Enhancing Communication: The Physician and Family in the Pediatric Intensive Care Unit

Death and bereavement in a paediatric intensive care unit: Parental perceptions of staff support

“…We found that contact with individuals who have had a similar experience can be helpful and this is confirmed by other studies (7,17). Contact initiated by the ICU staff about one month following a child's death was valued.…”

Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

“…16 Parental sources of stress include seeing their child in pain, frightened, or sad, and the inability to communicate with the child. 233 Increased attention to the fulfillment of parental needs can improve relations between parents and ICU staff.…”

“…Mixed messages from multiple consultants, particularly in the ICU setting, can be extremely confusing and upsetting for families, often leading to poor decision making as the parents (understandably) hold on to the most hopeful messages. Having a clear captain of the care team, one who is evaluating the situation as a whole, The use of open-ended questions and reflective explanation Hopeful but honest and clear communication; acknowledgment of uncertainty Discussion of likely and hoped-for outcomes Use of numeric terms when describing probabilities; use of drawings and models Provide timeframes for improvement and future discussion Participation of families in clinical bedside rounds, caregiving for their child and ability to stay with their child during invasive procedures Listen to and involve the nurse, chaplain, and social worker in the information loop Open visitation, including sibling and pet visitation Consistent caregivers; if this is not possible, ensure consistency of the message Prompt informing of parents of transitions, such as a change of location, condition, treatment plan, assignment of attending physician or residents Shared decision making rather than autonomy; encourage the parents to involve their family, friends, and medical home pediatrician to help them to understand information and make decisions Written, audiotaped, and computerized education for families (see www.icuusa.com) Discussion and support of coping mechanisms, including religious and spiritual values Initiation of palliative care at the time of admission Data were adapted from Todres et al, 16 Davidson et al, 228 Robinson et al, 231 and Todres. 232 …”

“…Children 16 Focus on the positive (hope) Minimize the significance of the information Preoccupation with medical details Support from family, friends, and clergy Religious faith Hostility, depression, irritability particularly as death nears, is extremely helpful in preventing such problems.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] The practicing clinician's ability to communicate openly and with compassion is essential for effective and efficient routine health care; this ability becomes a vital lifeline for parents and children confronted with lifealtering and sometimes life-ending conditions. [13][14][15][16] The purpose of this report is to provide research-based and practical guidance to enable effective communication with pediatric patients and their families in a number of common settings and situations. Although child abuse, sexuality, divorce, and many other situations are not individually addressed, the principles and approaches discussed apply equally to these situations.…”