Natuhwera Germanus, Ellis Peter, Namisango Eve
Clinical & Administration Departments, Hospice Africa Uganda, Kampala, Uganda.
Education Department, Institute of Hospice and Palliative Care in Africa, Kampala, Uganda.
Adv Med Educ Pract. 2025 May 7;16:773-787. doi: 10.2147/AMEP.S518988. eCollection 2025.
Handling challenging conversations remains a major challenge for both undergraduate and qualified nurses and medical doctors. However, challenging conversations are inevitable in daily patient-clinician encounters in clinical and care settings.
To explore nursing and medical students' experiences in handling challenging conversations with patients and their families.
The study was conducted among final-year undergraduate nursing and medical students selected from seven nursing and medical training schools and universities in Southwest, Midwest and Central Uganda.
This was an exploratory qualitative study. Purposive and convenience sampling were used to select training schools/universities and participants respectively. Data were collected between November 2022 and February 2023 through 10 face-to-face audio-recorded focus group interviews and were analyzed using inductive thematic analysis.
82 nursing and medical students participated in the study. The analysis yielded four major themes: (1) Students' understanding of bad news, (2) Emotional labor of handling challenging conversations, (3) Handling challenging conversations a theory but not a practice experience, (4) Sociocultural and medico-cultural dilemmas.
The study revealed that participants possessed limited theoretical knowledge, preparedness, and a significant unwillingness to engage in challenging conversations, particularly when communicating bad news or handling conversations related to death and dying. These issues are closely linked to inadequate training and particularly limited or deficient clinical exposure. Simulation-based learning and exposure to challenging conversations are required in clinical settings.
对于本科护理学生以及注册护士和医生而言，处理具有挑战性的对话仍然是一项重大挑战。然而，在临床和护理环境中，日常医患交流中不可避免地会出现具有挑战性的对话。
探讨护理和医学专业学生在与患者及其家属进行具有挑战性的对话时的经历。
该研究在乌干达西南部、中西部和中部地区七所护理和医学培训学校及大学中选取的本科护理和医学专业最后一年的学生中进行。
这是一项探索性定性研究。分别采用目的抽样和便利抽样来选择培训学校/大学和参与者。2022年11月至2023年2月期间，通过10次面对面录音焦点小组访谈收集数据，并采用归纳主题分析法进行分析。
82名护理和医学专业学生参与了该研究。分析得出四个主要主题：（1）学生对坏消息的理解；（2）处理具有挑战性对话的情感劳动；（3）处理具有挑战性的对话是理论而非实践经验；（4）社会文化和医学文化困境。
该研究表明，参与者的理论知识、准备程度有限，且明显不愿参与具有挑战性的对话，尤其是在传达坏消息或处理与死亡相关的对话时。这些问题与培训不足密切相关，特别是临床接触有限或不足。临床环境中需要基于模拟的学习以及接触具有挑战性的对话。
