A Smiling Nurse Makes All the Difference in Pediatric Oncology

Being hospitalized for cancer can be a frightening experience for a child, but a friendly and approachable nurse can make all the difference.

“For these children with an oncology diagnosis, they're very vulnerable. And many times they're excluded in decisions for their care,” said Bethany J. Petronio-Coia, PhD, RN, a nurse educator at the Rhode Island College School of Nursing. “So it's really important for pediatric nurses, and providers of all kinds that they think about and reflect on actions and words, and hopefully make some changes to improve the lives of these children.”

Petronio-Coia conducted research on what pediatric patients saw as “approachable nurses.” She shared her findings in an interview with Oncology Nursing News.

Oncology Nursing News: Can you give some background on your research, and why it was important to conduct?

Petronio-Coia: I've had a very varied career, all in pediatrics, but at many different capacities from home care, pediatric intensive care units, in hospital, inpatient setting, and then my experiences as a clinical nurse specialist, where I worked with pediatric hematology and oncology patients and all children. But at every level, I've noticed that health care providers and nurses really seem to struggle to communicate with children. And so what seems common sense to some may not to others. This isn't a natural behavior that everyone has. As I moved along my career, I became a nurse educator. And now I'm a professor at Rhode Island College teaching pediatrics to nursing students.

I would find my students standing outside the doors of the rooms of these children that I had assigned them. And I would go up to them and say, ‘What’s going on? Is everything okay?’ And their comment to me was not that they were afraid of being able to care for the child. But they would say, “I don't know how to talk to these kids. I'm scared. How do I talk to them?”

And so I started my doctoral work. And I started looking into communication with children and trying to find out with my literature searches, what work has been done, what hasn't been done. I found there was little to no research about communication and approachability. I started thinking about what makes a nurse approachable. I found the United Nations, they had a convention in 1989, about the rights of children. And it drew international attention. And there's been some spin off with research, but not a lot with the importance of hearing the voice of the child. So after my literature review, and really reflecting on all of my experiences as a pediatric nurse, I found, it became very transparent to me that that was where I needed to do my work.

What kind of emotional toll can a cancer diagnosis — and subsequent hospitalizations – have on a school-aged child?

Having that diagnosis presented to you, it's difficult to fathom as a child, but as a parent also… It's unimaginable, people immediately think, ‘Oh, my gosh, what did I do wrong? The parents? Is my child going to die?’ So that diagnosis is very challenging for these families, [as is] trying to explain it to the children what's going to happen.

[Multiple hospitalizations] cause a continual sense of disruption. It’s a disruption of the line of the child, and the family or siblings. There are many factors that impinge upon the family.

The hospital becomes like a second home to these families. Many of the children I interviewed reported that the nurses who were approachable were so kind and made the hospitalization more bearable for them. The children also reported feelings of fear … when they speak to nurses who are approachable, it helps to calm them down. It eliminated some of those fears and really made a difference.

What were some of the characteristics that approachable nurses had?

I was able to have these interviews that were open ended with children where I had some prompts. And the children described in their own words, and I will tell you, even though they were sick, they were so excited to share with me this information because they wanted to help other kids and they wanted the nurses to know they described an approachable nurse as one who was smiling and happy. They all mentioned the smile. That was an indication that made them feel comfortable… [But] they knew when it was a fake smile.

They also noted that approachable nurses were playful. These are children, play is part of their job as kids. [Nurses would do things like] dancing, making jokes, or even squirting water from syringes [without needles].

Nurses who were approachable also took the time to talk and listen to children and ask them about their fears. They felt valued and cared for when they were listening to. And interestingly, the children really wanted to hear about the nurses’ lives, too.