Exploring Nursing and Medical Students’ Experiences of Handling Challenging Conversations: A Qualitative Focus Group Study

Germanus Natuhwera,1,2 Peter Ellis,3 Eve Namisango2,4,5 1Clinical & Administration Departments, Hospice Africa Uganda, Kampala, Uganda; 2Education Department, Institute of Hospice and Palliative Care in Africa, Kampala, Uganda; 3Independent Nursing Researcher, Writer and Educator, London, UK; 4Research and Programmes Department, African Palliative Care Association, Kampala, Uganda; 5Cicely Saunders Institute, King’s College London, London, UKCorrespondence: Germanus Natuhwera, Email [email protected]; [email protected]: Handling challenging conversations remains a major challenge for both undergraduate and qualified nurses and medical doctors. However, challenging conversations are inevitable in daily patient-clinician encounters in clinical and care settings.Aim: To explore nursing and medical students’ experiences in handling challenging conversations with patients and their families.Setting and Participants: The study was conducted among final-year undergraduate nursing and medical students selected from seven nursing and medical training schools and universities in Southwest, Midwest and Central Uganda.Design and Methods: This was an exploratory qualitative study. Purposive and convenience sampling were used to select training schools/universities and participants respectively. Data were collected between November 2022 and February 2023 through 10 face-to-face audio-recorded focus group interviews and were analyzed using inductive thematic analysis.Results: 82 nursing and medical students participated in the study. The analysis yielded four major themes: (1) Students’ understanding of bad news, (2) Emotional labor of handling challenging conversations, (3) Handling challenging conversations a theory but not a practice experience, (4) Sociocultural and medico-cultural dilemmas.Conclusion: The study revealed that participants possessed limited theoretical knowledge, preparedness, and a significant unwillingness to engage in challenging conversations, particularly when communicating bad news or handling conversations related to death and dying. These issues are closely linked to inadequate training and particularly limited or deficient clinical exposure. Simulation-based learning and exposure to challenging conversations are required in clinical settings.Keywords: bad news, communication, difficult conversations, medical, nursing, student