Degree Name

Master of Science in Nursing (MSN)

Document Type

Major Paper


School of Nursing




Healthcare providers often have the difficult job of communicating difficult news to patients and patient families. However, few practitioners report having formal instruction on a systematic method for the delivery of difficult news. The purpose of the program was to give a cohort of Advanced Practice Registered Nurses (APRN) students in their final semester of their graduate program formal instruction on how to effectively deliver difficult news to their patients and patient families. The role of the APRN is ever expanding and APRNs will often find themselves treating more complex patients in their practice. Being prepared for an inevitable encounter with a poor diagnosis or the death of a loved one is an invaluable tool that has proven to enhance patient and provider relationships and alleviate provider frustration. The program incorporated formal instruction that included a lecture on evidence based theory using the SPIKES method of the delivery of difficult news as the backbone for the teaching and reference. Students participated in triads, role-playing the SPIKES method following the lecture. A sample comprised of 11 students representing 58% of the class met the inclusion criteria. The program was evaluated using a researcher designed and validated Likert type survey, measuring learner confidence both pre- and post-instruction. Confidence levels were measured and all who responded to the post-instruction survey reported increased confidence (> 90%) in the delivery of difficult news.

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