Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeffrey Gruen

Abstract

Family perceptions of suboptimal communication within the pediatric intensive care unit (PICU) are poorly understood. We designed a qualitative study to characterize the perspective and experiences of parents, guardians, and medical providers of critically ill children regarding how communication can be improved in a PICU setting. Semi-structured interviews were conducted from August 2017 to January 2018 in a PICU at a tertiary-care academic center. Participants included 42 parents and guardians whose children were admitted to the PICU and 12 interviews with nurses, residents, fellows, and attending intensivist staff. Interviews were conducted by an individual who was not part of the medical team and were audio-recorded and professionally transcribed verbatim. An inter-professional team of a physician, nurse manager, and medical student coded the transcripts. Interviewing continued until thematic saturation was reached. Codes were organized into common themes using a modified constant comparative method. The parents and guardians interviewed represented 16 acutely ill children with minimal past medical history, and 26 acutely ill children in the setting of a chronic health condition, while excluding patients being evaluated for end-of-life care. Staff interviewed included 3 residents, 3 fellows, 3 attending intensivists, and 3 nurses. Participants' perceptions and experiences of suboptimal communication challenges included: 1) Frustration over coordination of care, 2) Rounds can be intimidating and are insufficient for effective communication, 3) Undervaluing the knowledge of families of children with chronic health conditions or special needs, 4) Communication breakdowns occur across provider hand-offs and 5) Miscommunications and misunderstandings arise navigating multiple levels of providers. Suboptimal communication has the potential to negatively impact the families' PICU experience. Families identified suboptimal communication that was not perceived by PICU staff including the undervaluing of the knowledge of families of children with chronic health conditions. Interventions should be focused on these discrepancies in perception to see if they might improve patient care.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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