Sharing bad news and having difficult conversations with families are vital skills for NNPs. Yet, these skills are not often formally taught in NP training, leaving many NNPs feeling unprepared for the task.
A randomized controlled trial published in PLOS ONE set out to answer the question, “Can a simulation-based difficult conversations workshop for NNPs improve an NNP’s ability to navigate challenging conversations?”
The study
This study enrolled 13 participants and was held at a Level IV NICU. Five participants participated in the workshop before being evaluated in a difficult conversation test scenario. The seven participants who belonged to the control group participated in the test scenario and evaluation without having completed the workshop.
Ultimately, the workshop was found to significantly improve an NNP’s communication skills and empathy in conducting difficult conversations with a patient’s family. This 2019 study is the first of its kind for NNPs.
The importance of delivering bad news well
This study reflects on why these untaught skills matter. Whether it’s an unexpected diagnosis, complication, prognosis, or loss of life, bad news is never easy, and it’s crucial for the family and the NICU team that it’s delivered well.
Communicating bad news with a patient’s family is especially hard to do in the NICU because it centers on an infant’s birth that was not aligned with parental expectations. However, doing so effectively can bring much-needed comfort to the grieving family and the NICU team. It can also encourage the family and NNP to tend to their self-care, helping them to avoid mental health problems down the road.
What the simulation-based difficult conversations workshop entailed
In this study, the workshop consisted of three parts:
- 30-minute lecture: a class on the basics of healthcare communication, with an emphasis on difficult conversations
- 10-minute simulation teaching scenario per participant: a clinically-relevant, one-on-one practice session with a trained actor, observed by the remaining participants via live video
- 1-2 hr debriefing session: a facilitated debriefing led by a neonatologist who served as director and trainer for the Difficult Conversations for Neonatal Fellows Training Program
Benefits of the workshop
The study found that the workshop significantly improved an NNP’s communication skills and empathy in navigating difficult conversations in a simulated NICU setting. Further research is needed to determine if such an intervention could lead to improved and more cost-effective patient care outcomes.
