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      Breaking Bad News: A contextual model for Pakistan

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          Abstract

          Objectives:

          The purpose of the study was to identify the sequence of violence that ensues after breaking bad news and develop a contextual model of breaking bad news and develop a model contextual for Pakistan.

          Methods:

          A qualitative exploratory study was conducted using Six FGDs and 14 IDIs with healthcare providers working in the emergency and the obstetrics and gynecology departments of tertiary care hospitals of Karachi, Pakistan. Data was transcribed and analyzed to identify emerging themes and subthemes using thematic content analysis.

          Results:

          Impatience or lack of tolerance, lack of respect towards healthcare providers, unrealistic expectations from healthcare facility or healthcare staff were identified as main reasons that provoked violence after breaking bad news. A conceptual five step model was developed to guide communication of bad news by the health care providers. On initial testing the model was found to be effective in de-escalation of violence.

          Conclusion:

          Communication of bad news requires application of specific approaches to deal with contextual challenges for reducing violence against healthcare.

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          Most cited references20

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          Causes and management of patient aggression and violence: staff and patient perspectives.

          Richard Whittington, J Duxbury (2005)
          This paper reports a study of staff and patient perspectives on the causes of patient aggression and the way it is managed. The incidence of aggression in healthcare is reportedly on the increase, and concerns about the management of this problem are growing. A convenience sample of 80 patients and 82 nurses from three inpatient mental healthcare wards were surveyed using The Management of Aggression and Violence Attitude Scale. A further five patients and five nurses from the same sample participated in a number of follow-up interviews. Patients perceived environmental conditions and poor communication to be a significant precursor of aggressive behaviour. Nurses, in comparison, viewed the patients' mental illnesses to be the main reason for aggression, although the negative impact of the inpatient environment was recognized. From interview responses, it was evident that both sets of respondents were dissatisfied with a restrictive and under-resourced provision that leads to interpersonal tensions. There are differences between the views of staff and patients about reasons for aggression and its management. Future approaches therefore need to be developed that address these opposing views. For example, training in the use of fundamental therapeutic communication skills was advocated by patients, whilst the need for greater attention to organizational deficits was advocated by nurses. A move away from reliance on the use of medication was also felt to be necessary. Evaluation of local needs and practices must be an integral part of this process.
          Article 0 comments Cited 72 times – based on 0 reviews     Review now
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            Health care personnel and workplace violence in the emergency departments of a volatile metropolis: results from Karachi, Pakistan.

            J Razzak, Asad U Khan, Seemin Jamali … (2013)
            Workplace violence (WPV) is an important challenge faced by health care personnel in the emergency department (ED). To determine the prevalence and nature of WPV reported by physicians and nurses working in the EDs of four of the largest tertiary care hospitals in Karachi, Pakistan and to understand the mental health impact of experiencing WPV. This cross-sectional survey was conducted between September and November 2008 using a widely used questionnaire developed by the World Health Organization. Overall, 266 (86% response rate) questionnaires were included in this study. A total of 44 (16.5%) physicians and nurses said they had been physically attacked, and 193 (72.5%) said that they had experienced verbal abuse in the last 12 months. Among those who reported physical attack, 29.6% reported that the last incident involved a weapon, and in 64% of cases the attacker was a patient's relative. Eighty-six percent thought that the last attack could have been prevented, and 64% said that no action was taken against the attacker. After adjusting for covariates, physicians were less likely than nurses to report physical attack (odds ratio [OR] 0.46; 95% confidence interval [CI] 0.2-1.0), and personnel with greater work experience (OR 4.8; 95% CI 2.0-11.7) and those who said that there were procedures to report WPV in their workplace (OR 3.2; 95% CI 1.6-6.5) were more likely to report verbal abuse. WPV was associated with mental health effects in the form of bothersome memories, super-alertness, and feelings of avoidance and futility. WPV is an important challenge in the EDs of large hospitals in Karachi. A majority of respondents feel that WPV is preventable, but only a minority of attackers face consequences. Copyright © 2013 Elsevier Inc. All rights reserved.
            Article 0 comments Cited 50 times – based on 0 reviews     Review now
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              Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey.

              Sabine Hahn, Virpi Hantikainen, Ian Needham … (2012)
              AIM.: This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs' interventions and the consequences of violence for different professions are investigated.
              Article 0 comments Cited 42 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pak J Med Sci
                Journal ID (iso-abbrev): Pak J Med Sci
                Title: Pakistan Journal of Medical Sciences
                Publisher: Professional Medical Publications (Pakistan )
                ISSN (Print): 1682-024X
                ISSN (Electronic): 1681-715X
                Publication date (Print): Nov-Dec 2018
                Volume: 34
                Issue: 6
                Pages: 1336-1340
                Affiliations
                [1 ] Prof. Dr. Lubna Baig, MBBS, MPH, MMEd FCPS, PhD, APPNA Institute of Public Health, Jinnah Sind Medical University, Karachi, Pakistan
                [2 ] Dr. Sana Tanzil, MBBS, FCPS, APPNA Institute of Public Health, Jinnah Sind Medical University, Karachi, Pakistan
                [3 ] Dr. Syeda Kauser Ali MBBS, MHPE, PhD, Aga Khan University, Karachi, Pakistan
                [4 ] Dr. Shiraz Shaikh, MBBS, FCPS, APPNA Institute of Public Health, Jinnah Sind Medical University, Karachi, Pakistan
                [5 ] Dr. Seemin Jamali, MBBS, MPH, Jinnah Post Graduate Medical Centre, Karachi Pakistan
                [6 ] Dr. Mirwais Khan, MBBS, MPH, International Committee of Red Cross, Islamabad, Pakistan
                Author notes
                Correspondence: Prof. Lubna Baig, Pro-Vice Chancellor, Dean APPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan. E-mail: lubna.baig@ 123456jsmu.edu.pk
                Article
                Publisher ID: PJMS-34-1336
                DOI: 10.12669/pjms.346.15663
                PMC ID: 6290194
                PubMed ID: 30559781
                SO-VID: 869c9d22-91b0-45d4-9413-aaa43a961705
                Copyright © Copyright: © Pakistan Journal of Medical Sciences
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 May 2018
                Date revision received : 30 May 2018
                Date accepted : 20 September 2018
                Categories
                Subject: Original Article

                Keywords: breaking bad news,communication,health care providers,violence
                Data availability:
                Keywords: breaking bad news, communication, health care providers, violence

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