Influence of caregiver-nurse communication on quality of life and clinical outcomes of children with long-term ventilator dependence.

AIM

To determine the effects of communication behaviors observed during discussion of home management of hospitalized children with long-term ventilator dependence on post-discharge quality of life and clinical outcomes.

DESIGN

A descriptive, quantitative study of family caregiver and nurse communication.

METHODS

Conversations between 100 family caregivers and 48 nurses were recorded and transcribed. Transcripts were coded for key communication behaviors: ask, listen, explain, negotiate roles, verify understanding and advocate. Quality of life measures and clinical outcomes were collected one week and one month post-discharge. Analysis included descriptive statistics and linear mixed-effects models.

RESULTS

Each communication behavior was associated with quality of life outcomes. Family caregivers demonstrated more listening behaviors when there was poorer child quality of life (β = -1.52) and advocated more with increased child fatigue (β = 1.55). When family caregivers negotiated care roles with nurses, there was less child anxiety and mobility (β = -2.15, β = -1.54). Less child fatigue and more mobility were evidenced when nurses advocated (β = -1.49, β = 0.92). Better child quality of life was predicted by nurses asking family caregivers more questions (β = 1.03), while poorer child quality of life was evident when nurses negotiated care roles (β = -2.22). Overall, when family caregivers demonstrated a need or willingness to negotiate care roles with nurses, more respiratory infections were found post-discharge at one week (β = 1.23) and one month (β = 1.59).

CONCLUSION

Family caregiver and nurse communication can impact outcomes for hospitalized children with long-term ventilator dependence. Family caregivers advocate and negotiate roles to ensure support and appropriate care for themselves and their child.