British journal of nursing (Mark Allen Publishing)
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Some clinicians are at the leading edge of good practice in the introduction of integrated care management (ICM) (Wilson, 1996) based on partnership, quality and driven by performance. The new Government White Paper (Department of Health, 1997) outlines proposals for integrated care with all care planners and providers working collaboratively. A number of health and social care organizations have worked collaboratively to develop care programmes based on patient-centred care. ⋯ Involving patients and their carers in determining the process and outcomes of care provides a route to better communication, patient and staff satisfaction and the overall quality of care. This article deals with the use of ICM through the monitoring system of multidisciplinary pathways of care (MPCs) as a tool for minimizing risk and improving the continuous quality improvement of patient care. MPCs are one of the components of ICM which need to incorporate clinical guidelines, protocols, interdisciplinary standards, evidenced-based practice and clinical outcomes which are continuously monitored across all sectors of care.
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This article identifies the difficulties often associated with breaking bad news, from a nursing perspective. The additional considerations involved in breaking bad news to people with learning disabilities are identified, and a six-step protocol (Buckman, 1991) is introduced and explored in relation to this client group. ⋯ Finally, recommendations for helping professionals to learn how to break bad news sensitively to this client group are suggested. They include multi-agency working, education and training opportunities, standard statements, resources, support and research initiatives.