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Training Enhances Nurse-Parent Communication

Friday, July 25, 2014 - Campus News - Contact Theresa Green, (405) 833-9824

The University of Oklahoma College of Nursing has long emphasized that newly licensed nurses need training in people skills along with their technical training. Now, new research from the college reveals a specific type of communication training can effectively prepare less experienced nurses for emotionally difficult conversations with parents of children who are hospitalized.

The OU College of Nursing study utilized the Four Habits Model, a core set of communication skills developed 20 years ago to help physicians better communicate with patients. This marks the first time, however, the model has been adapted and used with pediatric nurses.

"The hospital experience is extremely stressful where parents' emotions are often expressed, either verbally or non-verbally. Nurses tend to be the ones typically at the child's bedside, they are also the ones who are frequently exposed to or witness parents' expressed emotions," said principal investigator Mark J. Fisher, Ph.D., R.N., assistant professor, OU College of Nursing. 

The study, published in this month's issue of Patient Education and Counseling, found that newly licensed nurses with brief exposure to the Four Habits Model reported significant improvement in emotionally difficult conversations with parents of pediatric patients.

In the study, one group of nurses participated in a one-hour, three-part education simulation session. The control group observed a one-hour video.

Nurses in the intervention group participated in a simulation that set up a fictitious scenario involving a medication error, the second medication error with the child during hospitalization.  In the simulated scenario, the role-playing mother becomes especially upset expressing her intense emotions both verbally and non-verbally based on the current error which are amplified by the severity of the previous medication error her child experienced. 

"The purpose of the specific scenario was to provide nurses with a simulated experience where empathy was the primary focus,” Fisher said.

Nurses in the simulation group were taught to apply an adapted version of the Four Habits Model for nurse-parent communication. The Four Habits Model was co-developed 20 years ago by Indiana University Regenstrief Institute investigator Richard Frankel, Ph.D., who was also an author of the study. The adapted version of the Four Habits Model used in this study included these principles:  
-      Invest in the beginning
-      Elicit the parent's perspective 
-      Demonstrate empathy
-      Invest in the end

Fisher said applying the Four Habits Model to the scenario meant the nurse first introduces himself or herself and explains to the mother what has happened; asks for and listens to the mother express her concerns; acknowledges the mother's emotions and that her concerns are understood; and finally collaborates and partners with the mother to develop a plan on what is to be done next to close or end the conversation in a positive way.

The study measured five areas – preparation, communication skills, relationships, confidence and anxiety. It found nurses in the Four Habits Model improved in four of the five areas measured.  Nurses in the study did not demonstrate a decrease in anxiety as hypothesized, however.  Researchers stress that is not necessarily bad because anxiety, when not excessive, can help lead to a higher level of vigilance, which is a critical to prevent errors.    

Fisher noted the standardized patient, acting as a parent in the intervention, along with the role-playing setting that included a hospital room decorated with children's drawings and a life-like mannequin in the hospital bed was meant to closely mimic the hospital setting. Nurses involved in the experiment indicated they appreciated the emphasis upon realism. 

"I think that was one of the most meaningful comments from a number of them was how real the experience felt,” said Fisher.

Improved caregiver-patient communications is one of the tenets of a campus-wide initiative begun almost a decade ago at the OU Health Sciences Center aimed at advancing excellence in care.

Although Fisher's study involved a limited number of pediatric nurses, he believes it points to the need for further study and perhaps the inclusion of still more of this type of communications training for nurses beginning their careers in health care.

"I am really excited about the possibilities of doing more with the Four Habits Model here at the OU College of Nursing, and the possibility of working with other colleges or schools of nursing, as well as hospitals across the nation,” Fisher said. 

A research grant from Sigma Theta Tau International Beta Delta-at-Large Chapter supported this research.

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