Four Habits Model prepares pediatric nurses for emotionally difficult discussions

June 30, 2014, Indiana University

A child's illness and hospitalization are extremely stressful for both the child and the parents. A new study reports that the Four Habits Model of Highly Effective Clinicians, a core set of communication skills developed to help physicians communicate with patients, can successfully prepare inexperienced nurses for emotionally difficult conversations with parents of pediatric patients.

The evidence-based Four Habits Model was co-developed 20 years ago by Regenstrief Institute investigator Richard Frankel, Ph.D., a sociologist and medical educator whose current research focuses on facilitating and improving clinician-patient communication in the context of advanced cancer. This is the first time the Four Habits Model's effectiveness has been tested with nurses.

The new study, published in the July 2014 issue of Patient Education and Counseling, found that when taught the Four Habits Model, newly licensed nurses reported significant improvements in emotion-focused conversations with parents in four of the five areas measured: preparation, communication skills, relationships and confidence.

"Newly minted nurses, like other newly trained professionals, tend to concentrate on getting the work done," Dr. Frankel said. "Getting the work done is obviously important to patient care, but so is being thoughtful and reflecting on what one is doing, not simply operating in the moment. We don't do a lot of real-world training of nurses, doctors or any type of health professional; we put them in classrooms and provide simulations exercises but don't really give them on-the-job coaching or opportunities to practice important communication and other skills. With exposure to the Four Habits, inexperienced nurses can improve how they interact with both young patients and their parents."

Newly licensed nurses involved in the study did not demonstrate a decrease in their anxiety level, which Dr. Frankel said is not necessarily bad for their relationship with young patients or families.

"All people with responsibility for others experience anxiety," he said. "In lower doses, anxiety can propel you to be vigilant. Vigilance is one of the major ways to prevent accidents and errors. So it is not surprising and actually might be a good thing that people just embarking on a professional career remain somewhat anxious but are able to convert that anxiety into vigilance."

Previous studies by Dr. Frankel and other researchers have shown that the Four Habits Model has a positive long-term effect on both clinician and patient satisfaction. The model is used extensively in the United States and other countries to train physicians. The Four Habits are:

1. Invest in the beginning.

2. Elicit the patient's perspective.

3. Demonstrate empathy.

4. Invest in the end.

Twenty-three skills make up the Four Habits.

Each of the Four Habits contributes to good . For example, eliciting the patient's perspective allows a better understanding of the disease and the person's psychological and social response(s), both of which contribute to improved outcomes, according to Dr. Frankel.

In addition to his Regenstrief appointment, Dr. Frankel is an Indiana University School of Medicine professor of medicine and the inaugural director of the Mary Margaret Walther Palliative Care Research and Education Program at the Indiana University Melvin and Bren Simon Cancer Center.

Additional authors of "The effectiveness of a brief intervention for emotion-focused nurse-parent communication" are first author Mark J. Fisher, Ph.D., of the College of Nursing, University of Oklahoma Health Sciences Center; Marion E. Broome, Ph.D., R.N.; Barbara M. Friesth, Ph.D., R.N. and Tracy Magee, Ph.D., R.N., all faculty of the Indiana University School of Nursing.

The researchers note that their findings suggest the use of effective , such as eliciting parents' perspectives and empathy, may result in increased parent satisfaction. They conclude "teaching nurses how to use a few new habits for nurse-parent during an emotionally charged situation is an effective way to shed light on an invaluable relationship in health care, the nurse-parent relationship."

Explore further: Training future doctors to enlist patients as partners in care

Related Stories

Training future doctors to enlist patients as partners in care

April 14, 2011
With mounting evidence that patient-centered care improves medical outcomes, investigators from the Regenstrief Institute and Indiana University School of Medicine are providing a call to action for the training of future ...

'Attention on the flight deck': What doctors can learn from pilots about communication

January 30, 2014
As computers become common in medical examination rooms across the United States, a new study explores the role this technology plays in the doctor-patient relationship. The researchers looked to aviation, with its long history ...

Peer-to-peer aggression threatens patient care and outcomes

February 24, 2014
Horizontal violence between nurses at the same level of authority is jeopardising patient outcomes, research has revealed.

Magnet hospitals have higher quality of care, study says

March 11, 2014
Magnet recognition is considered a leading source for measuring organizational success in nursing. Magnet hospitals show higher job satisfaction and lower odds of patient mortality than non-Magnet hospitals. However, only ...

Involving patients in their nurses' shift change reduces medical errors and satisfies patients

November 20, 2013
At shift change, incoming and outgoing nurses transfer accountability by exchanging information about the patients under their charge. Called bedside handover, this process empowers patients and allows them to become active ...

Recommended for you

Phone-addicted teens are unhappy, study finds

January 22, 2018
Happiness is not a warm phone, according to a new study exploring the link between adolescent life satisfaction and screen time. Teens whose eyes are habitually glued to their smartphones are markedly unhappier, said study ...

Baby brains help infants figure it out before they try it out

January 17, 2018
Babies often amaze their parents when they seemingly learn new skills overnight—how to walk, for example. But their brains were probably prepping for those tasks long before their first steps occurred, according to researchers.

NeuroNext biomarker study explores natural history of infantile-onset SMA

January 9, 2018
Research led by The Ohio State University Wexner Medical Center to define the natural history of infantile-onset spinal muscular atrophy (SMA) has been "critical" to accelerate the development of effective therapies and hasten ...

No link between childhood lead levels, later criminality

December 27, 2017
(HealthDay)— Exposure to higher levels of lead during early childhood can affect neurological development—but does that mean affected kids are doomed to delinquency?

Early puberty in girls may take mental health toll

December 26, 2017
(HealthDay)—A girl who gets her first menstrual period early in life—possibly as young as 7—has a greater risk for developing depression and antisocial behaviors that last at least into her 20s, a new study suggests.

Technology not taking over children's lives despite screen-time increase

December 21, 2017
With children spending increasing amounts of time on screen-based devices, there is a common perception that technology is taking over their lives, to the detriment and exclusion of other activities. However, new Oxford University ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.