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Collins SC, Ferrigno NK, King R, Chumpitazi CE, Stanley RM, Pulcini CD. Perspectives of Caregivers on Children Boarding With Mental Health Conditions. Pediatr Emerg Care 2024:00006565-990000000-00502. [PMID: 39141800 DOI: 10.1097/pec.0000000000003240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVE Addressing the acute mental healthcare needs of children is a national crisis. Despite the ongoing crisis, there are limited prior studies that capture caregiver perspectives on acute pediatric mental healthcare, notably in a general emergency department (ED) in a rural state. Based on these knowledge gaps, our objective was to assess caregiver opinions and perspectives of acute management for children boarding with mental health conditions. METHODS Semistructured interviews were conducted with caregivers of patients (under 18 years old) with a primary mental health condition boarding in a general ED (length of stay ≥24 hours) within a qualitative grounded theory approach. An interview guide was developed a priori and reviewed among key stakeholders. A trained study team performed the interviews. A coding tree was developed through an iterative process that included double-coding transcripts and monitoring of interrater reliability to perform thematic analysis. RESULTS Fourteen interviews were conducted to reach thematic saturation. Key themes elicited from caregivers included mental healthcare delivery, access to mental healthcare services, care setting, and level of support for families and caregivers. Most caregivers focused on the following challenges and suggestions: access to appropriate, evidence-based mental healthcare, improved communication between all stakeholders involved, and staff education on mental healthcare for children. CONCLUSIONS Caregivers face considerable challenges in attaining timely and appropriate acute mental health care for their children. Immediate and innovative resource allocation is needed across the healthcare continuum to bolster the acute mental healthcare services currently offered to children and families, especially in the general ED setting.
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Affiliation(s)
| | | | | | - Corrie E Chumpitazi
- Department of Pediatrics, Division of Emergency Medicine, Duke University School of Medicine, Durham, NC
| | - Rachel M Stanley
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH
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Haward MF, Lorenz JM, Fischhoff B. Antenatal Consultation Research and Practices Through the Lens of Decision Science. J Pediatr 2024; 274:114173. [PMID: 38942356 DOI: 10.1016/j.jpeds.2024.114173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
| | - John M Lorenz
- Department of Pediatrics, Morgan Stanley Children Hospital of New York, Vagelos College of Physicians & Surgeons Columbia University, New York, NY
| | - Baruch Fischhoff
- Department of Engineering and Public Policy and Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA
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Kruse RF, Stiel S, Schwabe S. Supporting Bereaved Family Members: A Qualitative Interview Study on the Experience of Bereavement Counselling by the Bereavement Network Lower Saxony (BNLS) in Germany for Parents Who Have Lost Children or Teenagers. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241263367. [PMID: 38907636 DOI: 10.1177/00302228241263367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
The "Trauer Netzwerk Niedersachsen" ("Bereavement Network Lower Saxony" (BNLS)) aims at supporting families after the loss of a child or teenager due to various causes. This study aims to describe the experiences of bereaved family members with the BNLS counsellors. 12 semi-structured interviews were conducted with parents who had received or were currently receiving BNLS counselling. The interviews revealed the vital role counselling played aiding individuals cope with their grief. Participants valued the bereavement support, which was often lacking in their personal support networks. Counselling assisted parents in returning to daily life and caring for loved ones. Discussing "death" and "dying" helped participants find peace with their loss. Our findings suggest that bereavement counselling should be considered an essential component of healthcare for family members dealing with the loss of a child. Additionally, there is need for awareness and publicity for both the BNLS and its bereavement counselling services.
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Affiliation(s)
- Rebecca F Kruse
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Sven Schwabe
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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Montoya MCM, Sánchez CH, Souto EP, Pérez EA, Matta GC, Daza M, Gama GL, Pimentel C, Mercado M, Niño AMA, Leegstra LM, Castro EM, Manders OC, Maxwell L. "I found out about Zika virus after she was born." Women's experiences of risk communication during the Zika virus epidemic in Brazil, Colombia, and Puerto Rico. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002808. [PMID: 38865420 PMCID: PMC11168637 DOI: 10.1371/journal.pgph.0002808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024]
Abstract
Providing accurate, evidence-based information to women with Zika infection during pregnancy was problematic because of the high degree of uncertainty in the diagnosis of the infection and the associated risk. The 2015-17 Zika virus epidemic overwhelmingly affected women in countries with limited access to safe abortion. Understanding women's perspectives on risk communication during pregnancy in the context of an emerging pathogen can help inform risk communication in response to future outbreaks that affect fetal or child development. We conducted a cross-sectional qualitative interview study with 73 women from 7 locations in Brazil, Colombia, and Puerto Rico to understand women's experiences of Zika virus (ZIKV) test and outcome-related communication during the ZIKV pandemic. We used thematic analysis to analyze the in-depth interviews. Participants in Brazil and Colombia reported that the healthcare system's lack of preparation and organization in communicating ZIKV test results and associated adverse outcomes led to their feeling abandoned and alone in confronting the challenges of a ZIKV-affected pregnancy. In contrast, participants in Puerto Rico reported that the regular testing schedules and clear, well-planned communication between the care team and between providers and pregnant women helped them to feel they could prepare for a ZIKV-affected pregnancy. Communication of the risk associated with an emerging pathogen suspected to affect pregnancy and developmental outcomes is a fraught issue. Public health authorities and healthcare providers should work together in the interpandemic period to understand families' preferences for risk communication during pregnancy in the presence of uncertainty and develop a community-informed plan for risk communication.
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Affiliation(s)
| | - Claudia Hormiga Sánchez
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Fundación INFOVIDA, Bucaramanga, Colombia
| | - Ester Paiva Souto
- Interdisciplinary Centre for Public Health Emergencies (NIESP-CEE-FIOCRUZ), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Edna Acosta Pérez
- Graduate School of Public Health / Hispanic Alliance for Clinical and Translational Research, Medical Science Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Gustavo Corrêa Matta
- Interdisciplinary Centre for Public Health Emergencies (NIESP-CEE-FIOCRUZ), Center for Data and Knowledge Integration for Health (CIDACS/FIOCRUZ-Bahia), Rio de Janeiro, Brazil
| | - Marcela Daza
- Grupo de Salud Materna y Perinatal, Instituto Nacional de Salud, Bogotá, Colombia
| | - Gabriela Lopes Gama
- Professor Joaquim Amorim Neto Research Institute (IPESQ), UNIFACISA University Center, Paraíba, Brazil
| | - Camila Pimentel
- Laboratory for Studies on Drugs, Vulnerabilities and Social Markers (LED), Department of Public Health (NESC), Aggeu Magalhães Institute—Fiocruz Pernambuco, Recife, Pernambuco, Brazil
| | - Marcela Mercado
- Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Angélica María Amado Niño
- Facultad de Salud, Departamento de Salud Pública, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Luz Marina Leegstra
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Olivia C. Manders
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Lauren Maxwell
- Heidelberger Institut für Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Çimke S, Yıldırım Gürkan D, Polat S. Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis. J Pediatr Nurs 2024; 76:199-206. [PMID: 38479074 DOI: 10.1016/j.pedn.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children. MATERIALS AND METHODS The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps. RESULTS A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS. CONCLUSION The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered. PRACTICAL IMPLICATIONS Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.
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Affiliation(s)
- Sevim Çimke
- Faculty of Health Sciences, Yozgat Bozok University, Turkey.
| | | | - Sevinç Polat
- Faculty of Health Sciences, Yozgat Bozok University, Turkey
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Jeppesen E, Schmidt AA, Skjødt CK, Hybschmann J, Gjærde LK, Thestrup J, Hansson H, Sørensen JL. Educational programmes for paediatric healthcare professionals in patient- and family-centred care. A scoping review. Eur J Pediatr 2024; 183:2015-2028. [PMID: 38430279 PMCID: PMC11035470 DOI: 10.1007/s00431-024-05455-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
To identify and describe educational programmes in patient- and family-centred care for paediatric healthcare professionals. This scoping review was conducted and reported according to the JBI Manual for Evidence Synthesis and the PRISMA guideline. The databases searched included MEDLINE (PubMed), PsycINFO, CINAHL, Scopus, Cochrane, and Embase. Inclusion criteria were experimental, observational and qualitative studies about educational programmes on patient- and family-centred care for paediatric healthcare professionals. Exclusion criteria were reviews and non-peer-reviewed literature. Two reviewers independently screened and extracted the data using Covidence. Of the 13922 records identified, 49 articles met the inclusion criteria. There was a large variety of educational programmes, half of which were interdisciplinary, that mainly targeted nurses and doctors. The median number of participants was 51 (range 7 to 1411). The predominant target population was children with chronic disabilities and neonatal intensive care units, and only one programme specifically targeted adolescents. The median duration was one day (range 5 min to 3.5 years). Development of competencies was the most common objective. We identified 12 different educational content areas. Content mainly focused on communication and relational competencies, including partnership, which involved shared decision-making, mutual agenda setting, and negotiation of a plan. Many kinds of educational strategies were found but experiential learning through simulation and roleplay was used most. Conclusion: A large variety of educational programmes in paediatric patient- and family-centred care exist. Educational content mainly focused on communication and relational competencies. Experiential learning including roleplay and simulation was the most used educational strategy. What is Known: • Delivery of patient- and family-centred care improves parental satisfaction of care but requires clinicians have a certain attitude towards involving the child and parents in a healthcare partnership as well as advanced triadic communication skills. Little is known about how this attitude, and more broadly, patient- and family-centred care, can be facilitated through education and training. What is New: • This scoping review found a wide array of programmes.. Workshops with simulation or roleplay was the most frequent educational strategy. The programmes, which typically targeted nurses and doctors, chiefly focused on basic and advanced communication and relational competencies, including partnership, which involved shared decision-making and negotiation of plans.
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Affiliation(s)
- Elisabeth Jeppesen
- Mary Elizabeth's Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Juliane Marie Centre, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark.
- Department of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Anne Aarslev Schmidt
- Juliane Marie Centre, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
- Department of Pediatric Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Camilla Kriegbaum Skjødt
- Juliane Marie Centre, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
- Department of Pediatric Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jane Hybschmann
- Mary Elizabeth's Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Line Klingen Gjærde
- Mary Elizabeth's Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Juliane Marie Centre, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
| | - Jakob Thestrup
- Mary Elizabeth's Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Helena Hansson
- Juliane Marie Centre, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jette Led Sørensen
- Mary Elizabeth's Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Juliane Marie Centre, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Watanabe M, Kato M, Matsuda YT, Taniguchi K, Itakura S. The infant-doctor relationship: an examination of infants' distress reactions in the presence of a doctor. Sci Rep 2024; 14:7968. [PMID: 38575648 PMCID: PMC10994921 DOI: 10.1038/s41598-024-58677-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
Fear of doctors is a common source of distress among infants; however, the underlying sources of this distress are unknown. To investigate the doctor-infant relationship, the behaviors of 61 healthy infants (176-617 days old) were observed in a simulated examination room. Their behaviors and electrocardiograms were recorded. Two groups of infants were analyzed: those who cried and those who did not. When an experimenter dressed in the doctor's attire entered the room, all 9 infants who were crying (14.8% of all infants) stopped crying, all infants gazed at the experimenter, and their mean heart rate (HR) decreased. After the auscultation started, 29.5% of all infants cried, and the HRs of infants who cried were higher than those of infants who did not cry. During the auscultation, 80.0% of infants who cried averted from the experimenter, while 34.4% of infants who did not cry. Within 5 s of gazing at the stethoscope, the number of infants who cried increased from 3 to 12, and their mean HR also increased. Our findings suggest that the fear of doctors is not due to the appearance of doctors but rather to specific actions performed by doctors, such as auscultation. Infants may regard a doctor's appearance as a source of interest. Furthermore, a stethoscope is a possible trigger for infants' crying. These behavioral observations suggest the potential for patient-centered care for infants.
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Affiliation(s)
- Motonobu Watanabe
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan.
- Department of Pediatrics, NHO Minami Kyoto Hospital, Joyo, Kyoto, Japan.
| | - Masaharu Kato
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
| | - Yoshi-Taka Matsuda
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
- Department of Child Studies, Shiraume Gakuen University, Kodaira, Tokyo, Japan
| | - Kosuke Taniguchi
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
- Department of Psychology, Kyoto University of Advanced Science, Ukyo-ku, Kyoto, Japan
| | - Shoji Itakura
- Center for Baby Science, Doshisha University, 4-1-1 Kizugawadai, Kizugawa City, Kyoto, 619-0225, Japan
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Karni-Visel Y, Dekel R, Sadeh Y, Sherman L, Katz U. "You Have to Find a Way for This Child to Be at the Center": Pediatric Cardiologists' Views on Triadic Communication in Consultations on Congenital Heart Defects. HEALTH COMMUNICATION 2024:1-12. [PMID: 38557305 DOI: 10.1080/10410236.2024.2329422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children's cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists' views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents' emotional needs, and (3) the physician's role as mediator between parent(s) and child. In each category, three elements are discussed: The physician's agenda, obstacles and challenges, and the physician's practical methods. Physicians strongly support children's involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents' and children's needs.
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Affiliation(s)
- Yael Karni-Visel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Yaara Sadeh
- School of Social Work, University of Haifa
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Liat Sherman
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Uriel Katz
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
- Sackler School of Medicine, Tel-Aviv University
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Kuriakose A, Arachchige SP, Emeto TI, Hiskens MI, Hariharan G. Descriptive feedback with targeted education to improve telephonic escalation of care: a simulation-based study. BMC MEDICAL EDUCATION 2024; 24:281. [PMID: 38481232 PMCID: PMC10938749 DOI: 10.1186/s12909-024-05260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Awareness of communication failures in healthcare has necessitated the implementation of standardized, validated handover tools such as Identification, Situation, Background, Assessment, Recommendation (ISBAR). Although educational sessions improve communication, the effectiveness of individualized care escalation communication training is unknown. The primary aim was to conduct a simulation-based study to assess individualized one-on-one communication training for junior medical doctors for improving care escalation in pediatric emergencies. The secondary aim was to assess the evaluation of the training. METHODS The prospective observational study assessed participants pre- and post-intervention. In Session One, participants presented a written case scenario telephonically to two senior pediatricians. Fifty participants were scored using an 18-item checklist based on the ISBAR tool and "free text" responses. Immediately following case presentations, participants completed individualized one-on-one 30-minute educational sessions regarding self-reflection, didactic teaching, and constructive feedback based on the ISBAR. Session Two included a second case presentation and reassessment. We conducted qualitative analysis of supervisor's feedback on performance and trainee doctor's evaluation of the training. RESULTS There was significant improvement in 8 of the 18 components of the ISBAR checklist. All elements of care escalation were significantly improved, and overall communication was higher post-intervention (P < 0.001); however, no improvement was noted in participants' explorations of differential diagnoses (P = 0.263). The qualitative analysis identified themes of improved urgency in seeking senior support and conversational clarity from supervisors, and improved intervention quality and self-confidence from participants. CONCLUSIONS Individualized communication training may improve pediatric emergency care escalation and communication among junior doctors.
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Affiliation(s)
- Aster Kuriakose
- Department of General Paediatrics, Mackay Base Hospital, 4740, Mackay, QLD, Australia
| | | | - Theophilus I Emeto
- Public Health & Tropical Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, 4811, Townsville, QLD, Australia
| | - Matthew I Hiskens
- Mackay Institute of Research and Innovation, Mackay Base Hospital, 475 Bridge Road, 4740, Mackay, QLD, Australia.
| | - Gopakumar Hariharan
- Department of General Paediatrics, Mackay Base Hospital, 4740, Mackay, QLD, Australia
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Kim E, Gomez JP, Mutter E, Campion J, Kumar M, Ramasamy D. Retaining Interest in Child and Adolescent Psychiatry Among General Residency Trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01941-7. [PMID: 38321353 DOI: 10.1007/s40596-024-01941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES This study aimed to identify factors affecting current general psychiatry residents' interest in child and adolescent psychiatry (CAP) at Lehigh Valley Health Network (LVHN). Furthermore, it aimed to identify areas for improvement in clinical education to address the shortage of child psychiatrists at the institution at the time of this study. METHODS An electronic anonymous pre-implementation survey was sent to all the current general psychiatry residents at LVHN. It assessed the most important factors for trainees in deciding their career paths into CAP, their comfort level with children and families, and overall CAP and related systems-based knowledge. Interventions based on the survey results were implemented in the LVHN psychiatry residency program. The residents then completed a post-intervention survey to assess the impact of these interventions on their perspectives toward CAP. RESULTS CAP rotation experience and work with families were strong influencers for general psychiatry residents at LVHN in pursing CAP. Systems-based knowledge was particularly lacking compared to overall CAP knowledge. Educational interventions that were implemented at LVHN led to improvements in residents' sense of competence working with children and families with no net loss of interest in CAP. CONCLUSIONS Educational modifications enhanced attitudes toward CAP among LVHN general psychiatry residents. Implementing such modifications at other residency programs may be likewise effective in retaining interest in CAP among their general psychiatry residents.
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Affiliation(s)
| | | | | | - John Campion
- Lehigh Valley Health Network, Bethlehem, PA, USA
| | - Maanvi Kumar
- Lehigh Valley Health Network, Bethlehem, PA, USA
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Forth FA, Hammerle F, König J, Urschitz MS, Neuweiler P, Mildenberger E, Kidszun A. Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants: The COPE Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240105. [PMID: 38393728 PMCID: PMC10891472 DOI: 10.1001/jamanetworkopen.2024.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/03/2024] [Indexed: 02/25/2024] Open
Abstract
Importance In the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents. Objective To examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication. Design, Setting, and Participants This crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022. Interventions Alternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing). Main Outcomes and Measures The primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates. Results Of 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P < .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, -0.34; -1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, -0.55; 95% CI, -1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P < .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16). Conclusions and Relevance When given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment. Trial Registration German Clinical Trials Register (DRKS): DRKS00024466.
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Affiliation(s)
- Fiona A. Forth
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Florian Hammerle
- Department of Pediatric and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael S. Urschitz
- Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp Neuweiler
- Journalistisches Seminar, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eva Mildenberger
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - André Kidszun
- Division of Neonatology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ong N, Lucien A, Long J, Weise J, Burgess A, Walton M. What do parents think about the quality and safety of care provided by hospitals to children and young people with an intellectual disability? A qualitative study using thematic analysis. Health Expect 2024; 27:e13925. [PMID: 38014873 PMCID: PMC10768875 DOI: 10.1111/hex.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Children with intellectual disability experience patient safety issues resulting in poor care experiences and health outcomes. This study sought to identify patient safety issues that pertain to children aged 0-16 years with intellectual disability admitted to two tertiary state-wide children's hospitals and a children's palliative care centre; to describe and understand these factors to modify the Australian Patient Safety Education Framework to meet the particular needs for children and young people with intellectual disability. DESIGN, SETTING AND PARTICIPANTS Parents of children with intellectual disability from two paediatric hospitals and a palliative care unit participated in semi-structured interviews to elicit their experiences of their child's care in the context of patient safety. Thirteen interviews were conducted with parents from various backgrounds with children with intellectual, developmental and medical diagnoses. RESULTS Eight themes about safety in hospital care for children and young people with intellectual disability emerged from thematic analyses: Safety is not only being safe but feeling safe; Negative dismissive attitudes compromise safety, quality and care experience; Parental roles as safety advocates involve being heard, included and empowered; Need for purposeful and planned communication and care coordination to build trust and improve care; Systems, processes and environments require adjustments to prevent patient safety events; Inequity in care due to lack of resources and skills, Need for training in disability-specific safety and quality issues and Core staff attributes: Kindness, Patience, Flexibility and Responsiveness. Parents highlighted the dilemma of being dismissed when raising concerns with staff and being required to provide care with little support. Parents also reported a lack of comprehensive care coordination services. They noted limitations within the healthcare system in accommodating reasonable adjustments for a family and child-centred context. CONCLUSIONS The development of an adapted Patient Safety Education Framework for children with intellectual disability should consider ways for staff to transform attitudes and reduce bias which leads to adaptations for safer and better care. In addition, issues that apply to quality and safety for these children can be generalised to all children in the hospital. PATIENT AND PUBLIC CONTRIBUTION Parent advocates in the project advisory team were shown the questions to determine their appropriateness for the interviews.
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Affiliation(s)
- Natalie Ong
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Child Development UnitChildren's Hospital at Westmead, Sydney Children's Hospitals NetworkWestmeadNew South WalesAustralia
| | - Abbie Lucien
- UNSW MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Janet Long
- Australian Institute of Health Innovation, Faculty of Medicine and Health SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Janelle Weise
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW MedicineUniversity of New South WalesRandwickNew South WalesAustralia
| | - Annette Burgess
- Medical Education, Education Office, Sydney Medical SchoolUniversity of SydneyCamperdownNew South WalesAustralia
| | - Merrilyn Walton
- School of Public HealthUniversity of SydneyCamperdownNew South WalesAustralia
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El Ali M, Licqurish S, O'Neill J, Gillam L. Truth-telling to the seriously ill child - Nurses' experiences, attitudes, and beliefs. Nurs Ethics 2023:9697330231215952. [PMID: 38128903 DOI: 10.1177/09697330231215952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child's bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children is worth exploring. METHODS A systematic academic database and grey literature search strategy was conducted using CINAHL, Medline Psych Info, and Google Scholar. Keywords used included truth, children, nurse, disclosure, serious illness, and communication. A total of 17 publications of varying types were included in the final data set. ETHICAL CONSIDERATIONS As this was a review of the literature, there were no direct human participants. Empirical studies included in the review had received ethics approval. RESULTS Of the 17 articles included in the review, only one directly reported on the experiences of nurses asked to withhold the truth from patients. Empirical studies were limited to HIV-positive children and children diagnosed with cancer and the dying child. CONCLUSION A paucity of literature exploring the experiences, attitudes, and beliefs of nurses with regard to truth-telling to seriously ill children is evident. Little consideration has been given to the role nurses play in communicating medical information to children in a hospital setting. The 17 articles included in the review focused on cancer, and HIV, diagnosis, and end-of-life care. Further research should be undertaken to explore the experiences and attitudes of nurses to clinical information sharing to children hospitalised with a wide range of serious illnesses and in diverse clinical scenarios.
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Affiliation(s)
- Mandy El Ali
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | | | - Jenny O'Neill
- The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Lynn Gillam
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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14
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Keating EM, Sakita F, Vonderohe M, Nkini G, Amiri I, Loutzenheiser K, Young B, Rent S, Staton CA, Mmbaga BT, Watt MH. Family caregiver perspectives on strengths and challenges in the care of pediatric injury patients at a tertiary referral hospital in Northern Tanzania. PLoS One 2023; 18:e0286836. [PMID: 38100475 PMCID: PMC10723720 DOI: 10.1371/journal.pone.0286836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Pediatric injuries are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). It is important that injured children get quality care in order to improve their outcomes. Injured children are nearly always accompanied by family member caregivers invested in their outcome, and who will be responsible for their recovery and rehabilitation after discharge. OBJECTIVE The purpose of this study was to identify family member caregiver perspectives on strengths and challenges in pediatric injury care throughout hospitalization at a tertiary hospital in Northern Tanzania. METHODS This study was conducted at a zonal referral hospital in Northern Tanzania. Qualitative semi-structured in-depth interviews (IDIs) were conducted by trained interviewers who were fluent in English and Swahili in order to examine the strengths and challenges in pediatric injury care. IDIs were completed from November 2020 to October 2021 with 30 family member caregivers of admitted pediatric injured patients. De-identified transcripts were synthesized in memos and analyzed through a team-based, thematic approach informed by applied thematic analysis. RESULTS Strengths and challenges were identified throughout the hospital experience, including emergency medicine department (EMD) care, inpatient wards care, and discharge. Across the three phases, strengths were identified such as how quickly patients were evaluated and treated, professionalism and communication between healthcare providers, attentive nursing care, frequent re-evaluation of a patient's condition, and open discussion with caregivers about readiness for discharge. Challenges identified related to lack of communication with caregivers, perceived inability of caregivers to ask questions, healthcare providers speaking in English during rounds with lack of interpretation into the caregivers' preferred language, and being sent home without instructions for rehabilitation, ongoing care, or guidance for follow-up. CONCLUSION Caregiver perspectives highlighted strengths and challenges throughout the hospital experience that could lead to interventions to improve the care of pediatric injury patients in Northern Tanzania. These interventions include prioritizing communication with caregivers about patient status and care plan, ensuring all direct communication is in the caregivers' preferred language, and standardizing instructions regarding discharge and follow-up.
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Affiliation(s)
- Elizabeth M. Keating
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Maddy Vonderohe
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Getrude Nkini
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kelly Loutzenheiser
- College of Nursing, University of Utah, Salt Lake City, UT, United States of America
| | - Bryan Young
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Sharla Rent
- Department of Pediatrics, Duke School of Medicine, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America
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Bernstein SM, Barks MC, Ubel PA, Weinfurt K, Barlet MH, Farley S, Jiao MG, Bansal S, Fisher K, Lemmon ME. Prognostic Discordance Among Parents and Physicians Caring for Infants with Neurologic Conditions. J Pediatr 2023; 263:113677. [PMID: 37611734 PMCID: PMC10841319 DOI: 10.1016/j.jpeds.2023.113677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/09/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To determine the frequency, degree, and nature of prognostic discordance between parents and physicians caring for infants with neurologic conditions. STUDY DESIGN In this observational cohort study, we enrolled parents and physicians caring for infants with neurologic conditions in advance of a family conference. Parent-physician dyads completed a postconference survey targeting expected neurologic outcomes across 3 domains (motor, speech, and cognition) using a 6-point scale. Prognostic discordance was defined as a difference of ≥2 response options and was considered moderate (difference of 2-3 response options) or high (difference of 4-5 response options). Responses were categorized as differences in belief and/or differences in understanding using an existing paradigm. RESULTS Forty parent-physician dyads of 28 infants completed surveys. Parent-physician discordance about prognosis occurred in ≥1 domain in the majority of dyads (n = 28/40, 70%). Discordance was generally moderate in degree (n = 23/28, 82%) and occurred with similar frequency across all domains. Of parent-physician dyads with discordance, the majority contained a difference in understanding in at least 1 domain (n = 25/28, 89%), while a minority contained a difference of belief (n = 6/28, 21%). When discordance was present, parents were typically more optimistic in their predictions compared with physicians (n = 25/28, 89%). CONCLUSIONS Differing perceptions about the prognosis of critically ill infants are common and due to differences in both understanding and belief. These findings can be used to develop targeted interventions to improve prognostic communication.
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Affiliation(s)
- Sarah M Bernstein
- University of Utah School of Medicine, Salt Lake City, UT; Duke University Medical Center, Durham, NC.
| | - Mary C Barks
- Duke Margolis Center for Health Policy, Durham, NC
| | | | | | | | | | - Megan G Jiao
- Duke Margolis Center for Health Policy, Durham, NC
| | | | | | - Monica E Lemmon
- Duke University Medical Center, Durham, NC; Duke Margolis Center for Health Policy, Durham, NC
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Kase SM, Christianson CA, Dow LA, Guttmann KF, Weintraub AS. PedsTalk: A Pilot Communication Skills Education Course for Pediatric Residents. Hosp Pediatr 2023; 13:e377-e383. [PMID: 38018161 DOI: 10.1542/hpeds.2023-007174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Communication skills are critical to pediatric practice, but few pediatric residency programs provide formal communication skills education. Pediatric residents often lack confidence in these skills. We hypothesized that a simulation-based communication skills course would improve resident confidence in the skills required for serious illness conversations with patients/families. METHODS In collaboration with multidiscipline VitalTalk-trained faculty, we developed PedsTalk, a communication skills course for pediatric residents based on the VitalTalk framework. In PedsTalk, faculty/peers offered real-time coaching during simulation sessions with actors. Resident participants self-rated confidence in 9 communication skills using a 5-point Likert scale before, immediately after, and 4 months after course participation, with course nonparticipants serving as controls. Responses were analyzed by using Friedman tests and Wilcoxon rank tests. Thematic analysis was conducted to identify themes among free-text responses. RESULTS Twenty-seven pediatric residents participated in PedsTalk, 11 of whom completed survey assessments at all timepoints. Eleven course nonparticipants served as controls. Over time, participants' confidence in the following communication skills was retained or significantly improved: "difficult conversations" (P < .001), "recognizing emotion" (P < .01), "using silence" (P < .008), "headline statements" (P < .001), eliciting "VALUES" (P < .001), and asking "permission to continue" (P < .001). Over time, controls had significant improvements in confidence in 2 skills: headline statements (P < .014) and eliciting "VALUES" (P < .031). CONCLUSIONS PedsTalk is a novel approach to communication skills education in pediatric residency. Participation improved residents' confidence in 6 communication skills, including overall confidence in having difficult conversations. Although confidence in some skills may naturally develop through clinical experiences, PedsTalk further enhances communication skills education among trainees.
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Affiliation(s)
| | - Caroline A Christianson
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Hassenfeld Children's Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Lindsay A Dow
- Brookdale Department of Geriatrics and Palliative Medicine
| | - Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrea S Weintraub
- Division of Newborn Medicine, Department of Pediatrics,Icahn School of Medicine at Mount Sinai, New York, New York
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Boztepe H, Çınar Özbay S, Akçam A, Kanbay Y. The pediatric provider communication skills assessment scale. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:307-315. [PMID: 37394543 DOI: 10.1111/jcap.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
PROBLEM Building rapport and trust between healthcare professional and patient/parents would improve satisfaction of patient/parents. The purpose of this study was to develop "The Pediatric Provider Communication Skills Assessment Scale" in this study. METHODS A trial form, with linguistic and psychometric validation and consisting of 44 statements, was administered to a sample of 325 individuals. Data were collected between January 20 and October 22, 2021. The validity of the scale was concluded after examining its construct validity and internal validity. "Exploratory factor analysis" was used for determining construct validity, and "comparison of lower-upper groups" for internal validity. "Cronbach's α reliability coefficient" and "split half test consistency coefficient" were calculated for testing the reliability of the scale. FINDINGS The Pediatric Provider Communication Skills Assessment Scale that we developed consists of one dimension and 20 items, and the variance it can explain was calculated as 62.3%. The Cronbach α reliability coefficient of the scale was calculated as 0.90, indicating high reliability. CONCLUSIONS According to the findings, "The Pediatric Provider Communication Skills Assessment Scale" is a scale with features that can measure in a valid and reliable way, with high variance and a low number of items. The study aims to develop the "The Pediatric Provider Communication Skills Assessment Scale," and present it to the literature as a validated and reliable new objective measurement tool. This study will enable us to understand more about the complex communication processes involved in pediatric care and how these may influence care delivery.
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Affiliation(s)
- Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atilim University, Ankara, Turkey
| | - Sevil Çınar Özbay
- Emergency Aid and Disaster Management, Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey
| | - Aysun Akçam
- Department of Turkish Language Teaching, Faculty of Education, Necmettin Erbakan University, Konya, Turkey
| | - Yalçın Kanbay
- Department of Nursing, Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey
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Mota M, Melo F, Henriques C, Matos A, Castelo-Branco M, Monteiro M, Cunha M, Reis Santos M. The relationship between acute pain and other types of suffering in pre-hospital trauma victims: An observational study. Int Emerg Nurs 2023; 71:101375. [PMID: 37913691 DOI: 10.1016/j.ienj.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Acute pain is an important complaint reported by trauma victims, however, the relationship between it and other types of discomfort, such as discomfort caused by cold, discomfort caused by immobilization, and psychological distress such as fear, anxiety, and sadness is limitedly studied and documented. AIM To assess the relationship between acute trauma pain and other types of suffering in pre-hospital trauma victims. METHODS This is a prospective multicentre cohort study conducted in Immediate Life Support Ambulances in Portugal. All adult trauma victims with a mechanism of blunt and penetrating injuries, falls, road accidents and explosions, were included. RESULTS 605 trauma victims were included, mainly male, with a mean age of 53.4 years. Before the intervention of the rescue teams, 90.5 % of the victims reported some level of pain, 39.0 % reported discomfort caused by cold, while 15.7 % felt fear, 8.4 % sadness, 49.8 % anxiety and 4.5 % apathy. Victims with high discomfort caused by cold tend to have higher pain levels. Significantly higher pain intensity were observed in victims with fear and anxiety. Univariate and multivariate analysis indicates that immobilization is associated with increased pain levels. CONCLUSIONS There is a statistically significant relationship between acute trauma pain, anxiety, fear, cold and immobilization.
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Affiliation(s)
- Mauro Mota
- Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal; Health School of the Polytechnic Institute of Viseu, Portugal; UICISA: E/ESEnfC - Cluster at the Health School of Polytechnic Institute of Viseu, Viseu, Portugal; CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal; Academic Clinical Centre of Beira, Portugal.
| | - Filipe Melo
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Active Ageing Competence Centre, Portugal
| | - Carla Henriques
- Polytechnic Institute of Viseu, Portugal; Centre for Mathematics of the University of Coimbra - CMUC, Portugal; CISeD - Research Centre in Digital Services, Instituto Politécnico de Viseu, Portugal
| | - Ana Matos
- Polytechnic Institute of Viseu, Portugal; Centre for Mathematics of the University of Coimbra - CMUC, Portugal; CISeD - Research Centre in Digital Services, Instituto Politécnico de Viseu, Portugal
| | - Miguel Castelo-Branco
- Academic Clinical Centre of Beira, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; UBI-Health Sciencies Reserarch Centre, Portugal; University Hospital Centre of Cova da Beira, Portugal
| | | | - Madalena Cunha
- Health School of the Polytechnic Institute of Viseu, Portugal; UICISA: E/ESEnfC - Cluster at the Health School of Polytechnic Institute of Viseu, Viseu, Portugal; Academic Clinical Centre of Beira, Portugal
| | - Margarida Reis Santos
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Nursing School of Porto, Porto, Portugal
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Horiuchi S, Nomura O, Curry L, Kushima M, Arnold L, Yamagata Z. 'Caregivers' awareness matters': Call for a child-centred approach to early detection of autism spectrum disorder through well-child visits in Japan. Child Care Health Dev 2023; 49:985-994. [PMID: 36807909 DOI: 10.1111/cch.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Early detection of autism spectrum disorder (ASD) is essential to provide children with timely treatment and support. Evidence-based screening measures make it possible to identify children with suspected ASD at an early stage. Although Japan has a universal healthcare system that covers well-child visits, detection rates of developmental disorders, including ASD, at 18 months vary widely between municipalities (0.2%-48.0%). The reasons for this high level of variation are poorly understood. The present study aims to describe the barriers and facilitators of incorporating ASD identification during well-child visits in Japan. METHODS This is a qualitative study that conducts semi-structured in-depth interviews in two municipalities of Yamanashi Prefecture. We recruited all public health nurses (n = 17) and paediatricians (n = 11) involved in the well-child visit in each municipality and caregivers of children who also participated in the visits during the study period (n = 21). RESULTS We identified four themes characterizing the process of ASD identification in the target municipalities: (1) Identification of children with ASD is driven by caregivers' sense of concern, acceptance and awareness. (2) Multidisciplinary cooperation and shared decision-making is limited. (3) Skills and training for developmental disabilities screening are underdeveloped. (4) Caregivers' expectations shape the interaction in important ways. CONCLUSIONS Non-standardization of screening methods, limited knowledge and skills on screening and child development among healthcare providers and poor coordination among healthcare providers and caregivers are the main barriers to effective early detection of ASD through well-child visits. The findings suggest the importance of promoting a child-centred care approach through the application of evidence-based screening measures and effective information sharing.
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Affiliation(s)
- Sayaka Horiuchi
- Department of Health Sciences, Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | - Osamu Nomura
- Department of Health Sciences Education, Hirosaki University, Aomori, Japan
- Centre for Community-based Health Professions Education, Hirosaki University, Aomori, Japan
| | - Leslie Curry
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, Connecticut, USA
| | - Megumi Kushima
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Linda Arnold
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, Connecticut, USA
- International Pediatric Association (IPA), IPA-LEAD program, Marengo, Illinois, USA
| | - Zentaro Yamagata
- Department of Health Sciences, Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
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20
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Graetz D, Ahmad A, Raza MR, Hameed A, Naheed A, Najmi A, tul Quanita A, Munir S, Ferrara G, Staples C, Rodriguez Galindo C, Hamid SA, Jeha S, Mack JW. Barriers and Facilitators of Quality Family-Centered Communication in Pakistan. JCO Glob Oncol 2023; 9:e2300178. [PMID: 38085038 PMCID: PMC10664852 DOI: 10.1200/go.23.00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Communication is a fundamental aspect of patient- and family-centered care. Unfortunately, there is a dearth of evidence regarding pediatric cancer communication in low- and middle-income countries, where over 90% of all children with childhood cancer live. The purpose of this study was to explore barriers and facilitators of quality communication within two pediatric cancer centers in Pakistan. METHODS Semistructured interviews were conducted with 20 multidisciplinary pediatric cancer clinicians and 18 caregivers of children with cancer at Children's Hospital of Lahore and Indus Hospital in Karachi, Pakistan. Interviews were conducted in English or Urdu, audio-recorded, transcribed, and translated to English. Two researchers coded each transcript using an inductively derived codebook. Thematic content analysis focused on barriers and facilitators of high-quality communication. RESULTS Pakistani clinicians and caregivers identified factors that affected the quality of patient-centered cancer communication. These included structural factors including setting, available interpreters, documentation, patient volume, teamwork, and financial support. Clinician-level communication barriers and facilitators included communication training, clinician distress/boundaries, and the ability to have recurrent conversations. Patient or family characteristics affecting communication included education, income status, primary language, and geography; the child's specific disease type; and relational elements such as social support, empowerment, and split decision makers. Participants identified existing or potential interventions related to each factor. CONCLUSION Multilevel factors serve as either barriers or facilitators for pediatric cancer communication in Pakistan. Identification of these elements of communication is an essential step toward interventions aimed at improving patient- and family-centered care in resource limited settings.
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Affiliation(s)
- Dylan Graetz
- St Jude Children's Research Hospital, Memphis, TN
| | - Alia Ahmad
- Children's Hospital Lahore, Lahore, Pakistan
| | | | | | | | | | | | | | - Gia Ferrara
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Sima Jeha
- St Jude Children's Research Hospital, Memphis, TN
| | - Jennifer W. Mack
- Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA
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Ferro MA, Basque D, Elgie M, Dol M. Agreement of the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in parents and youth with physical illness living in Canada. Disabil Rehabil 2023; 45:3125-3134. [PMID: 36066067 DOI: 10.1080/09638288.2022.2120095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study modelled the factor structure and tested for measurement invariance between youth and parent reports on the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0; estimated agreement between informants; and, examined moderators of youth-parent discrepancies. MATERIALS AND METHODS Data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117). Multiple-group confirmatory factor analysis was used to test for measurement invariance and Wilcoxon signed-rank tests compared informant scores. Intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement plots were used to examine the youth-parent agreement. RESULTS The WHODAS 2.0 demonstrated measurement invariance [χ2 = 221.8(136), p < 0.01; RMSEA = 0.073 (0.055, 0.091); CFI = 0.962; and, SRMR = 0.078]. Youth typically reported more disability compared to parent proxies, with the exception of item Q5 (emotional). The agreement was low (ICC = 0.08-0.53). Youth sex moderated informant agreement such that more consistent agreement was seen for female youth (β = 0.54, p < .01) compared to male youth (β = 0.11, p = .29). CONCLUSIONS Youth and their parents interpret the construct of disability, as measured by the 12-item WHODAS 2.0, similarly. Thus, informant differences represent real differences that are not a consequence of error. Low parent-youth agreement reinforces the need for collecting multiple perspectives in the pediatric setting, especially for male youth.Implications for rehabilitationThe WHODAS 2.0 is one of the most widely used measures of disability and functioning.Measurement invariance of the WHODAS 2.0 suggests that youth and parents interpret the construct of disability similarly.Parent-youth agreement was low and youth typically report more disability compared to parent proxies.More consistent agreement with parents was found for female youth compared to male youth.
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Affiliation(s)
- Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Dominique Basque
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Melissa Elgie
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Megan Dol
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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22
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Guttmann K, Silverman R, Weintraub AS. Neonatal serious illness: operational definition. BMJ Support Palliat Care 2023:spcare-2023-004305. [PMID: 37620122 DOI: 10.1136/spcare-2023-004305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES (1) To operationalise our previously published definition of neonatal serious illness by applying it to a patient cohort and (2) to evaluate timing of palliative care consultation, goals of care discussions and meeting serious illness criteria. METHODS This was a retrospective chart review. Inborn neonates delivered between January 2006 and December 2020 who died prior to neonatal intensive care unit discharge were identified through EPIC query. Kruskal-Wallis and Mann-Whitney-U tests were used to compare time intervals relating to transition to serious illness across causes of death and other factors. χ2 tests were used to examine frequency of goals of care conversations by factors. RESULTS Eighty-eight per cent of patients met criteria for neonatal serious illness within 48 hours of life. There were no significant differences in transition to serious illness between preterm and term infants. Time to identification of serious illness varied significantly by cause of death. Palliative care was consulted for 5.7% of patients. CONCLUSION All patients met criteria for serious illness early in life based on our definition. This definition may be useful for identifying neonates with serious illness in time to provide support. Additional work is needed to apply this definition prospectively to explore its utility for clinical care and research.
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Affiliation(s)
- Katherine Guttmann
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Silverman
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea S Weintraub
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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23
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van Woerden CS, Vroman H, Brand PLP. Child participation in triadic medical consultations: A scoping review and summary of promotive interventions. PATIENT EDUCATION AND COUNSELING 2023; 113:107749. [PMID: 37126992 DOI: 10.1016/j.pec.2023.107749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/15/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To promote patient centered care, children with health issues should be supported to participate in consultations with health care professionals. We aimed to summarize, in a scoping review, the evidence on child participation in triadic encounters and its promotive interventions. METHODS Two researchers systematically searched four major databases, and included studies on child participation in medical consultations. A synthesis of quantitative and qualitative data was made. RESULTS Of 1678 retrieved records, 39 papers were included: 22 quantitative, 14 qualitative and 3 mixed-methods studies. Child participation, measured by utterances, turns or speech time, ranged between 4% and 14%. Participation increased with age. Equidistant seating arrangements, child-directed gaze and finding the appropriate tone of voice by the physician promoted child participation. Despite all facilitative efforts of doctors and parents, such as social talk, eHealth tools or consultation education, no increase in child participation was observed over the last 50 years. CONCLUSIONS Children continue to participate only marginally in medical consultations, despite their desire to be involved in various aspects of the clinical encounter and their right to have their voice heard. PRACTICE IMPLICATIONS Health care professionals should provide more opportunities for children to participate in triadic medical encounters and create an inclusive environment.
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Affiliation(s)
| | - Heleen Vroman
- Department of Science, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Paul L P Brand
- Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Center, University of Groningen, the Netherlands
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24
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Rholl E, Leuthner SR. The logistics of withdrawing life-sustaining medical treatment in the neonatal intensive care unit. Semin Fetal Neonatal Med 2023; 28:101443. [PMID: 37596126 DOI: 10.1016/j.siny.2023.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Withdrawal of life sustaining medical treatments is a common mode of death in the neonatal intensive care unit. Shared decision making and communication are crucial steps prior to, during and after a withdrawal of life sustaining medical treatments. Discussion should include the steps to occur during the withdrawal. Physicians should recommend appropriate withdrawal steps based on family goals. Stepwise approach should be taken only if a family requests. Care should continue for the family and staff after the withdrawal and the infant's death.
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Affiliation(s)
- Erin Rholl
- Department of Pediatrics, Medical College of Wisconsin, 999 N 92nd St, Suite C 410, Wauwatosa, Wisconsin, 53226, USA.
| | - Steven R Leuthner
- Department of Pediatrics, Medical College of Wisconsin, 999 N 92nd St, Suite C 410, Wauwatosa, Wisconsin, 53226, USA.
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25
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Høeg BL, Sevillano PB, Enesco I, Wakefield CE, Larsen HB, Bidstrup PE. Child-centered communication interventions in pediatric oncology: A scoping review and proposed new communication model. Pediatr Blood Cancer 2023:e30533. [PMID: 37401446 DOI: 10.1002/pbc.30533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
Child-centered communication in pediatric oncology can be challenging. We aimed to review communication interventions with children about cancer treatment and prognosis to identify potentially effective child-centered communication models and approaches. We updated a previous review on communication interventions in oncology and searched MEDLINE, Scopus, and PsychINFO for studies indexed between October 2019 up to October 2022. We further searched for ongoing studies on ClinicalTrials.gov. Communication interventions targeting pediatric oncology patients (below 18 years), with outcomes of communication, psychological symptoms or satisfaction in the target population were eligible. We identified 685 titles/abstracts, screened the full text of 34 studies and included only one published study and two ongoing studies. The published study tested a communication tool to help clinicians inform adolescents about treatment options and facilitate shared decision-making. No communication models were identified. We drew on knowledge from existing studies and guidelines to develop a new child-centered communication model.
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Affiliation(s)
- Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Paula Barrios Sevillano
- Department of Developmental Psychology, Faculty of Psychology, Complutense University of Madrid, Spain
| | - Ileana Enesco
- Department of Developmental Psychology, Faculty of Psychology, Complutense University of Madrid, Spain
| | - Claire E Wakefield
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Hanne Baekgaard Larsen
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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26
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Haward MF, Lorenz JM, Janvier A, Fischhoff B. Antenatal consultation and deliberation: adapting to parental preferences. J Perinatol 2023; 43:895-902. [PMID: 36725985 DOI: 10.1038/s41372-023-01605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze and compare perspectives on antenatal consultation and decision-making from participants with varying degrees of prematurity experience and clinician-experts. STUDY DESIGN Open-ended interviews structured around topics previously identified by recognized clinician-experts were conducted with participants having different levels of prematurity experience. Analysis used mixed methods (thematic and mental models analysis). Secondary sub-group comparisons were performed, based on degree of experience. RESULTS Non-clinician participants' (n = 80) perspectives differed regarding: amount and content of information desired, decision-making strategies, and who - parent or clinician - should direct consultations. Most wanted to retain decisional authority, all recognized their emotional limitations and many advocated for deliberation support. Participants worried parents' would regret choosing palliative care contrary to clinicians. Bereaved parents often saw issues differently. CONCLUSIONS Parents approach risk and decision-making for extremely premature infants in a personal fashion. They need personalized support tailored to their unique circumstances, decision-making preferences, and emotions.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - John M Lorenz
- Department of Pediatrics, Morgan Stanley Children Hospital of New York and Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal and Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Unité de recherche en éthique clinique et partenariat famille, CHU Sainte-Justine, Montréal, QC, Canada
| | - Baruch Fischhoff
- Institute for Politics and Strategy, and Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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27
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Crellin E, Martyn M, McClaren B, Gaff C. What matters to parents? A scoping review of parents' service experiences and needs regarding genetic testing for rare diseases. Eur J Hum Genet 2023:10.1038/s41431-023-01376-y. [PMID: 37308600 PMCID: PMC10400618 DOI: 10.1038/s41431-023-01376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 06/14/2023] Open
Abstract
Patient care experiences are key to promoting better outcomes and are an essential consideration for successful implementation of genomics in paediatric care. To understand parents' service experiences and needs regarding testing of their child for rare diseases, we conducted a scoping review. Five databases were searched (2000-2022), with 29 studies meeting the inclusion criteria. Experiences of care wholly delivered by genetic services were most commonly reported (n = 11). Results were synthesised by mapping extracted data to adapted Picker principles of person-centred care. Parents especially valued and emphasised the importance of feeling 'cared for', continuous relationships with clinicians, empathic communication, being kept informed while awaiting genetic test results, linkage with informational and psychosocial resources following results disclosure, and follow-up. Strategies were often proposed by authors to address long-standing unmet needs but evidence from the literature regarding their potential effectiveness was rarely provided. We conclude that 'what matters' to parents regarding genetic testing is not dissimilar to other aspects of care. Paediatric medical specialists have existing skill sets, trusted relationships and can apply familiar principles of 'good' care to enhance experiences of genetic testing. The lack of evidence for service improvement strategies highlights the pressing need to undertake rigorous design and testing of interventions alongside mainstreaming of genomics into paediatric care.
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Affiliation(s)
- Erin Crellin
- University of Melbourne, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Melissa Martyn
- University of Melbourne, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, Melbourne, VIC, Australia
| | - Belinda McClaren
- University of Melbourne, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, Melbourne, VIC, Australia
| | - Clara Gaff
- University of Melbourne, Melbourne, VIC, Australia.
- Genomics in Society, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- Melbourne Genomics Health Alliance, Walter and Eliza Hall Institute, Melbourne, VIC, Australia.
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28
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Sandridge S, Palokas M, Odom A. Nursing staff communication with pediatric patients and families in a pediatric transitional care unit: a best practice implementation project. JBI Evid Implement 2023; 21:120-127. [PMID: 36573425 DOI: 10.1097/xeb.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The objective of this project was to promote evidence-based practices regarding nursing communication with pediatric patients/families. INTRODUCTION Effective communication between healthcare providers and patients/families is an essential component of patient care and plays a vital role in patient outcomes. Ineffective communication among the healthcare team and patient families has been described as a significant factor contributing to adverse events and poor health outcomes. METHODS The project used JBI's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for encouraging evidence-based practices. A baseline audit was conducted, followed by the implementation of targeted strategies. The project was completed with a follow-up audit to determine change in practice. RESULTS Three evidence-based practices were utilized as audit criteria for the project. The baseline audit on the three audit criteria revealed an average compliance of 30%. After providing communication skills training to nursing staff and education and visual aids to patients/families and nursing staff regarding the use of white boards, follow-up audits revealed an average compliance of 62%, an increase of 32%. CONCLUSIONS These implementation strategies will continue to be utilized on the unit and will be implemented in other areas of the hospital to further improve communication between patients/families and their healthcare team.
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Affiliation(s)
- Shanda Sandridge
- University of Mississippi School of Nursing
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence
| | - Michelle Palokas
- University of Mississippi School of Nursing
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence
| | - Anna Odom
- Children's of Mississippi, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence
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29
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Inhestern L, Brandt M, Driemeyer J, Denecke J, Johannsen J, Bergelt C. Experiences of Health Care and Psychosocial Needs in Parents of Children with Spinal Muscular Atrophy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5360. [PMID: 37047974 PMCID: PMC10094281 DOI: 10.3390/ijerph20075360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
Spinal muscular atrophy (SMA) is a neurodegenerative disorder that is characterized by progressive weakness, respiratory insufficiency, and dysphagia. Due to symptom burden and disease progress, its care management and impact on daily life can severely burden the families of affected children. The objectives of this study are (1) to explore the health care experiences and (2) to investigate the psychosocial needs of the parents of children with SMA. In total, 29 parents of patients with SMA participated in our study. All children received supportive therapy (e.g., physiotherapy) and most were dependent on medical equipment. Parents perceived the health care positively regarding team quality, communication and access to medical care. An assessment of the impact of the child's health on the family (e.g., stressors, burden, consequences) is not routinely integrated into care. On average, parents reported low to medium levels of psychosocial needs. Due to the complex health care needs of SMA patients, the health care experiences of parents can provide relevant information on care delivery. To enhance the inclusion of psychosocial and emotional issues, as well as family impact, into routine health care, health care providers should be sensitive towards parental needs for consistency in the health care team and emotional aspects and, if applicable, address them proactively.
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Affiliation(s)
- Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maja Brandt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Joenna Driemeyer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Medical Psychology, University Medicine Greifswald, 17475 Greifswald, Germany
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30
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Klasen JM, Beck J, Randall CL, Lingard L. Using Trainee Failures to Enhance Learning: A Qualitative Study of Pediatric Hospitalists on Allowing Failure. Acad Pediatr 2023; 23:489-496. [PMID: 36442834 DOI: 10.1016/j.acap.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/10/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Attendings allow trainee failure when perceived educational benefits outweigh potential patient harm. This strategy has not been explored in pediatrics, where it may be shaped by unique factors. Our objectives were to understand if, when, and how pediatric hospitalists allow trainees to fail during clinical encounters. METHODS Using constructivist grounded theory, we conducted semistructured interviews with 21 pediatric hospitalists from a children's hospital in the United States. Iterative, constant comparative analysis took place concurrent with data collection. During regular team meetings, we refined and grouped codes into larger themes. RESULTS Nineteen of the 21 participants shared that they intentionally allowed failure as a teaching strategy, acknowledging this strategy's emotional power and weighing the educational benefits against harms to current and future patients, caregivers, and trainees. Participants described a multistep process for allowing failure: 1) initiate an orientation to signal that they prioritize a psychologically safe learning environment; 2) consider factors which influence their decision to allow failure; and 3) debrief with trainees. However, participants did not explicitly alert trainees to this teaching strategy. They also avoided using the word "failure" during debriefs to protect trainees from psychological harm. CONCLUSIONS Most pediatric hospitalists in this study allowed failure for educational purposes. However, they did so cautiously, weighing the educational value of the failure against the safety of both current and future patients, the relationship with the caregivers, and the trainees' well-being. Future research should involve trainees to more comprehensively understand the experience and effectiveness of this teaching strategy.
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Affiliation(s)
- Jennifer M Klasen
- Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel (JM Klasen), Basel, Switzerland
| | - Jimmy Beck
- Department of Pediatrics, University of Washington (J Beck), Seattle, Wash.
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry (CL Randall), Seattle, Wash
| | - Lorelei Lingard
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University (L Lingard), London, Ontario, Canada
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31
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Zaidman-Zait A, Curle D, Jamieson JR. Health-related quality of life among mothers of children with cochlear implants with and without developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 133:104397. [PMID: 36586392 DOI: 10.1016/j.ridd.2022.104397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cochlear implants (CIs) are widely used among children with severe to profound hearing loss. Raising a child with a CI presents unique challenges to the family, especially when the child has a developmental disability (CI-DD). AIMS This study aimed to elucidate the relations between the functioning of children with CIs, their mothers' coping resources (i.e., social support and family-centered care), and maternal health-related quality of life (HRQoL). Also, it examined whether the presence of a DD in addition to the child's deafness moderated these relations. METHODS AND PROCEDURES A sample of 100 mothers of children with CIs (54 in the CI-DD group) completed questionnaires regarding perceived social support, family-centered care, and HRQoL. OUTCOMES AND RESULTS Mothers of deaf children with CIs and DD experienced lower levels of family functioning and HRQoL across all dimensions compared to mothers of deaf children with CIs without DD. In addition, social support was positively related to HRQoL only among mothers of children in the CI-DD group, indicating the protective role of social support. CONCLUSIONS AND IMPLICATIONS Social support is an important coping resource, and psychosocial support is needed for mothers of children with CIs, especially for mothers whose children also have a DD.
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Affiliation(s)
- Anat Zaidman-Zait
- Tel Aviv University, Israel; University of British Columbia, Canada.
| | - Deirdre Curle
- Washington Center for Deaf and Hard of Hearing Youth, USA.
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32
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The role of debriefing after cardiorespiratory arrest in the pediatric emergency department. Eur J Emerg Med 2023; 30:49-51. [PMID: 36542338 DOI: 10.1097/mej.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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33
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Alarjeh G, Boufkhed S, Alrjoub W, Guo P, Yurduşen S, Ahmed F, Abdal-Rahman M, Alajarmeh S, Alnassan A, Al-Awady S, Kutluk T, Harding R, Shamieh O. Communication and information sharing with pediatric patients including refugees with advanced cancer, their caregivers, and health care professionals in Jordan: a qualitative study. Front Oncol 2023; 13:1118992. [PMID: 37182158 PMCID: PMC10172987 DOI: 10.3389/fonc.2023.1118992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Effective communication in pediatric palliative cancer care is an important aspect of practice to enhance patient- and family-centered care, and to optimize decision-making. However, little is known about communication preferences practices from the perspectives of children, caregivers and their health care professionals (HCPs) in the Middle Eastern region. Furthermore, involving children in research is crucial but limited. This study aimed to describe the communication and information-sharing preferences and practices of children with advanced cancer, their caregivers, and health care professionals in Jordan. Methods A qualitative cross-sectional study was conducted using semi-structured face to face interviews with three groups of stakeholders (children, caregivers and HCPs). Purposive sampling recruited a diverse sample from inpatient and outpatient settings at a tertiary cancer center in Jordan. Procedures were in line with the Consolidated criteria for reporting qualitative research (COREQ) reporting guidelines. Verbatim transcripts were thematically analyzed. Findings Fifty-two stakeholders participated: 43 Jordanian and 9 refugees (25 children, 15 caregivers and 12 HCPs). Four major themes emerged: 1) Hiding information between the three stakeholders which includes parents who hide the information from their sick children and ask the HCPs to do so to protect the child from distressful emotions and children who hide their suffering from their parents to protect them from being sad; 2) Communication and sharing of clinical versus non-clinical information; 3) Preferred communication styles such as use of a companionate approach by acknowledging patients and caregivers' suffering, building a trustful relationship, proactive information sharing, considering child age and medical status, parents as facilitators in communication, and patients' and caregivers' health literacy; 4) Communication and information sharing with refugees where they had dialect issues, which hindered effective communication. Some refugees had unrealistically high expectations regarding their child's care and prognosis, which posed challenges to communication with staff. Discussion The novel findings of this study should inform better child-centered practices and better engage them in their care decisions. This study has demonstrated children's ability to engage in primary research and to express preferences, and parents' ability to share views on this sensitive topic.
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Affiliation(s)
- Ghadeer Alarjeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
- *Correspondence: Ghadeer Alarjeh, ; Omar Shamieh,
| | - Sabah Boufkhed
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- Humanitarian and Conflict Response Institute, The University of Manchester, Manchester, United Kingdom
| | - Waleed Alrjoub
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ping Guo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sema Yurduşen
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Türkiye
- Department of Psychology, Ankara Science University, Ankara, Türkiye
| | - Fahad Ahmed
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Türkiye
- Department of Public Health, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Mousa Abdal-Rahman
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Sawsan Alajarmeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Anwar Alnassan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Shireen Al-Awady
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Türkiye
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Omar Shamieh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
- Department of Palliative care, King Hussein Cancer Center (KHCC), Amman, Jordan
- College of Medicine, the University of Jordan, Amman, Jordan
- *Correspondence: Ghadeer Alarjeh, ; Omar Shamieh,
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Bradshaw S, Brinkley A, Scanlan B, Hopper L. The burden and impact of recurrent abdominal pain – exploring the understanding and perception of children and their parents. Health Psychol Behav Med 2022; 10:888-912. [PMID: 36186891 PMCID: PMC9518242 DOI: 10.1080/21642850.2022.2121710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Recurrent abdominal pain (RAP) is a common complaint for children and can result in a significantly lower quality of life due to the extent it can interfere with normal life. RAP can also significantly impact the quality of life of parents. This study sought to qualitatively explore parents’ and children’s understanding and perceptions of the burden and impact of RAP. Methods: Semi-structured interviews were conducted with a sample of parent/child dyads or families (N = 5) engaging with a psychology service. Findings: The findings of the inductive thematic analysis revealed four emergent themes common to both parents and children: (1) Perception, understanding and identification of RAP, (2) Contributing factors, (3) Coping mechanisms/pain management strategies, and (4) Impact and burden of RAP. Conclusions: These findings have important clinical implications regarding the identification and management of RAP and may also contribute to improving communication between clinicians, parents and children by providing insight from multiple perspectives into how RAP is experienced.
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Affiliation(s)
- Sam Bradshaw
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Aoife Brinkley
- Children’s Health Ireland (CHI) at Connolly, Dublin, Ireland
| | - Barry Scanlan
- Children’s Health Ireland (CHI) at Connolly, Dublin, Ireland
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
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Luff D, Buscher SW, Ward VL, Ballal SA, Holden P, Pierre R, Won P, Yu EJ, Toomey SL. Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience. Pediatrics 2022; 150:189912. [PMID: 36336649 DOI: 10.1542/peds.2021-056001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Racial and ethnic and socioeconomic differences in patient experience are prevalent and can negatively impact health outcomes. Our objective was to examine differences in family experience of care in the pediatric ambulatory setting. METHODS We conducted interviews with parents of patients from different demographic groups who had received care at 1 of 3 clinics at a quaternary children's hospital. Multidisciplinary team conducted inductive and deductive thematic analysis of transcribed interviews. Sentiments and recurring themes were compared within and between racial and ethnic groups, insurance status, and language. RESULTS Eighty parents were interviewed. Three primary themes were identified: (1) mitigation of system issues: parents' mixed experiences with staff or clinicians mitigating system issues impacted their overall perceptions of care; (2) pivotal role of personal interactions: clinicians' interactions positively influenced family-clinician relationships and offset negative experiences; (3) effective explanations: clinicians' clear and thorough explanations were crucial in enhancing parent confidence in care. As an overarching theme, discrimination and disrespect by staff undermined trust in care, affecting all aspects of experience. With the exception of explanations, a higher proportion of publicly-insured parents reported negative experiences across all themes compared to those with private insurance. Asian parents with public insurance had the highest proportion of interviews that were mainly negative in sentiment. CONCLUSIONS Our findings offer nuanced insights into differences in the experience of ambulatory care. Insurance status emerged as an important marker of differential perceptions of care. Our study points to areas for improvement and highlights family-clinician interactions as vital to overall positive experience.
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Affiliation(s)
- Donna Luff
- Simulator Program (SIMPeds).,Harvard Medical School, Boston, Massachusetts
| | | | - Valerie L Ward
- Office of Health Equity and Inclusion, Department of Radiology.,Harvard Medical School, Boston, Massachusetts
| | - Sonia A Ballal
- Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Sara L Toomey
- Division of General Pediatrics.,Harvard Medical School, Boston, Massachusetts
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Tian JD, Wu FF, Wen C. Effects of a teaching mode combining SimBaby with standardized patients on medical students' attitudes toward communication skills. BMC MEDICAL EDUCATION 2022; 22:825. [PMID: 36451143 PMCID: PMC9710049 DOI: 10.1186/s12909-022-03869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/07/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the effect of a teaching mode combining SimBaby with standardized patients (SP) on medical students' attitudes toward communication skills (CS). METHODS Forty 8-year medical program students majoring in clinical medicine were randomly divided into the SimBaby group (n = 20) and the SP + SimBaby group (n = 20). The Communication Skills Attitude Scale (CSAS) was used to evaluate medical students' attitudes toward CS learning. RESULTS In the SimBaby and SP + SimBaby groups, there were no statistically significant differences in the Positive Attitude Subscale (PAS) and Negative Attitude Subscale (NAS) scores between males and females (p > 0.05). Compared to the SimBaby group, the SP + SimBaby group showed statistically significant differences in PAS, NAS, and the two dimensions of importance in medical context and learning (p < 0.05). There were no statistically significant differences between groups in the dimensions of excusing and overconfidence (p > 0.05). CONCLUSION Compared with SimBaby alone, the SP + SimBaby teaching mode can improve medical students' attitude toward CS learning, suggesting that the organic integration of multiple simulation-based medical teaching methods plays an important role in the acquisition of CS.
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Affiliation(s)
- Ji-Dong Tian
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Fei-Feng Wu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Chuan Wen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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Gebre M, Uddin MF, Duke T, Haile K, Faruk MT, Kamal M, Kabir MF, Genetu A, Kebede RA, Demtse A, Weldetsadik AY, Demisse AG, Haile BW, Abdissa A, Elfu T, Tesfaye B, Balcha TT, Shemeles M, Ahmed T, Clemens JD, Chisti MJ. Perception and experience of clinicians and caregivers in treating childhood severe pneumonia and hypoxemia using bubble continuous positive airway pressure in Ethiopian tertiary and general hospitals. PLoS One 2022; 17:e0275952. [PMID: 36315509 PMCID: PMC9621408 DOI: 10.1371/journal.pone.0275952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In low and middle-income countries (LMICs), severe pneumonia with hypoxemia is the leading cause of child deaths, even with the provision of WHO-recommended antibiotic therapy, oxygen therapy and other supportive care. Previous studies found positive outcomes from the use of bubble continuous positive airway pressure (bCPAP) for treating these children compared to the standard oxygen therapy. Due to lack of data on the perceptions and experiences of hospital health care workers and caregivers of children on the feasibility and acceptability of bCPAP in treating children with severe pneumonia and hypoxemia in real-life settings, we examined these issues in tertiary and general hospitals in Ethiopia. METHODS As part of a three-stages clinical trial, this qualitative study was conducted in two tertiary (stage I) and two general (stage II) hospitals from September 2019 to July 2020. During stages I and II, we have consecutively enrolled children with severe pneumonia and hypoxemia and put them on bCPAP to examine its feasibility and acceptability by clinicians and parents. A total of 89 children were enrolled (49 from two tertiary and 40 from two general hospitals). Then qualitative data were collected through 75 repeated in-depth interviews by social-science experts with purposively selected 30 hospital health workers and 15 parents of 12 children who received bCPAP oxygen therapy in the hospitals. Interview data were supplemented by 6 observations in the hospitals. Data were analyzed using a thematic approach. RESULTS Identified structural and functional challenges for the introduction of bCPAP in treating childhood severe pneumonia and hypoxemia in the study hospitals include: inadequate number of pulse oximeters; unavailability of nasal prongs with age-specific size; inadequate and non-functioning oxygen flow meters, concentrator, and cylinders; disruption in power-supply; and inadequate number of staff. The opportunities in introducing bCPAP oxygen therapy included the availability of a dedicated corner for the study patients situated in front of nurse's station, required medicines and satisfactory level of clinicians' knowledge and skills for treating severe pneumonia patients. Additionally, the identified operational challenges were occasional lack of bubbling in the water-filled plastic bottle, lack of stand for holding the water-filled plastic bottle, and delayed shifting of oxygen source from an oxygen concentrator to a cylinder, particularly during electricity disruption. Participants (clinicians and parents) expressed their satisfaction as bCPAP oxygen therapy was found to be simple to handle, children had ease of breathing and recovered fast without major ill effects. CONCLUSION Our study identified some important structural, functional, and operational challenges that need to be addressed before implementation of bCPAP oxygen therapy especially in frontline general hospitals with limited resources. In spite of these observed challenges, the clinicians and caregivers were highly satisfied with the overall performance of bCPAP oxygen therapy.
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Affiliation(s)
- Meseret Gebre
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Md. Fakhar Uddin
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Trevor Duke
- Centre for International Child Health, Royal Children’s Hospital, The University of Melbourne, Melbourne, Australia
| | - Kassa Haile
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Md. Tanveer Faruk
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Mehnaz Kamal
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Md. Farhad Kabir
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Abebe Genetu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Asrat Demtse
- Centre for International Child Health, Royal Children’s Hospital, The University of Melbourne, Melbourne, Australia
| | | | | | | | | | - Teferi Elfu
- Butajira General Hospital, Addis Ababa, Ethiopia
| | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - John D. Clemens
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
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Walsh EI, Sargent G, Cevik-Compiegne B, Roberts M, Palfrey N, Gooyers-Bourke L, Vardoulakis S, Laachir K. Bushfire Smoke and Children's Health-Exploring a Communication Gap. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12436. [PMID: 36231731 PMCID: PMC9566720 DOI: 10.3390/ijerph191912436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The "Black Summer" bushfires of 2019/2020 in Australia generated smoke that persisted for over three months, mainly affecting Eastern Australia. Most communication strategies focused on the fire itself, revealing a knowledge gap in effective communication of the impact of bushfire smoke on health, especially for children and those living in non-English speaking minority groups. To address this, semi-structured qualitative interviews were undertaken with sixteen adults with caring (n = 11) or educational (n = 5) responsibilities for primary-school aged children (5-12 years, with some also having children up to 16 years) who had direct experience of the "Black Summer" bushfires. Overall, 43% (n = 7) of the sample spoke English as a first language, 25% (n = 4) spoke Turkish, with the remainder speaking Persian, Arabic, and Spanish. Thematic inductive qualitative content analysis revealed predominant themes of the role of parents and caregivers as conduits and curators of information. Air quality apps were the most common source of information. Language barriers and the lack of child-friendly methods of communication were highlighted as particular challenges. This qualitative study provides evidence for future development of communication strategies to better serve culturally and linguistically diverse individuals and the children in their care.
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Affiliation(s)
- Erin I. Walsh
- Population Health Exchange, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Ginny Sargent
- Population Health Exchange, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Burcu Cevik-Compiegne
- Centre for Arab and Islamic Studies, Australian National University, Canberra, ACT 2601, Australia
| | - Michelle Roberts
- Medical School, Australian National University, Canberra, ACT 2601, Australia
| | - Nicola Palfrey
- Headspace Australia, 1/1 Torrens St. Braddon, Canberra, ACT 2612, Australia
| | - Laura Gooyers-Bourke
- Australian Child and Adolescent Trauma, Loss & Grief Network, Australian National University, Canberra, ACT 2601, Australia
| | - Sotiris Vardoulakis
- Healthy Environments and Lives (HEAL) National Research Network
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Karima Laachir
- Centre for Arab and Islamic Studies, Australian National University, Canberra, ACT 2601, Australia
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Wu JM, Tam MT, Page PM, Lamb EA, Jordan I, Chambers CT, Robillard JM. Pain management communication between parents and nurses after pediatric outpatient surgery. J Pediatr Nurs 2022; 65:e87-e92. [PMID: 35459566 DOI: 10.1016/j.pedn.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to explore parent-nurse pain management communication during a child's discharge process following pediatric outpatient surgery. DESIGN AND METHODS Thirty-two clinical encounters at discharge between parents (N = 40) and nurses (N = 25) at BC Children's Hospital were audio recorded and transcribed verbatim. Content analysis was applied on the audio recordings and corresponding transcripts using MAXQDA qualitative research software and Microsoft Excel. RESULTS Overall, nurses delivered pain management instructions at an average sixth grade readability level and frequently used communication elements of reassurance, optimism, and question-asking. Less consistent communication elements included open-ended questions, interruptions, and promotion of parental decision-making. Parents most frequently asked one to five questions, with pain medication being the most inquired topic. CONCLUSIONS Several strengths of the nurse communication approach were identified, and parent questions highlighted a need for greater understanding around pain medication. PRACTICE IMPLICATIONS These findings will help guide effective pain management communication and care for young patients and their families.
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Affiliation(s)
- Julia M Wu
- Department of Medicine, Division of Neurology, The University of British Columbia, Vancouver, British Columbia, Canada; BC Children's and Women's Hospital, Vancouver, British Columbia, Canada.
| | - Mallorie T Tam
- Department of Medicine, Division of Neurology, The University of British Columbia, Vancouver, British Columbia, Canada; BC Children's and Women's Hospital, Vancouver, British Columbia, Canada.
| | - Patricia M Page
- BC Children's Hospital, Vancouver, British Columbia, Canada.
| | - Elizabeth A Lamb
- Department of Procedure and Surgical Services, BC Children's Hospital, Vancouver, British Columbia, Canada.
| | - Isabel Jordan
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Christine T Chambers
- Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada; IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada.
| | - Julie M Robillard
- Department of Medicine, Division of Neurology, The University of British Columbia, Vancouver, British Columbia, Canada; BC Children's and Women's Hospital, Vancouver, British Columbia, Canada.
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Gemmiti M, Hamed S, Wildhaber J, Pharisa C, Klumb PL. Physicians' Speech Complexity and Interrupting Behavior in Pediatric Consultations. HEALTH COMMUNICATION 2022; 37:748-759. [PMID: 33441020 DOI: 10.1080/10410236.2020.1868063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pediatricians' communication behavior affects a variety of outcomes in both children and their parents. This study analyzes how speech complexity and interruptions as indicators of accommodative behaviors relate to parental recall of medical information and to their satisfaction with the medical encounter. We recruited 19 pediatricians and 68 parents at pediatric inpatient and outpatient consultations in two Swiss clinics. All medical interactions were videotaped and transcripts were analyzed to assess pediatricians' speech complexity and interrupting behavior was coded from the videos. At the end of the encounter, parents rated their satisfaction with the medical encounter and were probed regarding their recall of medical information. Our results show recall of medical information to be unrelated to pediatricians' speech complexity and negatively associated with their interrupting behavior for parents who report low positive mood. We also found less educated parents to report lower satisfaction when pediatricians employed more complex language. Furthermore, parental satisfaction was negatively associated with pediatricians' interrupting behavior, especially when displayed by male pediatricians. Overall, these findings suggest that pediatricians' speech complexity and interruptions indicate a nonaccommodative stance reducing advantageous parent outcomes.
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Affiliation(s)
| | - Selei Hamed
- Department of Pediatrics, Faculty of Science and Medecine, Hospital Fribourg, University of Fribourg
| | - Johannes Wildhaber
- Department of Pediatrics, Faculty of Science and Medecine, Hospital Fribourg, University of Fribourg
| | - Cosette Pharisa
- Department of Pediatrics, Faculty of Science and Medecine, Hospital Fribourg, University of Fribourg
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Bonder R, Yonadam A, Snider A, Kassam-Lallani D, McPherson AC. Communicating about Mental Health with Youth and Their Families: A Scoping Review of Best Practices and Implications for Youth with Disabilities. Dev Neurorehabil 2022; 25:178-185. [PMID: 34365907 DOI: 10.1080/17518423.2021.1960921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Minimal attention has been placed on supporting the mental health needs of youth with disabilities. Due to a dearth of research on best practices in mental health communication with youth with disabilities, the aim of the scoping review was to identify existing peer-reviewed evidence regarding mental health communication for the general youth population in clinical settings. Three electronic databases were searched. Inclusion criteria were: 1) published in English between 2009 and 2019; 2) children and youth and/or their parents/caregivers; 3) addressed communication-based mental health practices; 4) based in pediatric health care settings. Seven articles were included. Promoting autonomy and engagement, building collaboration and trust, and supplementing conversations with alternative communication approaches were identified as important for having mental health conversations. While implications can be drawn, more work is needed for clinicians to have a rigorous evidence base to draw upon when having these conversations with youth with disabilities.
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Affiliation(s)
- Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Arbella Yonadam
- Public Health Student, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrea Snider
- Psychologist, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Dilshad Kassam-Lallani
- Spina Bifida and Spinal Cord Injury Program, Holland Bloorview Kids Rehabilitation Hospital, ON, Canada. Adjunct Lecturer, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, ON, Canada. Associate Professor, Rehabilitation Sciences Institute and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Ekberg K, Ekberg S, Weinglass L, Herbert A, Rendle‐Short J, Bluebond‐Langner M, Yates P, Bradford N, Danby S. Attending to child agency in paediatric palliative care consultations: Adults' use of tag questions directed to the child. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:566-585. [PMID: 35089602 PMCID: PMC9304193 DOI: 10.1111/1467-9566.13437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 06/18/2023]
Abstract
Children's agency in their own lives is increasingly recognised as important, including within paediatric health care. The issue of acknowledging child agency is complex in the context of paediatric palliative care, where children have serious and complex conditions that often impact their ability to verbally communicate with others. This study explores how clinicians and parents/guardians direct talk towards a child patient when they are present in a consultation. Conversation analysis methods were used to examine 74 video-recorded paediatric palliative care consultations. Detailed turn-by-turn examination of the recorded consultations identified the recurrent use of a practice described by linguists as a 'tag question', which follows some statement (e.g. 'he loves that, don't ya'). Both clinicians and parents/guardians often directed these tag questions towards the child patient. Analysis demonstrated how these tag questions: (1) validated the child's epistemic authority over what was being said and (2) made a child's response a possible, but not necessary, next action. The findings are discussed in relation to the sociology of child agency and how this agency is acknowledged and displayed within and through social interaction. This research provides direct evidence of children's competence as informants about their own symptoms.
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Affiliation(s)
- Katie Ekberg
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Stuart Ekberg
- School of Psychology & CounsellingQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Lara Weinglass
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Anthony Herbert
- Children’s Health Queensland Hospital and Health ServiceBrisbane CityQueenslandAustralia
- Centre for Children's Health ResearchBrisbane CityQueenslandAustralia
- School of NursingQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Johanna Rendle‐Short
- College of Arts and Social SciencesAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Myra Bluebond‐Langner
- Louis Dundas Centre for Children’s Palliative CareUniversity College London Great Ormond Street Institute of Child HealthLondonUK
- Department of Sociology, Anthropology and Criminal JusticeRutgers UniversityCamdenNew JerseyUSA
| | - Patsy Yates
- Centre for Healthcare TransformationQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Faculty of HealthQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Natalie Bradford
- School of NursingQueensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Susan Danby
- School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbane CityQueenslandAustralia
- Australian Research Council Centre of Excellence for the Digital ChildQueensland University of TechnologyBrisbane CityQueenslandAustralia
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Trowbridge A, Wightman A, Kett J. Promise me she'll survive: Navigating emotion and uncertainty in paediatric chronic disease with low-mortality rates. Acta Paediatr 2022; 111:464-466. [PMID: 34751969 DOI: 10.1111/apa.16179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Amy Trowbridge
- Division of Bioethics and Palliative Care Department of Pediatrics University of Washington School of Medicine Seattle Washington USA
| | - Aaron Wightman
- Division of Bioethics and Palliative Care Department of Pediatrics University of Washington School of Medicine Seattle Washington USA
| | - Jennifer Kett
- Division of Bioethics and Palliative Care Department of Pediatrics University of Washington School of Medicine Seattle Washington USA
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Holmes LC, Orom H, Lehman HK, Lampkin S, Halterman JS, Akiki V, Supernault-Sarker AA, Butler SB, Piechowski D, Sorrentino PM, Chen Z, Wilding GE. A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools. J Asthma 2022; 59:523-535. [PMID: 33322963 PMCID: PMC8281495 DOI: 10.1080/02770903.2020.1864823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma. METHODS Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care. RESULTS We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively). CONCLUSIONS Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03032744.
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Affiliation(s)
- Lucy C. Holmes
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Corresponding author: Lucy C. Holmes, Department of Pediatrics, 1001 Main Street, Buffalo, New York 14203, (716) 323-0034,
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Heather K. Lehman
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Stacie Lampkin
- Department of Pharmacy Practice, D’Youville College, Buffalo, NY, USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Vanessa Akiki
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Alicia A. Supernault-Sarker
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Denise Piechowski
- John R. Oishei Children’s Hospital, Kaleida Health, Buffalo, NY, USA
| | | | - Ziqiang Chen
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
| | - Gregory E. Wilding
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
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Measuring communication quality in the Neonatal Intensive Care Unit. Pediatr Res 2022; 91:816-819. [PMID: 33854213 PMCID: PMC9000989 DOI: 10.1038/s41390-021-01522-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND High quality communication between providers and parents of seriously ill neonatal patients is vital and yet poorly understood. Feudtner summarized five challenges and seven priorities to the study and advancement of pediatric palliative care. Improvement of communication is a priority, while lack of specification and measurement of outcomes relevant to the pediatric population remains a challenge. Specifically, measurement of communication quality in pediatrics, and especially neonatology, is problematic. METHODS We conducted a focused review of this topic which we hope will serve to support further research. We reviewed the current literature in Pubmed and searched the Palliative Care Research Cooperative (PCRC) instrument library. RESULTS We found five validated instruments which met our criteria, relied on patient or surrogate report, and were developed to measure quality of communication and/or satisfaction with communication with adult patients or their surrogates. Our Pubmed search yielded 249 unique results, only two of which met our inclusion criteria. CONCLUSION We conclude that development and exhaustive testing of a validated, comprehensive measure of communication quality for the neonatal population is needed. Without such a measure, it will be difficult to advance the field and achieve high quality prognostic communication for the parents of seriously ill babies. IMPACT Measurement of communication quality in pediatrics, and especially neonatology, is problematic, understudied, and yet critical to the advancement of the field. There has not been an overview of existing measures of communication quality in the NICU published, nor has there been a comprehensive discussion of this important topic. Our paper provides such an overview and initiates such a discussion. We present a narrative review of existing measures of communication quality in the NICU in order to highlight the need for further study.
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Tran BQ, Mendoza MM, Saini SK, Sweeny K. Let the Kid Speak: Dynamics of Triadic Medical Interactions Involving Pediatric Patients. HEALTH COMMUNICATION 2022:1-8. [PMID: 35081847 DOI: 10.1080/10410236.2022.2031450] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Communication in healthcare represents the complex interplay between multiple individual and contextual factors unfolding over the course of the medical encounter. Despite significant improvements in patient-centered care delivery, studies of health communication typically focus exclusively on clinical interactions between adult patients and their clinicians. Much less is known about non-dyadic interactions, such as pediatric triads involving a child patient and accompanying parent. Understanding the dynamics of triadic pediatric healthcare communication is the first step toward evaluating and ultimately optimizing these healthcare interactions. Thus, we undertook a mixed-method analysis of 28 audio-recorded triadic medical interactions between healthcare providers, pediatric asthma and allergy patients, and their parents to explore the prevalence of various features of these interactions. Our findings point to mechanisms through which healthcare providers and parents may facilitate or hinder children's involvement in their own asthma and allergy care, including interruptions, unclarified technical medical language, the flow of information exchange, and the formation of dyadic conversational partnerships (coalitions) between providers and parents. Our analyses further reveal that children's participation during their medical visits was minimal (13% of the interaction). Providers in our sample elicited input directly from pediatric patients more often than from parents, though the difference was small. Taken together, these findings provide a foundation on which to develop training and communication interventions to ensure that children have a voice in their medical care.
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Affiliation(s)
| | | | - Sunil K Saini
- Division of Basic and Clinical Immunology, University of California
| | - Kate Sweeny
- Department of Psychology, University of California
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47
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Dorsey BF, Kamimura A, Cook LJ, Kadish HA, Cook HK, Kang A, Nguyen JB, Holsti M. Communication Gaps Between Providers and Caregivers of Patients in a Pediatric Emergency Department. J Patient Exp 2022; 9:23743735221112223. [PMID: 35836779 PMCID: PMC9274403 DOI: 10.1177/23743735221112223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Communication gaps between the healthcare team and caregivers of pediatric patients can
result in negative consequences. This study aims to identify specific words and phrases
used in a pediatric emergency department (ED) that are unclear or confusing to caregivers.
Research assistants at the Primary Children’s Hospital recorded caregivers’ responses to
the question, “What words or phrases have been used during this visit that are
unclear or don’t make sense to you?” Across all steps in the care process, 62
of 220 participants (28.2%) reported unclear words and phrases used by the healthcare
team. Responses recorded after the discharge step had the highest proportion of
communication problems, followed by the initial evaluation and then the update step
(χ2 [2, N = 220] = 6.30,
P = .043). Themes among responses included ED logistics,
signs/symptoms, the diagnostic process, treatment/procedures, general confusion, and
language barriers. These results provide feedback to pediatric emergency medicine
providers about potential communication gaps and point to a need for further efforts to
train providers in the practice of high-quality communication.
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Affiliation(s)
| | | | | | | | | | | | | | - Maija Holsti
- University of Utah, Salt Lake City, UT, USA
- Maija Holsti, University of Utah, 295 Chipeta Way,
Salt Lake City, UT 84108, USA.
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Boer MCD, Zanin A, Latour JM, Brierley J. Paediatric Residents and Fellows Ethics (PERFEct) survey: perceptions of European trainees regarding ethical dilemmas. Eur J Pediatr 2022; 181:561-570. [PMID: 34430986 PMCID: PMC8821074 DOI: 10.1007/s00431-021-04231-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/06/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022]
Abstract
With an increasingly complex healthcare environment, ethics is becoming a more critical part of medical education. We aimed to explore European paediatric trainees' experiences of facing ethical dilemmas and their medical ethics education whilst assessing their perceptions of ethical dilemmas in current and future practice. The Young Sections of the European Academy of Paediatrics and European Society of Paediatric and Neonatal Intensive Care developed an explorative online survey covering demographics, ethical dilemmas faced and ethics training. The survey was made available in nine languages from November 2019 to January 2020 via newsletters and social media. Participants (n = 253) from 22 countries, predominantly female (82%) and residents (70%), with a median age of 29-years, completed the survey. The majority (58%) faced ethical dilemmas monthly or more frequently. Most ethics training was received by ethics lectures in medical school (81%) and on the job (60%). A disagreement between the healthcare team and patient/family was the most frequently faced moral dilemma (45%); the second was withholding/withdrawing life-prolonging measures (33%). The latter was considered the most challenging dilemma to resolve (50%). Respondents reported that ethical issues are not sufficiently addressed during their training and wished for more case-based teaching. Many have been personally affected by moral dilemmas, especially regarding withholding/withdrawing life-prolonging measures, and often felt inadequately supported.Conclusion: Paediatric trainees face many moral issues in daily practice and consider that training about managing current and future ethical dilemmas should be improved, such as by the provision of a core European paediatric ethics curriculum. What is Known: • Paediatric services are becoming more complex with an increase in ethical dilemmas asking for rigorous training in ethics. • Ethics training is often lacking or covered poorly in both pre- and postgraduate medical education curricula. • Existing ethics training for European paediatric trainees is haphazard and lacks standardisation. What is New: • The PaEdiatric Residents and Fellows Ethics (PERFEct) survey provides insight into the European paediatric trainees' views regarding ethical dilemmas in their current and future practice. • European paediatric trainees report a lack of ethics training during paediatric residency and fellowship. • This study provides content suggestions for standardised medical ethics training for paediatric trainees in Europe.
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Affiliation(s)
- M. C. den Boer
- grid.10419.3d0000000089452978Division of Neonatology, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Medical Ethics and Health Law, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands
| | - A. Zanin
- grid.5608.b0000 0004 1757 3470Department of Women’s and Children’s Health, University of Padua, Via Giustiniani, 3-35128 Padua, Italy
| | - J. M. Latour
- grid.11201.330000 0001 2219 0747School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, PL4 8AA UK ,grid.440223.30000 0004 1772 5147Nursing Department, Hunan Children’s Hospital, Changsha, China
| | - J. Brierley
- grid.83440.3b0000000121901201Paediatric Bioethics Centre, University College London, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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49
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Guttmann K, Kase S, Christianson C, Berns S, Kelley A, Weintraub A, Dow L. PedsTalk: Pediatric Communication Skills Training Through Interdepartmental Collaboration. J Pain Symptom Manage 2022; 63:e146-e148. [PMID: 34450239 DOI: 10.1016/j.jpainsymman.2021.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Katherine Guttmann
- Division of Newborn Medicine, Department of Pediatrics (K.G., A.W.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pediatrics (S.K., C.C.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Family Medicine (S.B.), Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Geriatrics and Palliative Medicine (A.K., L.D.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Samuel Kase
- Division of Newborn Medicine, Department of Pediatrics (K.G., A.W.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pediatrics (S.K., C.C.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Family Medicine (S.B.), Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Geriatrics and Palliative Medicine (A.K., L.D.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Caroline Christianson
- Division of Newborn Medicine, Department of Pediatrics (K.G., A.W.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pediatrics (S.K., C.C.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Family Medicine (S.B.), Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Geriatrics and Palliative Medicine (A.K., L.D.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen Berns
- Division of Newborn Medicine, Department of Pediatrics (K.G., A.W.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pediatrics (S.K., C.C.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Family Medicine (S.B.), Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Geriatrics and Palliative Medicine (A.K., L.D.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy Kelley
- Division of Newborn Medicine, Department of Pediatrics (K.G., A.W.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pediatrics (S.K., C.C.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Family Medicine (S.B.), Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Geriatrics and Palliative Medicine (A.K., L.D.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea Weintraub
- Division of Newborn Medicine, Department of Pediatrics (K.G., A.W.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pediatrics (S.K., C.C.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Family Medicine (S.B.), Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Geriatrics and Palliative Medicine (A.K., L.D.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lindsay Dow
- Division of Newborn Medicine, Department of Pediatrics (K.G., A.W.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Pediatrics (S.K., C.C.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Family Medicine (S.B.), Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Geriatrics and Palliative Medicine (A.K., L.D.), The Icahn School of Medicine at Mount Sinai, New York, New York, USA
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50
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Leaming-Van Zandt KJ, Zhu H, Banuelos RC, Lopez MA, Hsu DC. Impact of a Pediatric-Focused Communication Course on Patient/Caregiver-Perceived Physician Communication Skills in a Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:e1173-e1180. [PMID: 31851077 DOI: 10.1097/pec.0000000000001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the impact of a pediatric-focused, relationship-centered communication course on patient/caregiver assessment of emergency department (ED) physician communication skills. METHODS This was a prospective study; a previously validated assessment tool (Pediatric Physician Interpersonal Communication Skills Assessment [P-PICSA]) was used to collect pediatric patient/caregiver evaluation of ED physician communication skills. Emergency department physicians were required to attend a 5.5-hour communication course. Differences in precourse/postcourse P-PICSA and top-box scores were analyzed to determine course impact on ED physician communication skills. RESULTS From July 2016 to August 2017, 49 pediatric ED physicians participated in the course, and 24 physicians (49%) had 6-month precourse/postcourse P-PICSA data. Postcourse scores were higher for all 13 items, with 3 items achieving statistical significance: (1) the doctor used words I could understand; (2) the way the doctor involved me in making decisions about my child's care in the ED; (3) how the doctor discussed next steps and/or follow-up plans for my child's care after we leave the ED (P < 0.05). Additionally, postcourse, top-box score percentages were higher for 12 items, with 1 item achieving statistical significance (P = 0.0386). CONCLUSIONS An organization-wide, pediatric-focused, relationship-centered communication course improved patient/caregiver-perceived ED physician communication. Further research is necessary to assess long-term sustainability.
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Affiliation(s)
- Katherine J Leaming-Van Zandt
- From the Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital
| | - Huirong Zhu
- Texas Children's Hospital Outcomes and Impact Service
| | | | - Michelle A Lopez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Deborah C Hsu
- From the Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital
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