Staff engagement during complex pediatric medical care: the role of patient, family, and treatment variables

Abstract

Objective: To examine the role of patient, family, and treatment variables on self-reported engagement for physicians and nurses working with pediatric complex care patients.

Methods: Sixty-eight physicians and 85 registered nurses at a children's hospital reviewed eight case scenarios that varied by the patient and patient's family (each cooperative versus difficult) and the length of hospitalization (<30 days versus >30 days). Participants rated their engagement from highly engaged/responsive to distancing/disconnected behaviors.

Results: Nurses were more likely than physicians to engage in situations with a difficult patient/cooperative family but less likely to engage in situations with a cooperative patient/difficult family.Nurses were more likely to consult a colleague regarding the care of a difficult patient/difficult family,while physicians were more likely to refer a difficult patient/difficult family to a psychosocial professional.

Conclusions: Differences were found for engagement with "difficult" patients/families, with physicians more likely to distance themselves or refer to a psychosocial professional, while nurses were more likely to consult with a colleague.

Practice implications: Communication between health care team members is essential for optimal family-centered health care. Thus, interventions are needed that focus on communication and support for healthcare teams working with pediatric complex care patients and their families.

Figure 1

Odds ratios and corresponding 95% confidence intervals on how nurses differed from physicians in their perceived likelihood of engagement with a complex pediatric care case. The hypothetical behaviors ranged from highly supportive and engaging (behavior a) to exceedingly distancing and fragmented (behavior g). An odds ratio of 1.0 (vertical line) indicates that nurses and physician did not differ in their perceived likelihood of taking the target action. Nurses were marginally more likely than physicians to focus on the emotional concerns of a difficult patient/cooperative family pair (behavior a, marked by a triangle Δ, DPCF: OR = 2.05), while they were significantly less likely to do so than physicians for a cooperative patient/difficult family pair (behavior a, marked by an X, CPDF, OR = .30). Nurses were overall marginally more likely than physicians to consult a colleague on how to address the patient’s/family’s emotional response (behavior c, all 4 profiles) and significantly less likely, for a difficult patient/difficult family scenario, to make a referral to a professional who is specifically trained to manage the psychosocial aspects of pediatric specialty care (behavior d, marked by a diamond ⋄ DPDF, OR = .21). Nurses were also marginally more likely than physicians to avoid directly addressing the family’s emotional distress if they thought it was a situation they were unlikely to change (behavior e, DPDF, OR = 2.35).

Figure 2

Representation of the behavior in which respondents were most likely to engage: (a) use conversation to ease patient’s and/or family’s intense emotions and pain, (b) call a family meeting to review/address medical care and/or psychosocial issues, (c) talk with a colleague about how to work with the patient’s/family’s emotional response, (d) make a referral to a professional who is specifically trained to manage the psychosocial aspects of pediatric specialty care, (e) avoid directly addressing the family’s emotional distress because it is a situation that you are unlikely to change, (f) attend to the patient’s medical care during times that limit interactions within the family. Response choice g (remove self from active care) was excluded as no one selected it as their first choice.