Tips for Talking with Parents of Pediatric Patients
I can remember the moment so clearly; I was a few years into my nursing career but brand new to pediatrics. I had just finished getting a set of vitals and was standing next to the patient’s crib about to assess and flush the IV to make sure all was well. I picked up the saline flush, hooked it up, and just as I was about to push a few mL’s of saline through, the patient’s mom screamed, “What are you doing?!” as she frantically ran across the room. Waking her baby and making me pull my arm away so abruptly that it ripped the fragile IV right out of that poor kid’s arm.
No lies, I was annoyed when I left that room.
All of that, over an IV flush?
I was venting to a more seasoned nurse about how we needed a new IV, and the baby had finally fallen asleep before this happened, but the seasoned nurse stopped me.
She reminded me that this parent had no idea what was in that syringe. I was injecting something into her most precious person and didn’t tell her what it was or what it would do, which would have been terrifying for that mother.
It took me a few more years (and having my daughter admitted to the hospital) to fully understand the need to explain absolutely everything to parents and feel more comfortable communicating effectively.
Here are some tips for talking with parents, so when you are in a situation like I was, you can put parents and patients at ease from day one!
1: Set Clear Expectations & Clarify Boundaries
For most of the population, healthcare settings are overwhelming, so I like giving the parents a clear idea of what I think the shift may look like right from the start. It gives them some structure, and they have some idea of what to expect. Let them know the non-negotiables of the day with clear and direct language while also letting them know some soft goals and allowing them to see how they can modify some of the care.
Here’s an example: “Hi, I’m Liz, and I’ll be Charlie’s nurse until 7 a.m. I took a peek at what he had going on, and it looks like we have an x-ray scheduled for 6 a.m. Other than that, I’ll be coming in every four hours to grab his vitals, we will do a bath at some point, give him his meds every few hours, and I’d love it if we could get him out of bed for one walk before bedtime.”
After establishing what the day may look like, I also like to get a few boundary questions out of the way: “Do you want me to wake you up every time I come in and provide care for Charlie?”; “Are you going to be around tonight?”; “Would you prefer I give him his 2 a.m. bottle if you are asleep and I am able?”; “Are there any things you were hoping to accomplish today?” These general questions let parents know this is their child and can still make decisions about their care in this very different environment. It also clarifies what the expectations are and will give you a heads up on if they will be around so you can try to plan for the child’s care needs. Communication early in the shift is vital for everyone’s expectations to be met.
2. Talk Out Loud Through Everything You Are Doing
This may seem silly, but I ask the parents if they want me to explain what I’m doing. And most say yes. Many parents are not familiar with healthcare institutions, so the most mundane things, like flushing an IV, can seem foreign and frightening. I literally narrate my actions, describing precisely what I’m about to do so the parents understand the care being given to their child. This is also incredibly helpful to older patients, as explaining care before you do it is the decent thing to do.
Here’s an example: “Hi! I just popped in to grab a quick set of vitals. Let’s start with your pulse ox. I’m going to wrap this tape around your finger, and let’s see how still you can hold it. Great! Now I’m going to hug your leg with this blood pressure cuff.” Or, “This is Charlie’s ibuprofen and propranolol. Let’s pop those into your NG tube, sir.” It can often feel really weird to talk to the parents like this, so speak to the kid even if they are a baby, especially if they are a baby. Learning to get comfortable talking with parents will come with time, but I found that I could always speak to the patient, and it made everyone in the room more comfortable. Remember, even if the child is a teenager, the parents (and patient) still should be offered a description of everything that is going on. They’re still a baby to those parents, even when they’re 17.
3. Remember They Are Not Their Best Selves
Even if you are doing your best to explain what is happening, parents may get snippy. It’s important to remember that they are not having their best day. They didn’t snap at you because they dislike you. They dislike that their child is in the hospital. Keep being kind. They could probably use kindness in this situation.
4. Ask for Questions Often
Check-in with the parent at least once every shift and ask if they have ANY questions or concerns. Was there anything discussed that they don’t understand? One of your jobs as a nurse is to be an educator. If there is a knowledge gap, you can fill some of it in yourself if you feel comfortable or facilitate a conversation with another team member. I often found that poking my head in after rounds to see if the parents understood everything discussed was helpful. Usually, there needed to be some clarification, and I could grab the provider before they left the floor or schedule a time for the parents to meet with them again in a few hours to answer a few more questions. Parents will not always come up with questions on their own, so asking them directly if they have any questions is a great way to start that conversation.
5. Assess Baseline Understanding
You’ll do quite a bit of teaching as a pediatric nurse. And it is so important to find out what the parents’ background is right from the start. You don’t want to be jumping straight into your “how-to-place-an-NG-tube” lesson with a parent who doesn’t understand what an NG tube even is. Conversely, it would be pretty embarrassing to have a 20-minute talk about what an NG tube is to a parent of a baby whose brother had had one for three years, and the parents know more about it than you do. But you didn’t bother to ask and chose to explain it anyway. Yeah, that was another not-so-hot moment.
Find out where they are coming from and build from there. It will make education much more effective and targeted.
These are my five favorite tips for talking with parents of pediatric patients! I hope they help you navigate those new pediatric nurse waters with a bit more grace than I did. Do you have any tips for talking with parents? I’d love to learn from you, too!