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Discussion

Tips/Ideas for dealing with stressed/difficult parents in the PICU

Hello all! I wonder if I might ask for some advice on how you help parents to feel more relaxed when things don't go well with their child. I seem to be struggling in this area...particularly with bronchiolitis kiddos that cannot eat and cannot receive sedation. I try very hard to listen and validate the parents feelings of dealing with an upset and hungry child, and provide education and rationales as appropriate. But, my "schmoozing over" doesn't seem to be as effective as others. What sorts of phrases or approaches do you employ that work??

Thank you so much, appreciate any advice!!

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    My dialog with parents runs something like this:, "Your baby is very sick, and that's why she's in the PICU. We're going to take very good care of her so you can take her home as soon as she's better. Meanwhile, feeding her by mouth would be a really bad idea, because babies aren't really good at coordinating their breathing, sucking and swallowing when they're sick and they're breathing this fast. If she breathes in a mouthful of milk it will make her even sicker. Fluids are much more important for sick babies than food is, and we'll make sure she gets the fluid she needs. I know it's upsetting to see her like this, but we can't give her anything to calm her down right now because it might make her too sleepy and calm to remember to breathe. I can give her some Tylenol but it might slow down her recovery by blocking her immune response a bit. You can help her feel better by talking to her, rubbing her forehead, holding her hand and singing to her. You know what she likes, so you're the best one to do that!" They might have some questions but usually they're very receptive. Acknowledging their concerns, simple explanations and including them in care go a long way.

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    I also suggest cuing them into the assessment signs that you look for that would indicate that the child might be able to start eating.

    Stating something to the effect of "babies aren't very good at the coordination of breathing and eating, so when their breathing is a problem one of the things that we do to help maximize the amount of oxygen they are getting is to stop feeding them for a little while. Some of the things that we look for to see an improvement is the respiratory rate, we like that to consistently be under 60. We also want them to look like it isn't hard for htem to breathe (I point out accessory muscle use, head bobbing, etc). We are definitely keeping an eye on things and if you see any of those things definitely point them out to me so I can let the doctors know and we can all be on the same page. I know that it sucks when your kid can't eat and is fussy, but we all want what is best and this is what is medically best for your child. We will re-evaluate the child's status in (I usually say about two feeding times, so if kid typically eats every 2 hours I say 4 hours, if its every 3 hours I say six hours) so that we make sure to stay on top of it."

    Honestly, cluing into parents is usually the best way. One of the best "customer service" type of tips that I ever got (I know it sucks, but it is the way right now and I like to pay rent) is to sit down in the room with parents. I literally will pull up a chair, put all my brain sheets away except the one for their child, pull up the child's chart on the computer in the room and go over the plan of care. If I set that up where I can do that within the first couple hours of my shift, I usually have it go much better. It usually only takes about 5 minutes per patient but makes the entire experience way better.

    And give yourself a break, there are some parents that no amount of reassuring/explaining/etc is going to make them calm down. Do your best and then try to let it go.

  • Quote
    I also suggest cuing them into the assessment signs that you look for that would indicate that the child might be able to start eating.

    Stating something to the effect of "babies aren't very good at the coordination of breathing and eating, so when their breathing is a problem one of the things that we do to help maximize the amount of oxygen they are getting is to stop feeding them for a little while. Some of the things that we look for to see an improvement is the respiratory rate, we like that to consistently be under 60. We also want them to look like it isn't hard for htem to breathe (I point out accessory muscle use, head bobbing, etc). We are definitely keeping an eye on things and if you see any of those things definitely point them out to me so I can let the doctors know and we can all be on the same page. I know that it sucks when your kid can't eat and is fussy, but we all want what is best and this is what is medically best for your child. We will re-evaluate the child's status in (I usually say about two feeding times, so if kid typically eats every 2 hours I say 4 hours, if its every 3 hours I say six hours) so that we make sure to stay on top of it."

    Honestly, cluing into parents is usually the best way. One of the best "customer service" type of tips that I ever got (I know it sucks, but it is the way right now and I like to pay rent) is to sit down in the room with parents. I literally will pull up a chair, put all my brain sheets away except the one for their child, pull up the child's chart on the computer in the room and go over the plan of care. If I set that up where I can do that within the first couple hours of my shift, I usually have it go much better. It usually only takes about 5 minutes per patient but makes the entire experience way better.

    And give yourself a break, there are some parents that no amount of reassuring/explaining/etc is going to make them calm down. Do your best and then try to let it go.

    ^^^THis^^^ There's no rule that says they have to be relaxed.

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