Editor’s Note: Dr. Earl Chism (he/him/his) is a first-year resident physician in pediatrics at the University of California, San Francisco. He is a member of the Pediatric Leaders Advancing Health Equity (PLUS) Program, and his interests include medical education and improving health outcomes by increasing representation in healthcare. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
During my intern year, I’ve spent several weeks learning in the neonatal intensive care unit (NICU) at two different training sites. On those rotations, I’ve had numerous conversations and experiences while caring for patients and their caregivers. Intern year is a whirlwind; nonetheless, there are two very important lessons that I use to help me stay afloat. One of those lessons is the importance of communication—not only with colleagues and peers, but also with patients and their caregivers.
In their article “Enhancing NICU Care and Communication: Perspectives of Moderately Preterm Infant Parents,” being released in Pediatrics this week, Dr. Ashley Osborne from the Medical University of South Carolina and colleagues from the Children’s Hospital of Philadelphia analyze communication with parents in the NICU and make recommendations to improve it (10.1542/peds.2023-064419).
The authors interviewed 16 birth parents of moderately preterm infants (defined as those born at 32–36 weeks’ gestation) about the communication they received during the NICU admission. All the interviews were recorded, transcribed, and analyzed for recurrent themes.
Four major themes are described:
- Connection with the medical team: Overall, parents felt well supported by their medical teams while in the NICU. There was specific admiration for nurses, who were seen to be “empathetic, patient, and understanding.” (Remember how I said there were two lessons keeping me afloat during intern year? Yeah, the other one is to lean on our nursing colleagues whenever possible!) Parents felt more of a disconnect with the physician team, describing that it was more difficult to reach them and form a relationship.
- Confusion about care plans: Parents described several instances where there was unclear communication about many aspects of care, including reasons for admission, meanings of various alarms, and daily plans for the patient. Parents also did not always understand the medical terminology used in discussions. This can all be understandably distressing, and would sometimes be exacerbated when the messaging from different members of the care team was not consistent.
- Hospital discharge: Most parents generally felt well prepared for their infant’s discharge from the NICU, and some felt more prepared than a first-time parent who otherwise did not have their infant admitted to the NICU. There were, however, some aspects of the discharge communication that frustrated parents, including lack of timely communication about date of discharge and unanswered questions about their infant.
- Preferred type of communication: Throughout the hospital stay and beyond discharge, parents had different ways in which they preferred to be contacted by the care team. These methods varied from the more common phone calls and in-person discussions to less common modes such as texting and email.
The article goes on to make recommendations on how to improve communication related to these themes and based on the tenets of “family centered care,” which focuses on the collaboration between patients, caregivers, and the care team:
- Ensure nursing is adequately supported and equipped to care for and communicate with families.
- Collect family feedback to identify areas for improvement.
- Clearly communicate reasons for admission and daily plans.
- Optimize communication within the care team to help assure there are no mixed or conflicting messages.
- Give advanced notice for discharge as often as possible.
- Begin discharge planning as soon as possible.
- Ask for caregiver’s preferred method of communication and tailor it accordingly.
- Consider development of comprehensive electronic educational resources for parents.
There are a variety of ways in which we support our patients and their caregivers, and this article investigates how to optimize communication, one of the most important types of support. As clinicians, let’s continue to communicate, remembering to keep the voices of those who are directly impacted by the care we provide in the center of our communications.
