April 6, 2012

Best Practices

Provider/Parent Interactions in Pediatrics

Dr Betty Davies, RN, PhD, FAAN and Dr Rose Steele, RN, PhD (PIs)


When a child is seriously ill or dying, relationships and exchanges with health care professionals (HCPs) clearly determine parent satisfaction with care, and affect long term outcomes. We lack understanding of what makes it possible for some HCPs to employ best practices that include not only technical expertise but generous sharing of their full humanity.

The purpose of this 3-year prospective grounded theory study is to generate a detailed, contextually-based description and theoretical framing of the process of best practices in parent/HCP interactions with a view to understanding the factors that make such interactions possible. Guided by symbolic interaction theory and relational inquiry, and using a grounded theory approach, we will observe up to 60 parents of children with complex chronic conditions (CCCs). These observations will occur in three settings – two inpatient and one children’s hospice over a period of up to 7 days of an admission as the parents interact with HCPs (nurses, physicians, and social workers). We also will have conversations with these parents and HCPs about their perceptions of the interactions in order to delineate how some HCPs, operating under the same external stressors as other HCPs, relate to parents in the supportive and effective ways that are described by parents as “human”. Once these best practices for parent/HCP interactions are identified, strategies can be devised that assure their translation to the bedside, thus enhancing family-centred care.

Four objectives guide the study:

1. Drawing upon direct observations of interactions between parents and HCPs, describe and analyze these interactions and how they change over the week during inpatient care.

2. Drawing upon post-interaction interviews with parents and HCPs, critically explore and analyze the intent, impact and meaning of the interactions.

3. Drawing upon observation and interview data, compare and contrast the personal, cultural, situational, and environmental factors that impact parents’ and HCPs interactions.

4. Drawing upon observation and interview data, conceptualize best practices of parent/HCP interactions that optimize the care of children with a CCC.


Research Highlights:

  • When a child is seriously ill or dying, family relationships and exchanges with health care professionals (HCPs, including nurses, physicians, and social workers) clearly influence parent satisfaction with care and its outcomes.
  • When relationships are good and interactions are “human”, parents carry memories that are healing; conversely, when relationships are not good or interactions do not go well, parents carry memories of unnecessary additional suffering.