Lessons learned from parents of dying children

Hospital staff glean communication skills

Communication between health care providers and the families of critically ill and dying children is simultaneously the most important and most difficult task in some cases. To make the best use of what staff at Children's Hospital Boston have learned about talking with families and very sick young patients, the hospital established PERCS — the Program to Enhance Relational and Communication Skills.

Through realistic enactments — doctors and nurses practicing communicating difficult information to actors posing as pediatric patients and their families — PERCS trains staff from throughout the hospital. The instructors might be staff, but it is parents and patients who teach the teachers, according to PERCS director Elaine Meyer, PhD, RN.

"What we teach staff is based on our findings [from interviews and questionnaires completed by families], and it is very powerful," Meyer explains. "Because it comes from the parents, usually, and it's their priority and their recommendations, we felt like we needed to use that information to better train our staff."

Meyer says PERCS training brings many clinicians back to the "purity of their original vocation" — the human-to-human interaction and relation that drew them to health care in the first place.

"People want to do a good job with these conversations, but they're anxious and they are not feeling very well prepared," she says. "Through the realistic enactments, we have our staff learn how to have these difficult conversations, and they spend time as a team learning more about it."

The PERCS program is a day-long workshop, and is multidisciplinary in focus. Its core mission is to provide training to senior pediatric residents, fellows in critical care and emergency medicine, and nurses and other clinicians based in the Children's Hospital Boston intensive care units, though outside participants are welcome on a space-available basis.

For more information about PERCS, go to www.childrenshospital.org/clinicalservices.cfm, select "Critical Care Medicine" from the scroll-down menu, and scroll down the page to click on the link to PERCS. Or, e-mail Elaine Meyer, PhD, RN, director of PERCS, at elaine.meyer@childrens.harvard.edu.