Parent perceptions of early prognostic encounters following children’s severe traumatic brain injury: ‘Locked up in this cage of absolute horror’

OBJECTIVE: Little guidance exists for discussing prognosis in early acute care with parents following children’s severe traumatic brain injury (TBI). Providers’ beliefs about truth-telling can shape what is said, how it is said, and how providers respond to parents. METHODS: This study was part of a large qualitative study conducted in the USA (42 parents/37 families) following children’s moderate to severe TBI (2005 to 2007). Ethnography of speaking was used to analyse interviews describing early acute care following children’s severe TBI (29 parents/25 families). RESULTS: Parents perceived that: a) parents were disadvantaged by provider delivery; b) negative outcome values dominated some provider’s talk; c) truth-telling involves providers acknowledging all possibilities; d) framing the child’s prognosis with negative medical certainty when there is some uncertainty could damage parent-provider relationships; e) parents needed to remain optimistic; and, f) children’s outcomes could differ from providers’ early acute care prognostications. CONCLUSION: Parents blatantly and tacitly revealed their beliefs that providers play an important role in shaping parent reception of and synthesis of prognostic information, which constructs the family’s ability to cope and participate in shared decision-making. Negative medical certainty created a fearful or threatening environment that kept parents from being fully informed

Developing Culturally Sensitive Care in Japan: Comparison of Competence in Healthcare and Education

Competence in culturally sensitive care in healthcare has been included into the Japanese medical school curriculum since 2001 and will be integrated into the Japanese nursing school curriculum in 2018. Since the concept of competence in culturally sensitive care is new to the Japanese healthcare education, we need to gain knowledge about the concept from other forward-thinking countries. However, when introducing the concept of competence in culturally sensitive care from foreign countries to Japan, the knowledge and experiences of those countries should be considered