Communication between nurses, children and their parents in asthma review consultations

Aim and objective. To examine communication between nurses, children and parents in asthma review consultations. Background. Communication is an essential component of asthma care, but there has been little examination of nurses’ consultations with children and parents. Design. Observation of communication in consultations examined in the context of the perspectives of parents and nurses. Method. Qualitative analysis of audio recordings of nine consultations with nurses by children aged 7–12 years and their parents; and interviews with 18 parents and six nurses. Results. The triadic relationship between child–nurse–parent was constructed from dyads of nurse–parent, nurse–child and parent–child. Both cooperation and conflict were identified in the analysis of interaction in dyads although direct confrontations were minimised or avoided. Conflicts arose from differing beliefs about asthma and its treatment and from different perspectives on the impact of asthma and the goals of treatments, and about the roles of children, parents and practitioners. There was uncertainty about the appropriate role of children in their asthma management. Conclusions. The dyads of nurse–parent, nurse–child and parent–child each make distinct and important contributions to triadic communication. Personal and task elements of therapeutic alliance are important elements in communication between nurses, children and their parents in asthma review consultations. Relevance to clinical practice. Communication is an essential component of children’s asthma care. Guidance encourages practitioners to use review consultations to help children and parents to identify areas where they want treatment to have effect and to negotiate personalised action plans with practitioners. There is potential for conflict as well as cooperation. There is a need for more research into nurses’ communication with children and parents to provide an evidence base for practice, education and training.