Navigating Difficult Conversations: Factors Influencing Paediatric Nurses' Bad News Delivery and Their Professional Coping Responses

Abstract

ABSTRACT Background Breaking bad news (BBN) is a cognitively and emotionally demanding communication task for paediatric nurses, yet empirical evidence on its determinants remains scarce. This study aimed to assess the current status of BBN competence and identify demographic, professional, and training‐related factors associated with this competence among paediatric nurses. Methods A cross‐sectional survey was conducted among 382 paediatric nurses using a Breaking Bad News Ability Scale. The scale demonstrated good psychometric properties (Cronbach's α = 0.91; test–retest reliability = 0.85; S‐CVI/Ave = 0.94). The instrument comprises five dimensions: pre‐disclosure preparation, communication strategy, empathic response, child/family specificity, and communication/self‐reflection. The study was designed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Univariate analysis, Pearson's correlation, and multiple linear regression were performed. Results Total scores range from 20 to 100; each of the five dimensions ranges from 4 to 20. Higher scores indicate greater competence. The mean total score was 69.0 ± 6.3, indicating a moderate level of ability. Empathic response scored highest (14.2 ± 2.0), whereas pre‐disclosure preparation (13.5 ± 2.2) and child/family specificity (13.6 ± 2.2) were the lowest‐performing dimensions. Univariate analysis revealed significant differences by age, educational attainment, professional title, years of paediatric nursing experience, communication training within the preceding 6 months, and clinical department (all p < 0.01). Recent communication training demonstrated the strongest positive correlation ( r = 0.419, p < 0.001), followed by years of experience ( r = 0.392) and professional title ( r = 0.376). Multiple linear regression ( R 2 = 0.394, p < 0.001) identified recent training ( b = 2.09, p < 0.001), professional title ( b = 1.20, p = 0.002), years of experience ( b = 0.29, p = 0.007), and age ( b = 0.15, p = 0.013) as independent positive predictors. Conclusion Paediatric nurses demonstrated moderate BBN competence, with notable deficiencies in pre‐disclosure preparation and family‐specific tailoring. Patient or Public Contribution Communication training within the preceding 6 months emerged as the strongest modifiable predictor. Nurses in intensive care settings, despite frequent exposure to high‐stakes disclosures, warrant targeted competency development.