College of Health and Wellbeing, University of Central Lancashire, Preston, UK.
Therapies Department, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK.
Disabil Rehabil. 2020 Nov;42(22):3209-3214. doi: 10.1080/09638288.2019.1589586. Epub 2019 Apr 21.
Neurorehabilitation units play an important role in facilitating recovery for those with complex needs following a neurological event. National guidance highlights the importance of providing patients and their families with information and fostering realistic expectations. This may involve the breaking of bad news. The aim of this study is to explore health professionals' perspectives on breaking bad news in the neurorehabilitation setting. 15 health professionals (physiotherapists, occupational therapists, nurses, speech therapists, psychologists and doctors) working at a 24 bedded neurorehabilitation unit in a National Health Service acute trust in England were recruited. A qualitative study was conducted using patient vignettes to facilitate discussions during semi-structured interviews and a focus group. The results were analyzed using thematic analysis. Four major themes emerged: influencing factors, current approaches used, staff experiences, and strategies to improve breaking bad news. There was a need for better management of patients' and families' expectations. Breaking bad news was seen as emotionally demanding yet often unrecognized work. Breaking bad news in the neurorehabilitation setting is complex and under-recognized work, involving multiple health professionals. There is a need for both experience and training to improve skills and confidence in breaking bad news.Implications for RehabilitationExisting tools to support breaking bad news provide a structured step by step approach which may be helpful, but it is recognised there is also a need for experience, reflection, flexibility, and individualisation of the process.Discussing information about rehabilitation potential may be stressful for health professionals themselves and adversely affect their own well-being.Both novice and experienced staff require opportunities for reflective practice and training to develop the skills they need to discuss rehabilitation potential.
神经康复单元在促进神经事件后复杂需求患者的康复方面发挥着重要作用。国家指南强调了向患者及其家属提供信息和培养现实期望的重要性。这可能涉及打破坏消息。本研究旨在探讨卫生专业人员在神经康复环境中打破坏消息的观点。在英格兰一家国家卫生服务急性信托基金的一个 24 张床位的神经康复病房工作的 15 名卫生专业人员（物理治疗师、职业治疗师、护士、言语治疗师、心理学家和医生）被招募。使用患者小插图进行了一项定性研究，以促进半结构化访谈和焦点小组的讨论。使用主题分析对结果进行了分析。出现了四个主要主题：影响因素、当前使用的方法、员工经验和改善坏消息传递的策略。需要更好地管理患者和家属的期望。打破坏消息被视为情感要求很高但经常未被认识到的工作。在神经康复环境中打破坏消息是一项复杂且未被充分认识的工作，涉及多个卫生专业人员。需要经验和培训来提高打破坏消息的技能和信心。对康复的启示现有的支持打破坏消息的工具提供了一种结构化的逐步方法，这可能是有帮助的，但也认识到需要经验、反思、灵活性和个性化的过程。讨论康复潜力的信息可能对卫生专业人员本身造成压力，并对他们的幸福感产生不利影响。新手和经验丰富的员工都需要机会进行反思实践和培训，以发展他们讨论康复潜力所需的技能。
