Volume 11, Issue 2 (1-2026)
SJNMP 2026, 11(2): 129-139 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
lotfi E, Nouri B, Fathi M. Nurses’ Skills in Breaking Bad News and Related Factors: A Cross-Sectional Study. SJNMP 2026; 11 (2) :129-139
URL: http://sjnmp.muk.ac.ir/article-1-709-en.html
URL: http://sjnmp.muk.ac.ir/article-1-709-en.html
1- Clinical Research Center, Health Development Research Institute, Kurdistan University of Medical Sciences, Sanandaj, Iran , asrinlotfi25@gmail.com
2- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
3- School of Medicine, Islamic Azad University, Sanandaj Branch, Sanandaj, Iran
2- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
3- School of Medicine, Islamic Azad University, Sanandaj Branch, Sanandaj, Iran
Abstract: (245 Views)
Background and Aim: Delivering bad news is a challenging healthcare task, particularly for nurses who are primary points of contact for patients and families. Despite its importance, structured training and standardized guidelines for nurses remain limited. This study assessed nurses’ skills in delivering bad news and related factors in teaching hospitals affiliated with Kurdistan University of Medical Sciences, Sanandaj, Iran.
Materials and Methods: This cross-sectional study was conducted in 2022. A total of 150 nurses with at least one year of experience and a bachelor’s degree or higher were selected using multistage sampling, including stratified and convenience sampling. Data were collected using a four-part questionnaire addressing demographic characteristics, types of bad news, involvement in delivery, and delivery skills. Validity was confirmed by experts, and reliability was supported by a Cronbach’s alpha of 0.71. Data were analyzed using STATA (version 12), Spearman’s correlation, Mann–Whitney U, and Kruskal–Wallis tests (P<0.05).
Results: The most common bad news was announcing a resuscitation code (76.67%). The mean participation score was 17.68±5.85, and the mean delivery-skill score was 54.30±5.10. Delivery skills were significantly associated with work shift (P=0.026), familiarity with bad-news disclosure guidelines (P=0.040), clinical department (P=0.009), number of bad-news events delivered (P=0.012), and type of bad news (P=0.014). The association with organizational position approached statistical significance (P=0.055).
Conclusion: Nurses demonstrated moderate skills in delivering bad news. Structured educational programs and communication workshops are recommended to improve competence and the quality of patient and family care.
Materials and Methods: This cross-sectional study was conducted in 2022. A total of 150 nurses with at least one year of experience and a bachelor’s degree or higher were selected using multistage sampling, including stratified and convenience sampling. Data were collected using a four-part questionnaire addressing demographic characteristics, types of bad news, involvement in delivery, and delivery skills. Validity was confirmed by experts, and reliability was supported by a Cronbach’s alpha of 0.71. Data were analyzed using STATA (version 12), Spearman’s correlation, Mann–Whitney U, and Kruskal–Wallis tests (P<0.05).
Results: The most common bad news was announcing a resuscitation code (76.67%). The mean participation score was 17.68±5.85, and the mean delivery-skill score was 54.30±5.10. Delivery skills were significantly associated with work shift (P=0.026), familiarity with bad-news disclosure guidelines (P=0.040), clinical department (P=0.009), number of bad-news events delivered (P=0.012), and type of bad news (P=0.014). The association with organizational position approached statistical significance (P=0.055).
Conclusion: Nurses demonstrated moderate skills in delivering bad news. Structured educational programs and communication workshops are recommended to improve competence and the quality of patient and family care.
Type of Study: Research |
Subject:
Special
Received: 2026/08/31 | Revised: 2026/09/22 | Accepted: 2026/09/1 | Published: 2026/01/10 | ePublished: 2026/01/10
Received: 2026/08/31 | Revised: 2026/09/22 | Accepted: 2026/09/1 | Published: 2026/01/10 | ePublished: 2026/01/10
References
1. Galehdar N, Kamran A, Toulabi T, Heydari H. Exploring nurses' experiences of psychological distress during care of patients with COVID-19: a qualitative study. BMC Psychiatry. 2020;20(1):489. [DOI: 10.1186/s12888-020-02898-1]
2. Darrason M, Souquet PJ, Couraud S. Standardized vs peer-played patients for learning how to break bad news in lung cancer: a prospective crossover study. Respir Med Res. 2021;80:100856. [DOI: 10.1016/j.resmer.2021.100856]
3. Buckman R. Breaking bad news: the SPIKES strategy. Community Oncol. 2005;2(2):138-42. [Link]
4. Ptacek JT, Eberhardt TL. Breaking bad news: a review of the literature. JAMA. 1996;276(6):496-502. [Link]
5. Jouybari L. Disclosing bad news to the patient and family: laryngeal carcinoma and laryngectomy: an ethical case report. Educ Ethics Nurs. 2017;6(1):32-6. [Link]
6. Abel J, Dennison S, Senior-Smith G, Dolley T, Lovett J, Cassidy S. Breaking bad news-development of a hospital-based training workshop. Lancet Oncol. 2001;2(6):380-4. [DOI: 10.1016/s1470-2045(00)00393-4]
7. Khaki S, Fallahi-Khoshknab M, Hosseini M, Mohammadi-Shahboulaghi F, Can G. The role of nurses in delivering bad news to the patient and family: an integrated review study. Int J Cancer Manag. 2024;17(1):e145579. [Link]
8. National Academies of Sciences, Engineering, and Medicine. The future of nursing 2020-2030: charting a path to achieve health equity. Washington (DC): National Academies Press (US); 2021. [DOI: 10.17226/25982]
9. Baer L, Weinstein E. Improving oncology nurses' communication skills for difficult conversations. Clin J Oncol Nurs. 2013;17(3):E45-E51. [DOI: 10.1188/13.CJON.E45-E51]
10. Rassin M, Levy O, Schwartz T, Silner D. Caregivers' role in breaking bad news: patients, doctors, and nurses' points of view. Cancer Nurs. 2006;29(4):302-8. [DOI: 10.1097/00002820-200607000-00009]
11. Hashemi F, Mazlom SR, Vaghee S, Bagheri-Moghaddam A. Effect of using SPIKES protocol for delivering death news to patient family members on their anxiety symptoms. Evidence-Based Care. 2020;10(2):74-9. [Link]
12. Polivka L, Delcour C, Dufresne H, Bartoli S, Bataille P, Bekel L, et al. Breaking bad news: an active learning method for medical students. BMC Med Educ. 2024;24(1):994. [DOI: 10.1186/s12909-024-05821-4]
13. Karim Z, Imanipour M, Bahrani N. Bad news in critical care and emergency units and nurses' participation in the process of breaking bad news in affiliated hospitals of Tehran University of Medical Sciences. Nurs Midwifery J. 2015;13(5):377-85. [Link]
14. Wright JA. Prenatal and postnatal diagnosis of infant disability: breaking the news to mothers. J Perinat Educ. 2008;17(3):27-32. [DOI: 10.1624/105812408x324543]
15. Baghdari N, Torkmannejad Sabzevari M, Karimi Moonaghi H, Rad M, Amiri M. The effect of educational approaches on knowledge and attitude of midwifery students in breaking bad news to patients. J Med Educ Dev. 2017;9(22):12-20. [Link]
16. Hajiazizi AH, Bahmani B, Mahdi N, Manzari Tavakoli V, Barshan A. Effectiveness of group logotherapy on death anxiety and life expectancy of the elderly living in boarding houses in Kerman. Salmand. 2017;12(2):220-31. [Link]
17. Mirmolaei T, Shakari M. The role of midwives in maternal safety and reproductive health. Hayat. 2001;7(1):60-8. [Link]
18. Shomoossi N, Rad M, Kooshan M, Ganjloo J. Nurses as death notifiers: a report from nurses in Iran. Life Sci J. 2013;10(4s):26-31. [Link]
19. Stewart AE, Lord JH, Mercer DL. A survey of professionals' training and experiences in delivering death notifications. Death Stud. 2000;24(7):611-31. [DOI: 10.1080/07481180050132811]
20. Nordström A, Fjellman-Wiklund A, Grysell T. The effect of a role-playing exercise on clerkship students' views of death notification: the Swedish experience. Int J Med Educ. 2011;2:24-9. [Link]
21. Ravanipour M, Gholami S, Jahanpour F, Hashemi M, Hoseini S. Assessment of nurses' knowledge about how to convey bad news to patients and their companions. Med Ethics J. 2014;8(29):171-91. [Link]
22. Imanipour M, Karim Z, Bahrani N. Role, perspective and knowledge of Iranian critical care nurses about breaking bad news. Aust Crit Care. 2016;29(2):77-82. [DOI: 10.1016/j.aucc.2015.07.003]
23. González-Cabrera M, Ortega-Martínez AR, Martínez-Galiano JM, Hernández-Martínez A, Parra-Anguita L, Frías-Osuna A. Design and validation of a questionnaire on communicating bad news in nursing: a pilot study. Int J Environ Res Public Health. 2020;17(2):457. [DOI: 10.3390/ijerph17020457]
24. Sobczak K, Leoniuk K, Janaszczyk A. Delivering bad news: patient's perspective and opinions. Patient Prefer Adherence. 2018;12:2397-404. [DOI: 10.2147/ppa.s183106]
25. Annadurai K, Muthukumar T. Practices, perceptions, and challenges of postgraduate medical students on breaking bad news: a mixed-methods study. J Mar Med Soc. 2025;27(3):283-90. [Link]
26. Rosenzweig MQ. Breaking bad news: a guide for effective and empathetic communication. Nurse Pract. 2012;37(2):1-4. [DOI: 10.1097/01.npr.0000408626.24599.9e]
27. Burgener AM. Enhancing communication to improve patient safety and to increase patient satisfaction. Health Care Manag (Frederick). 2020;39(3):128-32. [DOI: 10.1097/hcm.0000000000000298]
28. Guerdoux E, Trouillet R, de Forges H, Valy L, Jouvet F, Chauvet C, et al. 'Bad news consultations' with oncology nurses: impact on perceived stress and patient experience. Eur J Oncol Nurs. 2022;56:102085. [DOI: 10.1016/j.ejon.2021.102085]
29. Managheb SE, Mohammadi M. Knowledge and attitudes of clinical teachers, family physicians, and medical interns towards giving bad news, a study in Jahrom University of Medical Sciences. Iran J Med Educ. 2011;11(5):436-43. [Link]
30. Ghafari Nezhad AR, Salari P, Mirzazadeh A. Study on breaking bad news to patients among physicians of Kerman University of Medical Sciences. Med J Hormozgan Univ. 2006;10(2):179-84. [Link]
31. Vogliotti E, Pintore G, Zoccarato F, Biasin M, Sergi G, Inelmen EM, et al. Communicating bad news to older patients from the physician's point of view: focus on the influence of gender and length of work experience. Gerontology. 2022;68(8):903-9. [DOI: 10.1159/000519710]
32. Gielen A, Koekkoek K, van der Steen M, Looijen M, van Zanten AR. Evaluation of the initial general ward early warning score and ICU admission, hospital length of stay and mortality. West J Emerg Med. 2021;22(5):1131-8. [DOI: 10.5811/westjem.2021.6.50657]
33. Basheikh M. Preferences of the Saudi population in breaking bad medical news: a regional study. Cureus. 2021;13(11):e19525. [DOI: 0.7759/cureus.19525]
34. Hauk H, Bernhard J, McConnell M, Wohlfarth B. Breaking bad news to cancer patients in times of COVID-19. Support Care Cancer. 2021;29(8):4195-8. [DOI: 10.1007/s00520-021-06167-z]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
