725 - Ethnographic observation of communication in the Neonatal Intensive Care Unit

Publication Number: 1702.725

Elizabeth Mari, Icahn School of Medicine at Mount Sinai, Flushing, NY, United States; Katherine Guttmann, Icahn School of Medicine at Mount Sinai, Larchmont, NY, United States

Background: Poor communication between parents of seriously ill infants and physicians has lasting effects on parents and patients. Little is known about the quality of bedside communication in the Neonatal Intensive Care Unit (NICU), and there is not a consensus definition of high-quality NICU communication.

Objective: We sought to explore communication between parents of sick infants and ICU providers in order to define high quality communication and identify communication challenges. We hoped to 1) learn how physicians and other healthcare team members communicate with parents of sick infants, 2) identify key themes relating to communication in the NICU, 3) explore how these themes impact families.

Design/Methods: We conducted ethnographic observations in the NICU over a two-year period. Purposive sampling was used to include both premature and term infants, and those requiring and not requiring respiratory support. Observations were conducted for a full day, from 8AM-4PM for each enrolled patient, and field notes were recorded. Thematic analysis was then conducted to identify key themes.

Results: 17 patients and their parents were enrolled in our study. 94% of enrolled patients were pre-term and 47% were on respiratory support. 24% of observed parents were Black, 24% were Hispanic, and 41% had completed at least college. Following thematic analysis, 3 themes were identified: 1) High quality communication (Table 1), 2) Communication Challenges (Table 2), and 3) Additional factors (Table 3). High quality communication sub-themes centered around including parents in decision making and communicating clearly. Within Communication Challenges, sub-themes included conflict and not addressing parents when present. Additional factors included external environment and religion.

Conclusion(s): Consistent inclusion of parents in their sick infant's care and regular communication among the healthcare team characterize high quality communication in the NICU. Additionally, helping parents feel comfortable through warm greetings, accessible body language, and providing emotional support during conversations contribute to strengthening the relationship between parents and the healthcare team. Communication challenges are common and relate primarily to lack of communication which suggests targeted interventions to encourage and support regular communication between clinicians and families may be helpful. Key external factors impact quality of communication. These may be important to consider when designing interventions to improve communication.

Table 1. High Quality Communication


Table 2. Communication Challenges


Table 3. Additional factors