Nurses’ experiences in delivering bad news to families of end-of-life patients; a qualitative content analysis

BACKGROUND: Delivering bad news to families of end-of-life (EOL) patients is a complex ethical and emotional task for nurses, particularly within culturally specific contexts. This study aimed to explore the lived experiences of Iranian nurses when communicating bad news to families of EOL patients. METHODS: A qualitative design using conventional content analysis was employed. Semi-structured, in-depth interviews were conducted with 18 purposively selected nurses from intensive care, emergency, oncology, and internal medicine units of teaching hospitals in Tehran, Iran. Data were transcribed verbatim and analyzed through open coding, categorization, and abstraction to identify latent themes. RESULTS: A core process emerged "Navigating the Harsh Reality" comprising three categories: (1) Preparation: assessing family readiness, creating a calm environment, and strategic timing and pacing; (2) Conveying the Bitter Truth: conveying the clinical truth, preserving truthful compassion, and facilitating intra-family communication; and (3) Providing Solace: offering professional reassurance, and communicating with empathetic language. CONCLUSION: Iranian nurses employ a structured, culturally embedded three-phase approach to bad news delivery that integrates truthfulness with compassionate, family-centered care. These findings offer a foundation for developing culturally appropriate communication guidelines and training programs in EOL care settings in Iran and comparable cultural contexts.