# Design and Validation of an Instrument to Measure the Communication of Bad News for Nurses

## TL;DR

This paper introduces a new validated tool for Spanish nurses to assess their ability to communicate bad news effectively.

## Contribution

The CBNN tool is a novel, validated instrument for evaluating bad news communication skills in nursing.

## Key findings

- The CBNN tool demonstrated good psychometric properties including reliability and validity.
- Four key components were identified through factor analysis: empathy, environment preparation, information delivery, and communication method.
- The tool correlates with existing communication skill assessments and reflects nurses' perceived training needs.

## Abstract

Background: There is a notable lack of Communication of Bad News (CBN) training for nurses, along with the absence of validated tools to assess this. The aim of this research is to design and validate an instrument to assess the communication of bad news among nursing professionals in Spain: the “Communication of Bad News in Nursing (CBNN)” tool. Methods: A multilevel nursing panel of experts participated in creating CBNN. A cross-sectional study was carried out on 218 Spanish nurses. Then, an Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and a convergent validity study were carried out with the Scale of Communication Skills in Nursing Professionals in the Spanish Environment (EHC), and a reliability study using internal consistency (Cronbach’s α) and Coefficient of Intraclass Correlation (ICC). Results: The KMO test gave an adequate value, and Bartlett’s sphericity test was significant. The EFA identified four components (empathy and perception; environment preparation, invitation, and strategy; information given and the act of communicating; and communication method) that explained most of the variance. A good fit was observed in the CFA for most of the evaluated indicators. CBNN correlated positively with EHC and was statistically associated with considering it necessary to be trained in CBN or degree of preparation. Cronbach’s α value was excellent. The ICC of absolute agreement after 96 h was good. Conclusions: The Communication of Bad News in Nursing questionnaire can be considered an effective tool for assessing the communication of bad news in nursing. It serves as a self-assessment tool for nurses to identify their strengths and areas for improvement in attitudes, knowledge, and skills regarding CBN.