My wish is that doctors and nurses talk to me (7-year-old). 1 (p298) N ot long ago, medical decisions were made exclusively by physicians with the philosophy that "doctor knows best." This thinking has evolved over time, as the current evidence-based literature supports a model of decision making in which health care providers engage in collaborative partnerships with patients and families. Unfortunately, strategies for communicating with pediatric patients may be a neglected part of health care provider education. 2 A lack of this important competency may be a barrier to building trusting partnerships with patients admitted to pediatric progressive and critical care units and their families. Intentional skill building in pediatric communication is vital, so that children feel comfortable in the care of the providers. 2 , 3 Although evidence supports collaborative partnerships between pediatric patients and health care professionals, some providers and pediatric researchers still think that it is best not to engage children in the assent process, as assent is nonbinding and provides no authority to proceed. 4 Note that the literature supports a moral and ethical obligation to communicate with children, and that the principle of self-determination applies not only to adults but also to children. 2 The purpose of this column is to consider communication with pediatric patients as it relates to assent and dissent in progressive and critical care, and to reflect on the ongoing journey toward respect for the individual capabilities and competencies of children. 5
Assent
Experienced acute and critical care nurses are poised to be high-impact leaders in the current, ever-changing health care landscape. These professionals need new skills to carry them to the next level, as they are called on to lead in a new age filled with increasing complexities. This article provides strategies for nurses to consider and reflect on throughout their leadership journey.
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