Communication skills training enhances nurses' ability to respond with empathy to parents' emotions in a neonatal intensive care unit

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Abstract

Aim

We quantitatively analysed the effect of a course in communication on the content of nurse–parent encounters and the ability of nurses to respond to the empathic needs of parents in a level III neonatal intensive care unit.

Methods

We evaluated 36 and 45 nurse–parent encounters audio recorded before and after 13 neonatal nurses attended a communication course. The number of empathic opportunities, the nurses' responses to these and the ways they involved parents in their infants' care were studied.

Results

Both before and after the course, the nurses talked more than the parents during the conversations. This nurse‐centredness decreased after the course. The use of empathic or exploring responses to empathic opportunities increased from 19.9 ± 9.0% to 53.8 ± 8.9% (p = 0.027), whereas ignoring the feelings of the parents or giving inadequate advice decreased from 63.0 ± 10.0% to 27.5 ± 8.4% (p = 0.043) after the course. Use of statements expressing caring for the parents and encouragement for parents to participate in the care of their infant increased after the course (p = 0.0034 and p = 0.043, respectively). The nurses felt the course was very useful for their profession.

Conclusion

A course in communication techniques improved nurses' ability to respond to parents' feelings with empathy.

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Most cited references 11

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SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer.

R. Buckman, A P Kudelka, W Baile … (1999)

We describe a protocol for disclosing unfavorable information-"breaking bad news"-to cancer patients about their illness. Straightforward and practical, the protocol meets the requirements defined by published research on this topic. The protocol (SPIKES) consists of six steps. The goal is to enable the clinician to fulfill the four most important objectives of the interview disclosing bad news: gathering information from the patient, transmitting the medical information, providing support to the patient, and eliciting the patient's collaboration in developing a strategy or treatment plan for the future. Oncologists, oncology trainees, and medical students who have been taught the protocol have reported increased confidence in their ability to disclose unfavorable medical information to patients. Directions for continuing assessment of the protocol are suggested.

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Oncologist communication about emotion during visits with patients with advanced cancer.

Kathryn I Pollak, Robert Arnold, Amy S Jeffreys … (2007)

Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses. We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of care. In 398 conversations, 37% contained at least one empathic opportunity; the range was 0 to 10, and the total empathic opportunities was 292. When they occurred, oncologists responded with continuers 22% of the time. Oncologist sex was related to the number of empathic opportunities; female patients seen by female oncologists had the most empathic opportunities (P = .03). Younger oncologists (P = .02) and those who rated their orientation as more socioemotional than technical (P = .03) were more likely to respond with empathic statements. Oncologists encountered few empathic opportunities and responded with empathic statements infrequently. Empathic responses were more prevalent among younger oncologists and among those who were self-rated as socioemotional. To reduce patient anxiety and increase patient satisfaction and adherence, oncologists may need training to encourage patients to express emotions and to respond empathically to patients' emotions.

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"Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expressions of worry.

Jennifer Carroll, Taj Hadee, Peter G. Shields … (2007)

Previous work suggests that exploration and validation of patients' concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care. To describe physicians' responses to patients' worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients' ratings of interpersonal aspects of care. Multimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about "something serious" in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS. One hundred primary care physicians and 4,746 patients. Patient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses. Physicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence. Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.

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Author and article information

Journal

Journal ID (nlm-ta): Acta Paediatr

Journal ID (iso-abbrev): Acta Paediatr

Journal ID (doi): 10.1111/(ISSN)1651-2227

Journal ID (publisher-id): APA

Title: Acta Paediatrica (Oslo, Norway : 1992)

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0803-5253

ISSN (Electronic): 1651-2227

Publication date (Electronic): 21 January 2016

Publication date (Print): April 2016

Volume: 105

Issue: 4 ( doiID: 10.1111/apa.2016.105.issue-4 )

Pages: 397-406

Affiliations

[ ¹ ] Department of Pediatrics Division of Clinical Sciences Sahlgrenska AcademyGothenburg University GothenburgSweden

[ ² ] Division of NeonatologyThe Queen Silvia Children's Hospital Sahlgrenska University Hospital GothenburgSweden

[ ³ ] The Queen Silvia Children's HospitalSahlgrenska University Hospital GothenburgSweden

[ ⁴ ] Institute of Health and Care Sciences Sahlgrenska AcademyGothenburg University GothenburgSweden

Author notes

[*] [* ] Correspondence

K. Bry, Department of Pediatrics, The Queen Silvia Children's Hospital, 41685 Gothenburg, Sweden.

Tel: +46 31 3434630 |

Email: kristina.bry@ 123456pediat.gu.se

Article

Publisher ID: APA13295

DOI: 10.1111/apa.13295

PMC ID: 5066675

PubMed ID: 26648201

SO-VID: 47a0f999-9a74-4426-b455-5854b5847523

License:

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

History

Date received : 05 August 2015

Date revision received : 08 November 2015

Date accepted : 30 November 2015

Page count

Pages: 10

Funding

Funded by: Swedish Heart and Lung Foundation

Funded by: Frimurare Barnhus Foundation

Funded by: Swedish Research Council for Clinical Research in Medicine

Custom metadata

source-schema-version-number 2.0

component-id apa13295

cover-date April 2016

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.5 mode:remove_FC converted:17.10.2016

ScienceOpen disciplines: Pediatrics

Keywords: communication skills,neonatal intensive care,neonatal nursing,newborn,training

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ScienceOpen disciplines: Pediatrics

Keywords: communication skills, neonatal intensive care, neonatal nursing, newborn, training

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Communication skills training enhances nurses' ability to respond with empathy to parents' emotions in a neonatal intensive care unit

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 11

SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer.

Oncologist communication about emotion during visits with patients with advanced cancer.

"Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expressions of worry.

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