Abstract
Background
Healthcare providers must effectively communicate with other professionals, multidisciplinary teams, and parents of patients in pediatric intensive care units (PICUs) to improve outcomes in children and satisfaction levels of parents. Few studies have focused on healthcare providers’ communication experiences, which are crucial for identifying current problems and suggesting future directions. This phenomenological study was conducted to address this gap.
Methods
A qualitative study using online and face-to-face interviews was conducted from January to June 2021 by a trained researcher in PICUs of two tertiary hospitals. Participants were five physicians and four registered nurses who worked in the PICUs and had over five years of clinical experience. The interviews were audio recorded with the participant’s consent and analyzed by the researchers using Colaizzi’s seven-step method.
Results
Healthcare providers’ communication experiences revealed four categories: facing communication difficulties in PICUs, communication relying on individual competencies without established communication methods, positive and negative experiences gained through the communication process, and finding the most effective communication approach.
Conclusions
Without adequate support or a systematic training program, healthcare providers often have to overcome communication challenges on their own. Therefore, support and training programs should be developed to facilitate better communication in the future.
Keywords: Health personnel, Communication, Intensive care unit, Pediatric
Background
Communication among patients, caregivers, and healthcare providers can affect overall satisfaction with hospital care, improving healthcare outcomes, clinical safety, and effectiveness of care [1, 2]. Communication is especially important in a pediatric intensive care unit (PICU), a highly sensitive treatment environment for children who are critically ill and involves multiple teams and patients’ family members [2].
PICU staff must synthesize and use a vast amount of information for patient/parent education so that parents can understand and utilize it. This empowers parents to make important decisions about their child’s care [3]. High-quality communication is accurate, comprehensive, and timely [4]. It enhances parents’ information-seeking and decision-making capacity, resulting in greater parental involvement in children’s daily care, greater advocacy for children, and better symptom control [5].
However, a PICU setting has several communication barriers because the conditions treated here are complex and require considerable coordination among diverse healthcare providers [2, 5]. In a PICU, communication takes various forms such as one-on-one dialogues, group meetings, and information exchanges using medical records. Furthermore, it occurs in different contexts, including stable daily rounds or acute stress situations and in separate, designated conference rooms or random locations outside the PICU, such as hallways [6]. The limited work hours of the PICU staff is another key barrier [3, 7].
Despite the growing research on communication in intensive care units (ICUs), the difficulty of communicating in PICU persists. To date, most studies conducted in PICU settings have only emphasized specific communication situations such as handoffs or visits, patient populations, technologies, or clinical situations [2]. Therefore, attention should be paid on communication throughout the care process to deeply understand the experiences of the parties and ensure effective communication, both between healthcare providers and between providers and caregivers.
To address this gap, our study used a phenomenological method to identify and describe healthcare providers’ communication experiences in PICUs. This study can serve as a resource to provide solutions to the communication challenges experienced in PICUs and help both healthcare providers and caregivers. In addition, it will broadly highlight hospital culture, communication practices, and their impact on patients and families in Korea.
Methods
Study design
We applied Colaizzi’s [8] phenomenological analysis approach to identify the essence of the communication experiences of physicians and nurses in PICUs. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) [9].
Participants
Participants, identified through purposive sampling [10], included five physicians and four nurses working in the PICUs of two tertiary hospitals in Seoul, Korea. The inclusion criteria were physicians and registered nurses (1) working in the PICUs and participating in direct patient care, (2) with over five years of clinical experience, and (3) who voluntarily agreed to participate in the study and provided informed consent. In-depth semi-structured interviews were conducted with open-ended questions. Participants were recruited until saturation, when no additional data emerged.
Data collection
A trained researcher (HK) conducted in-depth interviews from January to June 2021 using semi-structured interview guidelines developed based on a literature review and expert opinion (Table 1). The participants could choose either online or offline (face-to-face) interviews when they were contacted initially, depending on the COVID-19 pandemic situation. All interviews were conducted based on the participants’ convenient time and location which included a secure, quiet conference room in the hospital where they could talk freely. The interviews were audio recorded with the participant’s consent. The researcher made field notes during and after the interviews to describe the participants’ nonverbal expressions, such as facial expressions, behaviors, postures, loudness, and tone. Emotional expressions of the interviewees, such as crying, were included in the interview transcripts based on when it was recorded in the field notes.
Table 1.
Interview questions
| Introductory question |
How long have you been working in the PICU? What unique features characterize working in the PICU compared to adult ICU or general ward settings? |
| Key questions |
Could you share your experiences when communicating with parents of children in the PICU? What do you consider the most important factors in effectively communicating with parents? What was your most memorable positive experience when communicating with parents? Have you ever encountered conflicts, embarrassment, or difficulties while communicating with parents? What was the most challenging aspect in terms of negative experiences when communicating with parents? What personal approaches or strategies do you use to resolve conflicts when communicating with parents? How does the medical staff’s experience influence communication with parents? What disparities exist in the content or methods of communication with parents among healthcare providers (primary physician, attending physician, head nurse, and nurse-in-charge)? What communication issues have you encountered thus far, and what improvements do you believe are necessary? |
| Ending question | How do you feel about today’s interview? Is there any additional thing that you would like to share or elaborate on regarding communication with parents? If so, please feel free to write it here. |
Ethical approval
was obtained from the Institutional Review Board of Sungshin Women’s University (Approval No. SSWUIRB-2021-005). All participants provided informed consent after understanding the study’s purpose, methods (including audio recording), anonymity, confidentiality, and the right to withdraw participation at any time. The collected data (transcripts, field notes, etc.) were coded and stored on a secure computer. The recordings were destroyed after data analysis. Personal information was deleted after the study’s completion. All participants received a small monetary compensation for their participation.
Data analysis
The transcribed data was analyzed using Colaizzi’s [8] seven-step method: (1) three researchers independently coded the data after repeatedly reading the transcripts to determine the meaning and essence of the participants’ experiences; (2) meaningful statements were collected from the phrases and sentences that were directly relevant to the phenomena of communication experience; (3) meanings of the extracted phrase or sentence were formed and the latent meanings were identified; (4) the meanings were organized into themes formed by grouping similar codes into meaningful sentences, and categories were formulated based on similar themes; (5) the themes were integrated into a full and inclusive description of the phenomenon; (6) the phenomenon’s fundamental structure was identified by condensing it into a short, concise statement and ensuring the validity of the research; and (7) the essence of the phenomenon was validated through participants’ feedback and researchers’ consensus after a final discussion.
Investigator training and preparation
The researchers have worked as nurses in ICUs and pediatric wards, which helped them develop a good understanding of communication with PICU patients’ parents. They have also completed courses in communication and qualitative research methods in graduate school and have adequate experience in conducting qualitative research.
Establishing data rigor
During data collection and analysis, we followed Sandelowski’s [11] method to establish rigor. For credibility, the researchers explained the research aim to the participants, secured a quiet place to ensure reliability, asked open-ended questions to help participants share their experiences freely, and solicited post-interview feedback to validate the extracted themes. For auditability, the researchers transcribed the interviews on the same day they were conducted to avoid distorting the participants’ perspectives, documented all research procedures, carefully discussed participants’ communication experiences during data analysis, and validated the essence of the phenomenon through consensus-building. For fittingness, researchers included participants with diverse clinical experiences, collected data until saturation was reached, and checked saturation through peer debriefing with others experienced in qualitative research. For confirmability, the researchers conducted interviews from a neutral perspective to prevent preconceptions and experiences from influencing the participants and to accurately capture their communication experiences.
Results
All participants were women (Table 2) with an average clinical experience of 8.8 years (5–22 years). The average interview time was 54.7 min (45–70 min).
Table 2.
Characteristics of physicians and nurses
| Position | Clinical experience (years) | Duration of interview (minutes) |
|---|---|---|
| Professor (physician) | 22 | 45 |
| Professor (physician) | 12 | 45 |
| Clinical fellow (physician) | 6 | 62 |
| Clinical fellow (physician) | 6 | 50 |
| Clinical fellow (physician) | 5 | 45 |
| Nurse | 5 | 60 |
| Nurse | 10 | 50 |
| Nurse | 5 | 65 |
| Nurse | 8 | 70 |
Analysis of the interview data on physicians’ and nurses’ communication experiences in the PICUs yielded 36 formulated meanings, merged into 13 themes and, ultimately, four categories (Table 3).
Table 3.
Participants’ communication experiences in pediatric intensive care units (PICUs)
| Categories | Themes | Formulated meanings |
|---|---|---|
| Facing communication difficulties in the PICU | Prioritizing children’s health condition | Parents’ emotional state depends on the child’s condition |
| The child’s condition affects the entire family | ||
| Encounters with parents who have varying levels of knowledge, experience, and reaction to the child’s condition | High intellectual and occupational demands | |
| Experienced nurses were preferred over new nurses | ||
| Expressing negative sentiment to the medical staff | ||
| Challenges communicating a child’s deteriorating condition | Remaining silent because of not knowing what to say | |
| Difficulty delivering bad news | ||
| Communication relying on individual competencies without established communication methods | Reliance on individuals’ communication experiences and education | Differences in communication capabilities according to individual capabilities and experience |
| Lack of training on systematic communication | ||
| Communication gap among healthcare providers and implicit role division | Communicating according to individual rules based on a provider’s experience | |
| Implicit role division | ||
| Lack of communication between physicians and nurses | ||
| Positive and negative experiences gained through the communication process | Importance of communicating with parents while providing treatment | Semi-specialist parents |
| Parents who understand their child(ren)’s needs well | ||
| Information provided by parents is important in identifying a child’s condition | ||
| Warm words of gratitude | Warm words from parents provide huge encouragement | |
| Grateful for parents who express gratitude for healthcare providers’ efforts | ||
| Feeling hurt by the communication process with parents | Self-questioning after criticism from parents | |
| Pain caused by the communication process leads to resignation | ||
| Good intentions not leading to good results | ||
| Exhaustion from repeated questions and requests | Cultural characteristics of heightened requests | |
| Many questions stemming from guilt and attachment toward the child | ||
| Repetitive questions and explanations are demotivating | ||
| Finding the most effective communication approach | Revising communication strategy through trial-and-error | Do not explain all medical acts |
| Focus on explaining objective facts | ||
| Deliver facts rather than hopeful news | ||
| Explanation based on a long-term plan rather than a short-term condition | ||
| Approaching parents first to build trust | Approach parents first and gain their trust | |
| Do your best to explain the child’s condition in detail | ||
| Importance of rapport-building | ||
| Empathizing with parents | Communication from the parents’ perspective (empathy) | |
| Trying to understand the parents’ perspective | ||
| Expresses intimacy for the child as if they were a parent | ||
| Journey toward a better communication approach | The necessity of educational materials to supplement explanations for providers on how to communicate better | |
| Communication training needs to be institutionalized so that everyone can receive education at the organizational level | ||
| The necessity of dedicated staff for communication |
Category 1: facing communication difficulties in the PICU
Prioritizing children’s health condition
The health condition of the children admitted to the PICU would often deteriorate within a few hours of admission. As the child’s condition can significantly affect the parents’ emotional state, the participants tended to prioritize restoring the child’s health condition before communicating with the parents. One physician said, “The state of the parents is entirely dependent on the child’s condition, so the priority is to save the child’s life” (Physician 1). A nurse stated, “If the child is ill, the life pattern of the entire family changes. If there is any improvement, the mother becomes hopeful, but in case of a deterioration, the mother is saddened…I feel bad” (Nurse 2).
Encounters with parents who had varying levels of knowledge experience and reaction to the child’s condition
Parents who are sensitively attuned to their children’s conditions tend to prefer experienced healthcare providers and question the judgments of less experienced ones. Sometimes, parents react emotionally to their children’s conditions and express anger or denial. This causes healthcare providers to experience considerable mental stress, emotional challenges, and, in severe cases, fear. A nurse stated, “Mothers of children who have been ill since birth tend to demand certain precautions. They have a series of questions that serve to test whether we comply with them. Some mothers have panic attacks and cry a lot until they get used to the situation” (Nurse 1). Another nurse noted, “Some parents tend to think that they know more than newbie doctors and sometimes express that they want a smarter doctor to take care of their child. Their attitude toward young nurses seems different as well” (Nurse 3). A physician stated, “It is difficult to deal with parents who have a bit of a temper. We are scared if they are too angry—we are also humans, and that really scares us” (Physician 4).
Challenges communicating a child’s deteriorating condition
The task of explaining a child’s deteriorating condition or end-of-life situation to the parents deeply upset the participants, who would sometimes remain silent, not knowing what to say. Having years of experience in dealing with end-of-life situations did not make this task any easier. A nurse said, “Actually, I’ve been through a lot of end-of-life situations but still find them difficult to deal with…I still don’t quite know what to say. I think now I say even less. Just silence…” (Nurse 3). A physician noted, “Even as healthcare providers, we’re cautious when explaining to the parents that the child’s condition is deteriorating as we find it difficult…” (Physician 4).
Category 2: communication relying on individual competencies without established communication methods
Reliance on individual communication experiences and education
The participants mainly learned about nursing and treatment during their undergraduate period and did not receive any systematic training on communication. Therefore, their communication with parents mainly depended on their personal capabilities, such as personality, experience, and clinical career, resulting in stark differences in communication skills. They expressed that a more systematic approach to communication training would reduce the impact of individual differences on communication skills. One of the nurses said, “Actually, nurses and physicians learned how to care for and treat patients, but there was no training in communication. This was largely dependent on the skills, personality, or experience…Seniors tend to explain more, while juniors sometimes avoid the parents as they don’t know how to explain well” (Nurse 3). Another nurse stated, “Communication is, in a way, an individual’s ability, so I think the problem is that there is a big difference between individuals. Most are doing a good job but there are some who are obviously not doing it right. I think that even a little bit of systematic education is needed in clinical practice” (Nurse 4).
Communication gap among healthcare providers and implicit role division
The participants had “their own rules” for communicating with parents, which entailed implicitly dividing roles depending on a child’s condition. However, this approach sometimes led to miscommunication between the physicians and nurses, revealing a conflicting understanding of the child’s condition. One physician said, “Because each physician and nurse has their own rule, how they approach communication varies. The disease state is communicated by physicians and the nurses communicate the condition and daily matters of the child” (Physician 1). One nurse noted, “The professor does not communicate to us his intentions during rounds and simply explains to the parents that it is getting better. When the parents tell us, ‘We heard that it is getting better?’ it makes us look bad” (Nurse 2).
Category 3: positive and negative experiences gained through the communication process
Importance of communicating with parents while providing treatment
Participants regarded communication as critical for identifying a child’s condition and needs and considered parents as semi-specialists of their children’s conditions. Thus, they readily incorporated parents’ comments and assessments of their children’s conditions when deciding on the treatment course. A nurse said, “In fact, mothers of children who have been ill for a while are semi-specialists, and there is nothing for us to train” (Nurse 2). Another nurse stated, “If they can make sounds, they express themselves by crying, so it is difficult to identify their needs. So, we think that it is important to listen to the mothers who usually take care of them” (Nurse 4). A physician explained, “Communicating with the parents is very important in pediatrics. I don’t think we can treat the child without communicating with their parents. The deeper the parents’ understanding, the better we can decide the direction of the treatment” (Physician 3).
Warm words of gratitude
The participants reported that parents’ warm words of gratitude made them feel appreciated. They recalled instances where parents expressed gratitude toward healthcare providers for their efforts, which, in turn, made the participants feel thankful. One nurse stated, “Parents’ words of encouragement really make a big difference. In one end-of-life case, the parents of the child told us ‘Thank you for watching my child till the end.’ I know it must have been really difficult for the parents, so I was extremely grateful that they said those words” (Nurse 4). One physician noted, “Some parents are really mature at the end of their child(ren)’s life; sure, they were extremely saddened by the death, but they called us and thanked us for taking care of the child and expressed gratitude to the medical staff. I still remember those parents” (Physician 5).
Feeling hurt by the communication process with parents
The participants reported feeling deeply hurt when parents criticized them for their care and treatment and did not trust them. Sometimes, despite the medical staff’s best efforts and good intentions, the condition of a patient who is critically ill continues to deteriorate, owing to the nature of the disease. Distrust and criticism from parents challenge the medical staff and, in extreme cases, force healthcare providers to quit their jobs. One of the nurses said, “When the parents blame and express that they do not trust me, I start questioning myself, ‘Am I not good enough as a medical staff? Am I not qualified for my job? Am I a nurse who can’t even earn trust from the parents?…’ New nurses are hurt by this and some even quit their jobs” (Nurse 3). One of the physicians stated, “Sometimes, the parents blame the healthcare providers when the child’s condition deteriorates by saying, ‘Are you sure this was the best decision? Maybe it was not necessary to do this…’ Good intentions do not always lead to good results, and it is difficult to predict the result when the condition is critical, and that’s what makes it difficult” (Physician 5).
Exhaustion from repeated questions and requests
The participants reported feeling exhausted by the parents’ repetitive questions and requests. Repeating the same information daily or witnessing parents approaching another doctor for the same information caused healthcare providers to doubt themselves and lose motivation. Cultural characteristics such as heightened requests for healthcare providers or frequent requests to see the child also fatigued the participants. One of the physicians said, “Culturally, Korean parents request a lot and this makes our job difficult. Korean parents are sensitively attuned to their child(ren) … not allowing them extra services (such as additional time with the child(ren) leaves them with guilt” (Physician 2). Another physician described, “They say the same thing again and again, even after I explain the same thing over and over again. That really tires us out…” (Physician 3). One nurse noted, “Even when the nurses explain everything during visits, they (parents) ask the same question to the attending physician or professor when they come and it really makes the nurses lose motivation. Why did they ask me in the first place…I am the one who sees the child the most…” (Nurse 4).
Category 4: finding the most effective communication approach
Revising communication strategy through trial-and-error
The participants reported that their communication methods changed significantly through trial-and-error and experience. Initially, they would quickly communicate the good news to give parents hope and provide detailed updates on their child’s condition. However, with experience, they began delivering only the facts, rather than explaining all medical procedures to parents. Instead of providing daily updates, they communicated the long-term plan for the child’s condition. One of the physicians said, “In a PICU, the child is in critical condition and it can always go bad very quickly, so we do not explain all medical acts by the healthcare providers to the parents” (Physician 2). Another physician noted, “When I was a resident, I focused on explaining the condition of the child, but now I focus on the long-term plan for the child and tell them we need to do this to avoid complications” (Physician 5). One of the nurses said, “When I was a newbie, I wanted to tell the parents the good news as soon as possible, so I would call them even when I was busy…but now, I simply tell them facts and that’s it” (Nurse 3). Another nurse stated, “I really wish I could tell them it will all get better soon. But if that doesn’t happen, problems can arise, so I try not to give false hope and try to convey facts as much as possible” (Nurse 4).
Approaching parents first to build trust
The participants emphasized building trust as a key aspect of communication. By approaching the parents proactively to explain their child’s condition, the participants aimed to earn even difficult parents’ trust, reassuring them that they were doing their best. One of the nurses said, “Gaining their trust is the most important thing in communication. At the start of the visitation, I approached them first and said hello, and then gave them patient information to make them feel more comfortable” (Nurse 3). One of the physicians said, “Rapport formation, detailed explanations by medical staff, and parents’ understanding are also important. Let the parents know that I am doing my best in caring for the patient…no parent will just complain, no matter how bad they are. There are difficult parents but not impossible parents. This is why I think communication is important” (Physician 3).
Empathizing with parents
The participants emphasized the need to think and communicate from the parent’s perspective. Accordingly, they attempted to comprehend the parents’ thoughts and feelings. Rather than treating the child as a patient, they treated them as if they were their own by referring to them by their names and using familiar expressions. One of the nurses stated, “Some physicians who have children have a deeper understanding of parents’ minds and understand the discomfort experienced by the children. This makes them able to communicate from the parent’s perspective” (Nurse 3). Another nurse said, “I think what’s most important is trying to understand the parents’ perspectives. Rather than using the word patient, referring to the patient by their name expresses familiarity and makes me think that I am performing the role of the parent” (Nurse 4). One of the physicians said, “There are some who only take the words from the professor and focus on treatment only, instead of trying to think, ‘What would I do as a mother?’ I think this is wrong” (Physician 3).
Journey toward a better communication approach
For better communication, the participants suggested the following measures: implementing organizational-level communication training, having dedicated communication personnel for all medical staff, and using various auxiliary tools such as pictures, videos, and applications to improve parents’ understanding of the information. One of the nurses noted, “As far as I know, if you apply at the hospital, you can receive an education. But I have to invest time when I’m off… It’s an opportunity to learn everything systematically, and if it’s an education that can be tailored to the actual situation, it will naturally help a lot” (Nurse 3). One physician said, “Images, complications, etc. are difficult to understand even if explained. In foreign countries, such materials are already well-documented with pictures and videos. It would be nice to select only the necessary information for non-medical people and create an instruction manual for educational materials with illustrations” (Physician 2). Another physician stated, “I think there are more ways to communicate as there is a dedicated professional nurse, which provides an opportunity for having personnel dedicated to communication. I always thought it would be nice for the parents to access applications (PICU diary) to see test results” (Physician 4).
Discussion
In this study, the communication experience of healthcare providers in PICUs was expressed as a journey to find better ways to communicate when the answer is unknown while receiving positive and negative feedback in difficult situations. From their communication experiences, the following four categories emerged: “facing communication difficulties in the PICU,” “communication relying on individual competencies without established communication methods,” “positive and negative experiences gained through the communication process,” and “finding the most effective communication approach.”
As an integral part of hospital care, the PICU environment is urgent, complicated, unpredictable, and crisis-oriented; therefore, practitioners experience high stress and severe time crunch while stabilizing a child’s condition [12, 13]. Given their deep concern about their children’s health, parents are sensitively attuned when their children are sick and receiving treatment; thus, healthcare providers must be more careful when communicating with such parents [14]. Parents are unprepared for bad news and may not fully understand the complex medical explanations provided by healthcare providers, leading to communication gaps [13, 15, 16]. How healthcare providers deliver bad news is critical because parents want to receive honest and complete information with care, even if it is bad; otherwise, they may feel angry, distrustful, or betrayed [13, 17]. This aspect tests even experienced healthcare providers [18, 19].
Communication with parents is essential in PICUs to help them understand their children’s health conditions. Simultaneously, parents’ knowledge of their children’s medical history and current symptoms is critical in determining the direction of their care [16]. Therefore, good communication is essential for parental involvement and family-centered childcare [13, 16, 20]. However, communication with parents is limited to 30 min at the time of hospitalization or twice daily based on hospital policy; given the lack of a systematic method, healthcare providers had to implicitly determine the best way to convey information and educate the parents. Additionally, healthcare providers who did not receive systematic communication training often relied on their past experiences, personal capabilities, and trial-and-error to communicate. This finding was consistent with those of previous studies suggesting that the reasons for lack of communication include limited time for ICU visits, differences in experience and roles of healthcare providers, not communicating plans directly to the PICU team, and a mismatch between theory and practice [2, 12, 21]. High-quality communication between healthcare providers and parents can lead to better patient satisfaction with care outcomes and processes [3]. Simultaneously, effective communication among healthcare providers can help reduce patient safety risks and improve treatment outcomes [22].
When the communication process is ambiguous, healthcare providers receive various types of feedback from the parents, which helps them gain new experiences. Parental distrust and heightened requests regarding their child’s treatment or care considerably can make healthcare workers question their role and competence. Conflicts commonly arise in two situations: (1) when parents of children who are acutely ill require more explanations and reassurance and especially (2) when parents of children with chronic illness challenge the expertise of healthcare providers based on their accumulated knowledge and deep involvement in their child’s long-term care [20]. Despite healthcare providers’ best efforts and intentions, negative experiences with communication can lead to emotional burnout and existential crisis regarding their decision to be healthcare workers [21]. However, many parents express their gratitude toward healthcare providers in difficult or stressful situations. Such positive feedback can motivate healthcare providers to become more engaged in communication, improve their psychological well-being, and enhance team performance [23]. In a study of neonatal ICU teams (physicians and nurses) in acute care simulation-training workshops, gratitude expressed by mothers was associated with positive medical team performance through enhanced information sharing [24]. Communication is an interactive aspect and the main component of human-centered care in the ICU [13, 21, 25]. Effective therapeutic communication programs could significantly help healthcare providers cope with the negative feedback they receive during communication and ensure that parents and families provide positive feedback for their efforts, which will lead to improved patient outcomes through improved quality of care.
Individualized communication, depending on the clinical situation and family characteristics, is a cornerstone of human-centered care in the PICU [13, 21]. The study’s participants were experts with more than five years of pediatric experience; however, their communication skills and abilities were at the novice level. Despite making changes through trial-and-error and experience, their communication skills were insufficient compared with other competencies. They relied more on role modeling for existing communication problems and lacked professional training [20, 26]. Nonetheless, participants expressed keen interest in finding the best way to communicate by reaching out, building trust, and empathizing with parents [21].
Healthcare providers receive continuous education for providing specialized care in the ICU using various approaches; however, communication skills training remains insufficient [27]. Accompanying verbal communication with visual and written tools (i.e., whiteboards, daily checklists, pictures, videos, and applications) may fulfill the need for multiple forms of communication and may improve communication among all parties to foster a better understanding of the children’s condition [12, 16, 28]. Specific training is especially required in dealing with stressful situations in the PICU [21, 29]. Many simulation studies of communication with family involvement were conducted using standardized patients or role-plays. In a 3-hour interactive session on pediatric palliative care utilizing communication drills and role-play, students showed improvement in confidence in communicating with families [30]. After a 3-day pediatric critical care communication course featuring simulation with actors as family members, fellows reported increased confidence in difficult discussions (delivering bad news, having a family conference, eliciting families’ reactions to their child’s end-of-life situation, and discussing the child’s current status and religious issues) [31]. Moreover, previous studies have reported the effectiveness of simulation training for healthcare providers in the PICU on fundamental communication skills, sharing bad news, determining goals of care, discussing resuscitation preferences, conducting family conferences, forgoing life-sustaining treatment, and navigating conflict with family programs [32, 33], as well as the provision of web and videoconference-based training platforms [34]. Therefore, it is essential for organizations to develop guidelines or education programs to deal with the communication needs of specific situations, which should be conducted continuously.
This study has some limitations. First, the study was conducted at a single site with female healthcare providers in the PICU. Therefore, caution should be exercised in generalizing the study’s findings and applying them to other ICUs in Korea. Second, healthcare providers’ experience of communication in the PICUs of South Korea may differ from those in other countries owing to cultural differences. Lastly, as the study was conducted during the COVID-19 pandemic, the post-pandemic communication experience may be different.
Conclusion
This study provided a phenomenological analysis of the communication experienced in a PICU. A key finding was that healthcare providers still faced communication difficulties and felt that they lacked a support system or training program and were left to deal with these challenges on their own. By revealing these experiences, we provided a discourse to improve the quality of patient care and professional practice in PICUs. Communication problems threaten teamwork among healthcare providers and can adversely affect children’s outcomes, hamper their and their families’ well-being, and generate professional burnout. In the future, various support programs to facilitate communication should be developed; become mandatory for institutions; and include all healthcare workers, in both interprofessional and interpersonal contexts with parents.
Acknowledgements
Not applicable.
Abbreviations
- PICU
Pediatric intensive care unit
- ICU
Intensive care unit
Author contributions
Jooyoung Cheon: Conceptualization; Data curation; Formal analysis; Methodology; Validation; Writing - original draft; Writing - review & editing.Hyojin Kim: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Validation; Writing - original draft; Writing - review & editing.Dong Hee Kim: Conceptualization; Data curation; Formal analysis; Funding acquisition; Methodology; Project administration; Resources; Supervision; Validation; Writing - review & editing.A: Jooyoung Cheon, B: Hyojin Kim, C: Dong Hee Kim.
Funding
This work was supported by the Sungshin Women’s University Research Grant [No H20220052].
Data availability
Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from the Institutional Review Board of Sungshin Women’s University (Approval No. SSWUIRB-2021-005). All participants provided informed consent after having understood the study’s purpose, methods (including audio recording), anonymity, confidentiality, and the right to withdraw participation at any time.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Jooyoung Cheon and Hyojin Kim contributed equally to this work.
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Associated Data
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Data Availability Statement
Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.