Iranian Journal of Medical Ethics and History of Medicine

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Breaking bad news emotionally affects both health professionals and patients. Breaking bad news is a sensitive issue for both health care providers and patients. It is generally believed that the patient’s adjustment can be affected by either a positive or a negative experience in this respect. This study aims to determine health care providers’ attitudes toward breaking bad news to parents in NICU and labor wards.This cross-sectional study was conducted in Shahrecord in 2011 with a study sample of 70 health care providers drawn from neonatal intensive care units and labor wards and the department of nursing and midwifery who had had at least one year’s clinical experience. The sampling method was census. Data were collected through a self-administered questionnaire in two sections: demographic information and health care providers’ attitudes toward breaking bad news. Data were analyzed by SPSS software with descriptive and Chi-square and T-student test statistics. Most participants (63.2%) had a positive attitude toward disclosing bad news to parents. 77.6% of caregivers faced difficulties in delivering bad news to parents, 92.6% of them believed that training workshops in this field are necessary. There was a significant statistical relationship between the attitudes of the health care providers and their education level and work place (P < 0.0001). Health professionals with higher education levels and nursing and midwifery staff had more positive attitudes.There was no significant statistical relationship between the attitudes of the health care providers and their history of difficulties in transferring bad news, workshop trainings, work experience, gender, age and marital status (P > 0.05). The majority of health professionals had a negative attitude toward immediate disclosure of bad news to parents, mothers holding and seeing their deceased babies, dedicating a special room to perinatal loss mothers with similar problems, and preventing other patients and their families from contacting them.Based on the findings of this study, teaching bad news communication skills to personnel of NICU and labor wards should receive prioritization in future continuing medical education programs in order to best prepare the staff for disclosure of bad news to parents.

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Nurses nowadays are faced with complex moral problems, which put them in conditions where their proper performance may conflict with the values and beliefs of other health care providers. In such situations, maintaining commitment to patients requires considerable moral courage, and moral sensitivity can play a significant role in the development of moral courage. The present study was performed to investigate the correlation between moral courage and moral sensitivity of the nurses working in selected hospitals of Tabriz University of Medical Sciences.In this study, 260 nurses were selected by randomized sampling. Data were collected through a demographic questionnaire, the Moral Sensitivity Questionnaire by Han et al., and the Professional Moral Courage Scale by Sekerka et al. Content validity and face validity of the moral sensitivity questionnaire and moral courage scale were qualitatively investigated, and Cronbach's alpha was used for assessing their reliability. Data were analyzed by descriptive and analytic statistical tests using SPSS 21.The results indicated that the average score of nurses’ moral courage was 90.36 ± 10.56, and the highest moral courage pertained to the dimension of moral agent. The average score of the nurses’ moral sensitivity was 60.99 ± 17.78, and the highest moral sensitivity was observed in the dimension of respect for the patient. The statistical analysis indicated a positive correlation between moral courage and moral sensitivity (P < 0.05, r = 0.15). The subjects’ moral courage differed according to their age, work experience and employment type, but not according to their gender, marital status, education level and work shift. The results of the present study indicate that there is a positive and significant statistical correlation between moral courage and moral sensitivity. It seems that promoting nurses’ awareness of moral principles and increasing their moral sensitivity lead to the development of courageous moral behaviors in nurses.