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 began this study because of a 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.

Four objectives guided 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.

The purpose of this 3-year prospective grounded theory study, therefore, was 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 interviewed 34 parents of children with complex chronic conditions, as well as 80 HCPs who were primarily nurses (n = 46), physicians (n = 19), and social workers (n = 5), with chaplains, counselors, a child life specialist, a physiotherapist, an occupational therapist, and respiratory therapists (RT) accounting for the remaining 10 HCPs. We also engaged in 88 ethnographic observations of HCP/parent interactions across three settings – two inpatient and one children’s hospice over a period of up to 14 days of an admission as the parents interacted with HCPs. In addition, researchers observed 18 of the 80 HCPs who were interviewed (two of them twice for a total of 20 observations) while accompanying them for up to 2 hours during clinical activities. For each observation, researchers wrote processual field notes documenting actual occurrences and investigator impressions of such aspects as nonverbal communication, responsiveness of parents and HCPs to each other’s cues, emotional atmosphere, potentially influencing factors, investigator impressions of reciprocity, and questions for follow-up during interviews. Finally, 51 general observations across the three settings were conducted to contribute to a greater understanding of each of these contexts.

Best practice health care providers (BPHCPs) were identified across disciplines. These BPHCPs engaged in best practices in every encounter with parents, regardless of parents’ characteristics or contributions to the interaction. Our results showed that the components and dimensions of best practice in provider/parent interaction could be identified, described, and ultimately, taught/learned. These findings have been published and we are currently in the preliminary stages of writing a book proposal that we envision being used by both students and clinicians across healthcare disciplines, as well as by educators, volunteers, and so forth.

Please click here for articles resulting from this project

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.