Lauren Beam
Professor Shrack Wood
Fco PA 10
September 28th, 2018
Discourse Community Research
Pediatric Intensive Care Unit nurses work directly with children and adolescents who are experiencing severe and life-threatening injuries. Children found in the PICU require constant monitoring and care. The rise of teaching communication skills is on for many nursing schools; because communication is the number one “procedure” occuring. When comparing nurses to other health professionals, the International Council of Nurses (2010) says, “Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people.” Pediatric nursing has incrementally increased in child-centered conversations and decision making. Evidence-based research has translated itself into pediatric nursing, delivering innovative strategies to enhance communication, educating and discharge procedures. For my discourse community I have chosen to research further communication PICU nurses have with their patients, children and adolescents. I found this decision easy to make because I am interested in working in a PICU in the future of my nursing career. Gaining insight on communication specifically with the patient from a PICU nursing standpoint is my goal from this research.
For my research, I chose to find journal articles relating children and nursing. After studying the different directions of the field I found that PICU nursing was the choice that would compliment me best. I searched for academic articles about PICU nursing communication, leading me to a world full of journals discussing methods for the most efficient ways to talk to a child. Experimental support and scientific research allowed me to narrow down the best methods to use in my discourse community. There is sufficient support for the methods I have chosen, such as the ILS and RESPECT models. Pediatric nursing varies in the age of your patients. These may range from infant to 18 years old, creating a difference in the communication techniques that are most effective.
To begin, lack of communication is the number one factor for lack of function in nursing professional settings. Nurses tend to shorten discussion times by having their patients “cut to the chase.” These time saving efforts lead to miscommunications and dissatisfied patients. Miscommunications are potentially dangerous to the treatment a child will receive. PICU nurses need to move quickly so they are often switching from patient to patient. Charts and forms are a very broadly used genre in the medical field. If an important aspect of the child’s condition is found by one professional and not charted the next nurse may never know. The use of standardized handoffs is an example of a simple procedure with many aspects that could go wrong. Standardized handoffs are when the patient is moving to a different sector of the hospital or is undergoing x-rays, CT scans, etc. The handoff is the transfer from one medical provider to the next. Also, nurses need to avoid using negative words like “hurt,” this is immediately alarming to the child and will cause distress in the patient. To reduce the anxiety a child is feeling they should be provided with treatment and care options instead of being stuck with only one option. This allows for the child to feel empowerment in their environment. Children being preverbal is a common issue not related to the PICU staff. Engaging some children in a conversation may be difficult. Studies show this to be especially true when it comes to open-ended questions. Young and quiet children are often being spoken over by both the parents and nursing team. This is likely because they need longer time to answer and they urge to give the answers desired by his or her own parents and nurses. Since there is such a rush of time in any ICU setting, nurses may ignore the patient’s input or not listen long enough to get crucial information.
Actually, effective communication alone can reduce potential risks and the likelihood of adverse events. PICU nurses have the responsibility of advocating an academic focus for their patients, and a need to promote health. Luckily there were methods created to facilitate communication between nursing professionals and pediatric patients. The ILS model stands for invite, listen, summarize. It was created to reduce the high-control barrage medical professionals have by dismembering closed questions. This method includes an illustrative dialogue and discussion. Patients are invited to lead a story instead of just an answer. Inviting the patient into telling a story allows for more information surrounding the injury as well any other issues the patient may be suffering. This leads to patient satisfactory as well as taking care of any issues that would require the patient to return for recurring visits. Listening is much more complex than it sounds, it requires sitting level with the patient, making eye contact, and including signs of listening. Summaries allow for the repetition of the issues and circumstances, that way the patient is acknowledged as being heard and everyone remains on the same frame.
Another example, is the RESPECT model. This particular model allows for communication followed by related behaviors to build a sense of trust and empathy. It creates a personable experience for the pediatric patient with the PICU nurse. This is especially critical qualities for a setting with children. Several skills are incorporated into this model including Respect, Explanatory model, Social context, Power, Empathy, Concerns, and Trust. For Respect, it should be shown. The patient should be treated as an individual and talked to with importance and concern. The explanatory model, relates to simply asking. The nurse should grasp the issue at hand by the causes for it and why it happened. Again, asking occurs in the social context of the RESPECT model. This includes the patient’s life and the illness effects on eachother. Including, stressors, strengths, education, and family on child’s health. Power, addresses sharing which is discussions, graphs, and building a broader background. Empathy, is the nurse showing the child they care by expressing concern, listening, head nods, etc. In the respect model, the nurse should address with the child any worries they are having over the prognosis or treatment, regarding concerns and fears. Trust is built off of the other pieces of the model, including empathy, respect, and sharing. With all of these characteristics being used together, empowerment and empathy are given to the child. This connection created by using the RESPECT model gives children the trust needed to communicate with the nurse.
Continuing on, the age of the patient decides the best communication strategies. Although there may be recommendations on how to speak to a certain age group or gender this does not mean all children follow the same maturity levels or interests. At the infancy level there is no verbal communication taking place. However, the child will cry to signify their distress. Cooing, babbling, and vocalization are all ways for children at the infancy level to communicate. Goals of PICU nurses in this situation are to soothe and relieve stress, assess the child’s prelinguistic communication, and simulation. Toddlers and preschoolers are able to answer simple questions with comprehension, as they do understand the basic rules of communicating. At this level, the nurse should have the same goals as infancy and obtain information about the child’s current symptoms. School-aged children tend to have variables weighing in on their communication, including family, social, and cultural. The same goals as the two previous age groups and educating the child about health conditions with cooperation and adherence. Adolescence tend to reach a lot of sensitive topics. This makes it extremely important to use the RESPECT model and find that bond and trust with the patient. Home life, suicidal ideation, substance abuse, and sexual activity are some of the many daring topics seen in the PICU.
Furthermore, another form of communication used universally in all healthcare fields is distraction. In the PICU setting, patients are more than likely in severe distress and discomfort. This makes implementing distractions crucial for the nurses to execute. Stress levels are reduced by taking the child’s attention into a different direction than the pain they are experiencing. The more interactive the distraction is, the less distressed the child will become. This form of communication between the nurse and patient occurs again in different ways for different ages. According to The Royal Children’s Hospital Non-Pharmacological Methods of Pain Management chart for children classified as babies, breastfeeding, singing, and watching bubbles are listed as the best distractors. For toddlers and preschool age children, favorite blankets and toys, online games, and interactive books seem to be the most effective. School-age children can be comforted by humour, relaxed breathing, and online technology and communication. PICU nurses should be familiar with and prepared to help distract their pediatric patients with these adverse distractions.
They should be able to give options to the child with backups to be introduced again if the child becomes distressed. Distraction as a communication is most successful when trust between the nurse and their patient has been built.
In conclusion, the communication that occurs between a PICU nurse and their patients is very important. Every child has their own unique personality and differences that nurses are able to sense out on how they should interact with the child. Luckily methods and distraction methods for different age groups have been created to assist nurses with this difficult communication process. From conducting this research, I have learned about the many challenges that occur in a PICU just from the communication a nurse carries out with their patient. This alone can pertain to many difficulties and misunderstandings, especially considering the high speed and volume of patients being seen. I believe the community should encourage their own children to be expressive and speak the truth to nurse, telling them every detail about their injuries regardless of what they may think. If it is being encouraged by both the parents and nurses the PICU extremity may move much smoother with this reassurance. Nurses obtaining more education on communication in their field is so important to this operation as well. PICU nurses and their pediatric patients have a very special communication together that is built from trust and bonding. Luckily, we are implementing communication classes to teach this field how to communicate effectively with children. How will this communication continue to change over the next several years?