Communication gap exists in NICUs


Up to two-thirds of mothers of critically ill newborns in neonatal intensive care units (NICUs) believe their children are less sick than their treating physicians indicate. How can you optimize communication in this most stressful setting?

Up to two-thirds of mothers of critically ill newborns believe their children are less sick than their treating physicians indicate, according to a new study.

Researchers from Johns Hopkins determined that although the majority of mothers of babies in neonatal intensive care units (NICUs) are satisfied with the communication with their treating clinicians, almost half misinterpret 1 of the primary messages-the severity of their babies’ conditions.

The investigators interviewed 101 mothers of infants admitted to the NICU for at least 48 hours and their clinicians (ie, physicians, neonatal nurse practitioners, nurses, and a respiratory therapist).

The vast majority of mothers (89%) and clinicians (92%) believed their discussions with each other went well. All the mothers could identify their infants’ diagnoses and most could identify at least 1 treatment (93.4%), but a gap existed among almost half the pairs (45%) when it came to agreeing on illness severity. More often than not, the mothers (62.5%) believed their children to be less sick than their clinicians indicated.

Some of the discrepancy might arise from language differences and semantics. For example, clinicians sometimes use the word “sick” to indicate an infant’s risk of death or significant morbidity, while mothers sometimes interpret “sick” to mean having acute symptoms, such as a fever or vomiting. They do not necessarily perceive the term to be synonymous with long-term illness.

The researchers point out that mothers’ satisfaction with communication with their clinicians does not necessarily equate with true understanding and that both satisfaction and understanding are necessary to optimize care in any setting.

They also emphasize that clinicians cannot deny the roles that hope and optimism play in mothers’ assessments of the severity of their children’s illnesses. Parents feel it is their duty to be hopeful, and so even when they fully understand what is being told to them, they may verbalize the information with a more positive spin.

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