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Published on: February 23, 2024
Little words BIG impact: Perioperative communication for children with burns
Allan M Cyna1,2
1Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, Australia.
Insights
Effective communication strategies, including specific language techniques and adjunctive therapies like play therapy, can significantly improve anaesthetic care for children with burns. These methods enhance patient and family interactions, optimize pain management, and improve overall safety during treatment.
Area of Science:
- Anesthesiology
- Pediatric Burn Care
- Medical Communication
Background:
- Anaesthetists play a crucial role in managing burn-injured children throughout their treatment, from initial resuscitation to long-term scar management.
- Effective communication is vital for anaesthetists interacting with pediatric burn patients, their families, and the multidisciplinary care team.
- Limited guidance exists on optimizing communication strategies for anaesthetists in pediatric burn care across pre-, intra-, and postoperative phases.
Purpose of the Study:
- To provide guidance for anaesthetists on communication strategies to optimize anesthetic care for children with burns.
- To explore the impact of communication on subconscious processes (placebo/nocebo) in pediatric burn patients.
- To highlight the importance of communication as a core clinical skill in pediatric anesthesia for burn management.
Main Methods:
- Review of communication techniques and their application in pediatric anesthesia for burn patients.
- Discussion of neurobiology of communication, including placebo and nocebo effects.
- Introduction of structured communication models like GREAT (Greeting, Rapport, Expectations, Addressing concerns, Tacit agreement) and LAURS (Listening, Acceptance, Utilisation, Reframing, Suggestion).
- Exploration of alternative pain management strategies such as play therapy and hypnosis.
- Emphasis on team communication strategies, including the use of time-outs during surgery.
Main Results:
- Learnable language structures (GREAT, LAURS) can improve patient and family interactions, ensuring they feel heard and understood.
- Framing communication positively (e.g., focusing on 'finishing' painful procedures) and avoiding negative suggestions (nocebo) can enhance patient experience.
- Adjunctive therapies like play therapy and hypnosis can be valuable for pain management in children, minimizing side effects.
- Regular communication during surgery (time-outs) improves patient safety.
- Communication is identified as a critical skill requiring further research in pediatric burn anesthesia.
Conclusions:
- Optimizing communication is essential for providing comprehensive anesthetic care to pediatric burn patients.
- Implementing evidence-based communication strategies and adjunctive therapies can significantly improve outcomes and patient safety.
- Further research is needed to fully understand and enhance the role of communication in pediatric burn anesthesia.
Abstract:
Anaesthetists are key members of teams caring for burn-injured children in almost every aspect of their management. Their role can involve initial resuscitation, intensive care, analgesia, and anaesthesia for multiple procedures both acutely and subsequently for scar management. As key members of burns management teams, effective communication with patients and their families as well as other members of the burn care team is vital. There is little guidance, however, addressing how the anaesthetist might communicate and optimise anaesthetic burns care of children pre-, intra-, and postoperatively. Advances in the understanding of the neurobiology of communication suggests that we need to consider positive (placebo) or negative (nocebo) subconscious processes. Learnable language structures GREAT (Greeting, Rapport, Expectations, Addressing concerns, Tacit agreement) and LAURS (Listening, Acceptance, Utilisation, Reframing, Suggestion) can facilitate any patient or family interaction ensuring children and their parents feel they are being heard and understood. Talking about finishing rather than starting when about to perform a potentially painful procedure can also facilitate burns care with children. Other strategies include the avoidance of nocebo communications or apologising before a painful procedure and, instead, focusing on therapeutic (placebo) alternatives. Children do not view pain in the same way as adults do, and techniques such as play therapy and hypnosis can be valuable adjuncts to traditional analgesia administration in burns care, with the added benefit of minimising side-effects. The use of regular time-outs during prolonged burns surgeries is a helpful communication strategy between the anaesthetist and other members of the burns team that can optimise patient safety. Communication is a core clinical skill in the practice of anaesthesia during paediatric burns care and is an area for future research.
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