# 3 Poor communication

A child’s admission to hospital is often a scary and daunting prospect. However, Simons et al. (2024) revealed that some nurses sometimes forget to explain to a child and parent how hospital works. This can add to the feelings of anxiety.

For more than 20 years, it has been recognised that poor communication between nurses and parents contributes to children experiencing unnecessary pain (Simons et al., 2001; Simons and Roberson, 2002). Poor parent–nurse communication has also been reported as the main reason for dissatisfaction related to postoperative pain management among parents (Valizadeh et al., 2016; Nascimento et al., 2010).

Kampouroglou et al. (2020) explored the issue of parental health literacy and noted that where parents have low levels of health literacy they experienced higher levels of parental anxiety. Therefore, a lack of understanding on the parents’/carers’ part around how hospitals work can be stress inducing and can mean parents/carers are unaware that they need to alert a nurse to their child’s pain.

Figure 3 A child’s admission to hospital is often a scary and daunting experience

As a result of a parent/carer not immediately approaching a nurse when their child is in pain, pain levels can escalate. Not only does this lead to the child experiencing unnecessary pain, but by the time a parent/carer approaches a nurse about their child’s pain they may be tense, anxious and frustrated about waiting for help. Unfortunately, nurses who have been busy elsewhere won’t be aware of this build-up.

Moreover, differences in how different parents/carers and nurses respond to a given situation can make ensuring effective communication difficult. For example, one nurse taking part in the Simons et al. study (2024) commented: ‘Some parents just don’t want to speak. Some parents don’t want to bother us. Some parents on the other side want to shout at us.’

Nurses also provide care in different ways depending on their individual practice and personality (Simons et al., 2024) as suggested by the following quotes:

> ‘I do genuinely think it’s just nurse specific – how they approach the situations.’

> ‘I know all nurses know what they should be doing, but some people don’t necessarily say the same things.’

> ‘I genuinely think it’s a lack of communication culture.’

So, parents/carers can experience different levels of engagement and care, depending on which nurse is looking after their child.

## Activity 2 Parent–nurse communication

This activity should take approximately 10 minutes

1. Choose one thing discussed in this section that hindered a parent/carer approaching a nurse for help and identify one key change a nurse could make to help empower parents/carers to seek help when their child is in pain.

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### Comment

Parents/carers whose child is in pain often hesitate before finding a nurse, which can mean their child’s pain escalates. If parents/carers are confident in approaching their nurse, such a delay can be avoided.

Nurses who encourage parents/carers to find them if their child is in pain, and check in regularly with parents/carers, are more likely to be seen as approachable by parents/carers, empowering them to seek help when needed if their child is in pain.

2. Identify one key change a parent/carer could make to get help when their child is in pain.

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### Comment

A study by Jordan et al. (2021) identified ‘pain talk’ as a process which involves nurses talking to children and parents about pain and creating engagement opportunities for children and parents. This was perceived by participants to be essential in ensuring that both the child and the parent were central to discussions and decisions made in relation to the child’s experience of pain.

You will now look at one of the primary challenges parents/carers face when trying to communicate with a nurse about their child’s pain: nurse busyness.

OpenLearn - Promoting the effective management of children’s pain – part 2
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