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Journal scan Breaking bad news to patients
Effectiveness of therapy after stroke is time dependent Thrombolytic therapy is approved, based on clinical trials, for treatment of patients with acute ischaemic stroke up to 4.5 hours after the onset of the stroke. This large retrospective study examined the records of 84,439 patients in Germany to study the time-dependent effectiveness of thrombolytic therapy in daily clinical practice. Researchers found a clear association between shorter time from onset of treatment and better functional outcome. This includes results for the 36% of the sample aged over 80; although some guidelines would consider this group to be ‘off label’, there was no difference in their response. Those treated after 4.5 hours did show improvement but this was outweighed by increased mortality. Findings support the trial data showing that the chance to achieve better outcomes
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Nurses can find imparting bad news, relating to any information that alters patients’ perceptions of their present or future, difficult for a variety of reasons. They may be concerned about patients’ possible reactions, which can include anger, hysteria, denial, verbal abuse, threatening behaviour, bargaining and silence. Nurses can experience guilt or a sense of failure that they have not managed to ‘fix things’, even when they know this is unrealistic. Nurses may also worry about how to find the right time to break bad news, not knowing what to say or causing harm by destroying hope. Ideally discussions will be planned so that nurses can decide who needs to be present, select the right environment and allow sufficient time. They should check how much patients know and how much they want to know, use clear language, break information into chunks and repeat important information. In practice, patients and their relatives may ask for information at times that are unpredictable and awkward, leaving no time for nurses to prepare. If nurses think they do not have the knowledge, expertise or time to respond, it is essential that they acknowledge the importance of concerns and say that they will be addressed, although not at that
moment. Breaking bad news is a process rather than a one-off event. Maintaining hope is important to coping, but it is possible to shift to new hopes and goals; perhaps from hoping for a cure to hoping to go home from hospital. Warnock C (2014) Breaking bad news: issues relating to nursing practice. Nursing Standard. 28, 45, 51-58.
Staff should view breaking bad news as a process rather than a one-off event, and plan discussions carefully
NURSING OLDER PEOPLE
with treatment is time dependent and declines through the first 4.5 hours after stroke onset. The authors say their research upholds the usefulness of initiatives to raise public awareness of stroke symptoms and the need to shorten the time between the onset of the stroke and the start of treatment. Gumbinger C, Reuter B, Stock C et al (2014) Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials. BMJ 2014; 348:g3429.
Novel treatment for post-herpetic neuralgia Neuropathic pain, including post-herpetic neuralgia after shingles, is not well controlled by existing treatments. EMA401 is an angiotensin II type 2 receptor antagonist developed in the search for antihypertensive drugs. The renin-angiotensin system has roles outside the cardiovascular system, including in the central and peripheral nervous systems. This double-blind, randomised controlled trial included 183 patients across six countries who had experienced post-herpetic neuralgia for at least six months. The patients given EMA401 100mg twice a day for 28 days reported significantly less pain than those given the placebo. Further studies with longer periods and higher doses are needed. Rice A, Dworkin R, McCarthy T et al (2014) EMA401, an orally administered highly selective angiotensin II type 2 receptor antagonist, as a novel treatment for postherpetic neuralgia: a randomised, double-blind, placebo-controlled phase 2 clinical trial. The Lancet. 383, 9929, 1637-1647. Journal scan is compiled by Ruth Sander, independent consultant, care of the older person September 2014 | Volume 26 | Number 7 13
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Journal scan Breaking bad news to patients
Effectiveness of therapy after stroke is time dependent Thrombolytic therapy is approved, based on clinical trials, for treatment of patients with acute ischaemic stroke up to 4.5 hours after the onset of the stroke. This large retrospective study examined the records of 84,439 patients in Germany to study the time-dependent effectiveness of thrombolytic therapy in daily clinical practice. Researchers found a clear association between shorter time from onset of treatment and better functional outcome. This includes results for the 36% of the sample aged over 80; although some guidelines would consider this group to be ‘off label’, there was no difference in their response. Those treated after 4.5 hours did show improvement but this was outweighed by increased mortality. Findings support the trial data showing that the chance to achieve better outcomes
iStock
Nurses can find imparting bad news, relating to any information that alters patients’ perceptions of their present or future, difficult for a variety of reasons. They may be concerned about patients’ possible reactions, which can include anger, hysteria, denial, verbal abuse, threatening behaviour, bargaining and silence. Nurses can experience guilt or a sense of failure that they have not managed to ‘fix things’, even when they know this is unrealistic. Nurses may also worry about how to find the right time to break bad news, not knowing what to say or causing harm by destroying hope. Ideally discussions will be planned so that nurses can decide who needs to be present, select the right environment and allow sufficient time. They should check how much patients know and how much they want to know, use clear language, break information into chunks and repeat important information. In practice, patients and their relatives may ask for information at times that are unpredictable and awkward, leaving no time for nurses to prepare. If nurses think they do not have the knowledge, expertise or time to respond, it is essential that they acknowledge the importance of concerns and say that they will be addressed, although not at that
moment. Breaking bad news is a process rather than a one-off event. Maintaining hope is important to coping, but it is possible to shift to new hopes and goals; perhaps from hoping for a cure to hoping to go home from hospital. Warnock C (2014) Breaking bad news: issues relating to nursing practice. Nursing Standard. 28, 45, 51-58.
Staff should view breaking bad news as a process rather than a one-off event, and plan discussions carefully
NURSING OLDER PEOPLE
with treatment is time dependent and declines through the first 4.5 hours after stroke onset. The authors say their research upholds the usefulness of initiatives to raise public awareness of stroke symptoms and the need to shorten the time between the onset of the stroke and the start of treatment. Gumbinger C, Reuter B, Stock C et al (2014) Time to treatment with recombinant tissue plasminogen activator and outcome of stroke in clinical practice: retrospective analysis of hospital quality assurance data with comparison with results from randomised clinical trials. BMJ 2014; 348:g3429.
Novel treatment for post-herpetic neuralgia Neuropathic pain, including post-herpetic neuralgia after shingles, is not well controlled by existing treatments. EMA401 is an angiotensin II type 2 receptor antagonist developed in the search for antihypertensive drugs. The renin-angiotensin system has roles outside the cardiovascular system, including in the central and peripheral nervous systems. This double-blind, randomised controlled trial included 183 patients across six countries who had experienced post-herpetic neuralgia for at least six months. The patients given EMA401 100mg twice a day for 28 days reported significantly less pain than those given the placebo. Further studies with longer periods and higher doses are needed. Rice A, Dworkin R, McCarthy T et al (2014) EMA401, an orally administered highly selective angiotensin II type 2 receptor antagonist, as a novel treatment for postherpetic neuralgia: a randomised, double-blind, placebo-controlled phase 2 clinical trial. The Lancet. 383, 9929, 1637-1647. Journal scan is compiled by Ruth Sander, independent consultant, care of the older person September 2014 | Volume 26 | Number 7 13
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 18, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
