you can.

Poor little baby!!!

By: realityrounds

realityrounds — Wed, 15 Jul 2009 21:35:56 +0000

It was a very difficult situation. I certainly did not want to tell the mom over the phone, but I also wondered how I would have wanted to find out if it was my baby. It is such a complicated diagnosis that explaining it over the phone would not have been helpful. I agree there needs to be more humaneness brought back into medicine. It can be very lonely and impersonal. Patients who have a good relationship with their doctors rarely sue, even in cases of malpractice.

By: realityrounds

realityrounds — Wed, 15 Jul 2009 21:30:55 +0000

It REALLY sucks. I always feel like I am lying to the patient.

By: realityrounds

realityrounds — Wed, 15 Jul 2009 21:29:11 +0000

Midwest Woman
Always feel free to link your posts. Knowing something the family does not know is always a horrible feeling.

By: Kathy

Kathy — Wed, 15 Jul 2009 16:59:27 +0000

My husband and I watched “You’ve Got Mail” with Meg Ryan and Tom Hanks the other day. You remember how that Hanks’ character repeatedly says, “It’s not business; it’s personal.” Finally, Ryan’s character questions, “Why do people always say that? It was personal *to me*. It seems that whatever else life is, it ought to start by being *personal*.”

You may have done what is legally and medically and ethically right or accepted… but it still somehow seems like a personal wrong. I don’t know that I would have done any different, though. But in some ways, because you were personally attached to the baby, from months of caring for him, that you may have been in a better position to tell the mother the truth. Because it is not just medical to her — it’s personal. Intensely personal.

When my father was killed in a car wreck ten years ago, there was much “passing the buck” among people to finally tell our family. He was a volunteer firefighter in our small town, so when the first responders looked in his wallet to identify him and found his fireman’s card, they contacted the fire department or the mayor; the person they responded talked to somebody else who they thought was closer; he remembered that my mom would frequently go for walks with another woman in town, so he asked her to go with him and be the one to break the news to my mom. Because bad news is personal, even if it’s a medical nature. It sucks being the bearer of bad news, and I don’t know anyone who willingly steps up to do it. But sometimes, the harder it is, the more right or necessary or beneficial it is to do it. And the better it is for someone closer to give the information.

It may not have been your place to give her the news over the phone; it may have even been a breach of trust or overstepping your bounds, since you weren’t the doctor. It would have been devastating to receive such news over the phone, too. It’s hard to know what to have done. Stammering and evading are probably what I would have done, too. But I don’t know that that would have been the right or best course of action. Because it may be that the mom needed that personal (rather than impersonal, clinical, medical, sterilized) touch to better receive the news.

To me, this points to a bigger problem than just this case, and that is the impersonal nature of “proper” medicine. Sometimes I think it’s one of the things that is so wrong with medical care in this country; as well as one of the things that leads to so many medical lawsuits. Perhaps, if we just started off by *being personal*, a lot of other problems would just resolve themselves.

By: Akiko

Akiko — Wed, 15 Jul 2009 16:51:46 +0000

You did the right thing. I would not want to be told this diagnosis over the phone. I would want face to face, with the ability to ask questions, to be given choices.