Breaking bad news: a phenomenological exploration of Irish nurses' experiences of caring for patients when a cancer diagnosis is given in an acute care facility (part 1).

BACKGROUND: The focus of this article is on the meanings attributed by nurses who worked with patients receiving a cancer diagnosis within acute care settings in Ireland. OBJECTIVE: The aim of this article was to explore the nurses' perceptions of caring for patients who receive bad news in the form of a cancer diagnosis while in an acute care setting. METHODS: The article focuses on the perceptions of 20 nurses who formed the nurse participant group in a larger phenomenological study exploring giving and receiving a cancer diagnosis. Data were collected using unstructured in-depth interviews. Analysis was conducted using Koch's analytical framework. RESULTS: The nurses' narratives provided 2 emerging themes entitled, "connectedness: journeying as professional within the everyday world" and "connectedness: exclusion of professional within the everyday world." This article focuses on the first emerging theme and highlights the experiences of nurses as they reflect on their interactions with their patients before, during, and after the giving of a cancer diagnosis. CONCLUSIONS: This study highlights the importance of professional companionship. It provides insights into the nurse-patient challenges as a result of lack of information. IMPLICATIONS FOR PRACTICE: Lack of information and involvement affects the nurse's ability to be authentically present for the recipient and results in a fracture to the nurse-patient relationship. Understanding the experiences of nurses from acute care settings where the cancer diagnosis is often given will inform and enable the nurse working in oncology settings to engage patients in a more meaningful and focused way.

Receiving bad news: a phenomenological exploration of the lived experience of receiving a cancer diagnosis.

This article explores the process of coming to a place of knowing one's diagnosis of cancer. The study was guided by the philosophy of hermeneutic phenomenology, with data collected via unstructured in-depth interviews. This article focuses on 10 people who received a cancer diagnosis (recipients). The analysis of the recipient narratives offered an interpretation of the phenomenon of receiving bad news as a process occurring over a period of time and not as a one-off event in time. The concept of bad news as a trajectory was clearly evident in the narratives and was represented through 3 themes: "disturbance of the everyday world," "surfacing within the lived world," and "embodiment within the lived world." The findings are consistent with the literature addressing diagnosis and end-of-life issues. Understanding the phenomenon of "knowing" is crucial in helping the healthcare professional recognize the changing information and psychosocial needs of the recipient as they experience the trajectory of bad news.

Methodological rigour within a qualitative framework.

AIM: This paper discusses the literature on establishing rigour in research studies. It describes the methodological trinity of reliability, validity and generalization and explores some of the issues relating to establishing rigour in naturalistic inquiry. BACKGROUND: Those working within the naturalistic paradigm have questioned the issue of using validity, reliability and generalizability to demonstrate robustness of qualitative research. Triangulation has been used to demonstrate confirmability and completeness and has been one means of ensuring acceptability across paradigms. Emerging criteria such as goodness and trustworthiness can be used to evaluate the robustness of naturalistic inquiry. DISCUSSION: It is argued that the transference of terms across paradigms is inappropriate; however, if we reject the concepts of validity and reliability, we reject the concept of rigour. Rejection of rigour undermines acceptance of qualitative research as a systematic process that can contribute to the advancement of knowledge. Emerging criteria for demonstrating robustness in qualitative inquiry, such as authenticity, trustworthiness and goodness, need to be considered. Goodness, when not seen as a separate construct but as an integral and embedded component of the research process, should be useful in assuring quality of the entire study. Triangulation is a tried and tested means of offering completeness, particularly in mixed-method research. When multiple types of triangulation are used appropriately as the 'triangulation state of mind', they approach the concept of crystallization, which allows for infinite variety of angles of approach. CONCLUSION: Qualitative researchers need to be explicit about how and why they choose specific legitimizing criteria in ensuring the robustness of their inquiries. A shift from a position of fundamentalism to a more pluralistic approach as a means of legitimizing naturalistic inquiry is advocated.