Life Science Journal 2013;10(4s) http://www.lifesciencesite.com http://www.lifesciencesite.com lifesciencej@gmail.com 26 Nurses as Death Notifiers: a Report from Nurses in Iran Nematullah Shomoossi 1* , Mostafa Rad 2 , Mohsen Kooshan 3 , Javad Ganjloo 3 1. Department of English, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran 2. PhD Candidate, Department of Nursing, Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran 3. Department of Nursing, Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran Correspondence author: nshomoossi@yahoo.com Abstract: Background and Purpose: Breaking bad news, particularly death notifications, is among the hardest tasks of a medical team. Therefore, the present study was intended to investigate delivering death notifications to survivors from the perspectives of nurses in Iran. Methods and Materials: This descriptive analytical study was conducted 97 (29 male and 68 female) nurses in Iran, who completed a questionnaire including demographic information, questions on their training and familiarity with SPIKE or ABCDE strategies, as well as 25 Likert questions based on ABCDE strategies. The obtained data were analyzed in SPSS using descriptive statistics and correlation coefficients. Results: The results indicated that most nurses had witnessed death victims but they reported no formal training for death notifications and helping survivors to control their emotions. Also, the participants were unfamiliar with SPIKE (99%) or ABCDE (88%) strategies. Also, most of the participants agreed with adopting the ABCDE strategies in delivering death notifications. Conclusion: The results indicated an urgent need for training nurses on communication skills to deliver death notifications, with special attention to the emotions and reactions of the survivors. [Shomoossi N., Rad M., Kooshan M., Ganjloo J. Nurses as Death Notifiers: a Report from Nurses in Iran. Life Sci J 2013;10(4s):26-31] (ISSN:1097-8135). http://www.lifesciencesite.com . 4 Keywords: Bad News; Death Notification; Nurses; Patients; Survivors. 1. Introduction Death is a painful socio-cultural reality and the last stage in one’s life. People often avoid talking about death since it is associated with emotions such as fear, fury and grief. Thinking about one’s own death or encountering the death of a loved one is a difficult and disheartening task too (Nordstrom et al., 2011). In case of end-stage patients, the patient and the kinsmen have enough time to prepare themselves for accepting the forthcoming death; equally, the attending physician and the medical team members may not encounter a hard task to inform them of a threatening fact. In such cases, talks may arise about autopsy, donations, and other legal issues. However, the patients expect the medical team to provide them with an honest notification (Ausman, 2006). In medical emergency cases, patients find themselves helpless, and their significant others, kinsmen and relatives need to be notified about the treatment and progress of medical procedures; consequently, the death notification can be unexpectedly disappointing with emotional consequences (Nordstrom et al., 2011). However, in traumatic cases (such as accidents) or heart attacks, the chances of preparing for a successful death notification may be low; accordingly, unpredictable emotions and reactions from the survivors and significant others will be more likely. In some cases, the broken heart syndrome may occur, which is a temporary heart condition brought on by stressful situations, such as the death of a loved one. People with broken heart syndrome may experience sudden chest pain or feel a menacing heart attack. The condition was originally called takotsubo cardiomyopathy, also referred to as stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome; affecting women more than men, the syndrome is treatable, and the condition usually reverses itself in about a week (Steliosa et al., 2010). Studies show that death notification without prior training and preparation takes practitioners to emotional embarrassment, with negative outcomes for survivors. Other studies show that patients, significant others and survivors of victims wish to be provided with an outspoken, but sympathetically- stated, death notification (Ausman, 2006). Their satisfaction and inclination to accept the death notification cannot be achieved without nurses' prior training in communication skills (Nordstrom et al., 2011), and the cooperation of nurses and doctors (Wakefield et al., 2003). The importance of death notifications has also led to the development of some strategies. For instance, ABCDE mnemonic is suggested by some oncologists, which stands for five expressions Advanced preparation, Build a therapeutic