Safewards intervention refresher: Bad news mitigation

Background
•	Some people leave the unit impulsively and in anger following unwelcome news 
•	Bad news from home can also cause conflict.
•	Bad news can include death in the family, termination of a relationship with intimate partner, loss of tenancy, burglary, illness in the family, childcare issues
•	The resulting stress and distress can then be acted out on the unit in increased irritability, aggression, violent incidents and absconding 
Aims
•	Help us notice flashpoints rapidly and act fast to provide psychological and social support, before distress turns into conflict
•	Cut connection between a flashpoint and conflict
•	Recognise the possible impacts of bad news
•	Increase people’s sense of being known as human beings
•	Increase people’s feelings of being supported by others and not being alone with their problems
Task: Bad news scenarios
•	What have you found helpful when working with people who have received bad news?
•	What has not been helpful?
 Bad news mitigation in practice
•	Be aware of occasions and events that might trigger angry or upset reactions
•	At handover, discuss as a team and share knowledge to predict who might receive unwelcome news and how support will be offered
•	Work with the multidisciplinary team (MDT) to express bad news empathically or intercept after it has happened
•	Maintain awareness of what is going on through regular one-on-one contact with the patient
•	Know everyone’s general demeanor 

Bad news mitigation in practice 
•	Be aware of signs of distress/upset/unhappiness - ask if anything is the matter, particularly after phone calls or visits

•	Find a quiet place, give the person time to express their feelings

•	Acknowledge their frustration, express sympathy and empathy

•	Make a friendly gesture, offer a cup of tea or snack

•	Answer any questions honestly, giving time, attention and respect

•	Show you are receptive to concerns - use listening techniques (make eye contact, ask about concerns, use open ended questions, such as ‘Tell me more…’) 
	
Bad news mitigation in practice 
•	Find out how much people understand about care decisions and correct any misconceptions 
•	Frame treatment in positive way
•	Some people may not be able to absorb all information – follow up to assess emotional state and understanding 
•	Shock and anger accompanying bad news can create confusion and hinder understanding. This may be compounded by illness or medication
•	Help the person understand decisions, acknowledge feelings. This can improve relationships and make aggression, self-harm and absconding less likely 
•	Be responsive and respectful of a person’s views

Task: Applying the bad news mitigation intervention 
Jayne is a patient on your unit. She has just received bad news from home, how will you care for her in this situation?
Task: Examples of bad news we might have to deliver
•	No leave this weekend
•	Discharge may be later than first thought
•	There is no smoking on the unit
•	Family are not able to visit today

Bad news mitigation revisit
Reflect on a past example when bad news had to be delivered
 and it did not go as well as it could have:

What could have been done differently?
What could be put into place to assist?
What other suggestions do you have?
Processes for bad news mitigation
•	What processes do we have in place to support bad news mitigation?
•	How does potential bad news get handed over? 
•	Do we have some way of alerting others?
•	How do we deliver the news using bad news mitigation?

Task: Practising bad news mitigation
Each group picks a card and role plays how you would deliver the news on the cue card using the bad news mitigation intervention.
Bad news mitigation – long-term implementation
•	Periodically remind staff to maintain awareness and scan the horizon for bad news
•	Extend the intervention to make patients’ family and friends aware of the issue and share responsibility for managing any 'bad news' that might arise 
•	Place signs and leaflets on the ward about the issue
Bad news mitigation fidelity
•	A way of protecting patients from life or threatening them with consequences or assuming how they will feel
•	Attaching the phrase ‘I am sorry to let you know’ when we tell patients they cannot have something they desperately want

Bad news mitigation adjustments
CAMHS	None, but understanding for meaning and relevance to age group
Forensic	None
Older people	None, but understanding for meaning and relevance to age group