- Title
- Language and the built, natural, social, and symbolic environments during bad news conversations for people with a life-limiting illness : a case study methodology
- Creator
- Miller, Elizabeth
- Date
- 2023
- Type
- Text; Thesis; PhD
- Identifier
- http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/198375
- Identifier
- vital:19044
- Abstract
- Background Bad news of a life-limiting illness is devastating to receive and remains a difficult conversation for healthcare professionals to undertake, despite education and training. Bad news conversations occur anywhere along an illness trajectory and often take place with the acute ward that is busy, sterile, and unfamiliar to patients and family members. Method A qualitative case study research methodology was used to explore the case, being the phenomenon of receiving bad news of a life-limiting illness for people living in regional Victoria, Australia. The literature was examined to understand the physical hospital environment and truth disclosure within bad news delivery. Data was collected between November 2021 and August 2022, through 14 semi-structured interviews with patients and family members, 13 semi-structured interviews with registered nurses, a three week observation period at a private regional hospital. The theoretical framework of Therapeutic Landscapes enabled the built, nature, social, and symbolic environments to be examined. Data was analysed using reflexive thematic analysis and qualitative content analysis. Results A review of the literature resulted in the development of the "SSAFER place approach" concept model and found that patients need to feel safe in the hospital environment and that safety is equated with space for family and familiar notions of home. Nurses aimed to provide holistic person-centred through therapeutic relationships with patients and family members and create a home-life environment. It was found that a calm and quiet environment was essential for absorbing bad news, and patients and family members believed the way bad news was delivered, and the language used often needed to be improved. The audit of 17 family meeting s highlighted that death and dying language was rarely documented, and late referrals to palliative care services often occurred. The "Breaking bad news model," created from a second literature review supported the results of the thesis. Due to the COVID-19 pandemic, patients, family members and nurses were negatively affected, creating a non-therapeutic social environment. Conclusion For patients and family members, a therapeutic landscape comprised of therapeutic relationship, open, honest and empathetic language delivered within holistic person-centred care. In addition, care needed to be provided within a calm and quiet environment to allow absorption and processing of bad news. Nurses providing palliative care aimed to meet patients and family needs holistically within an environment aesthetically tuned to be more home-like than clinical.; Doctor of Philosophy
- Publisher
- Federation University Australia
- Rights
- All metadata describing materials held in, or linked to, the repository is freely available under a CC0 licence
- Rights
- Copyright Elizabeth Miller
- Rights
- Open Access
- Subject
- Bad news; Therapeutic landscapes; Home-like; Hospital environment; Life-limiting illness; Case study; Nurses
- Thesis Supervisor
- Porter, Joanne
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE2 | Australian Digital Thesis | 12 MB | Adobe Acrobat PDF | View Details Download |