Table 3 Extracts of verbatim statements illustrating the different themes
From: Analysis of communication and logistic processes in neonatal intensive care unit
Themes | Subtopics | Excerpts |
|---|---|---|
(1) Critical care | Clinical Situation Unreasonable obstinacy Death | “She had a lot of trouble breathing. It took too much effort so we had to support her a lot.” “We know very well that it is serious, that the risk of death is very high” “So there, there is (sic) everything we do, in fact, does nothing for her. Okay? And it’s, well, it’s a medical failure, but it’s something that’s too serious for us and it doesn’t make sense to continue to do aggressive, potentially painful things. “There’s everything that’s gradually going towards a... a departure.” “It is by nature not acceptable, I, I, I know it well [...] again the death of a little baby it is not explicable, it is not admissible” |
(2) Establishing a physician-patient relationship | Common Framework Partnership | “We’ll keep you informed, as much as possible, of all the developments. So, it’s sometimes hard, quite raw because we have to tell you, we have to tell you the truth and (…) the state of your daughter at the time we see you”. “Do you have any questions? Any other questions? Is this clear? Do you understand?” “We’re all on the same page, so this is very important that we see/deal with this together.” “It’s up to us doctors, in alliance with you, with everything I’m doing right now, to tell you what level of care we’re going to do. |
(3) Decision making support | Uncertainty Certainty Team | “But we can’t know what will work in this child, this child (sic), that child” “We know for sure that it will result in significant sequelae, okay?” “I’m talking about us because it’s a team effort. The team asked me right away. |
(4) Social-emotional dimensions | Empathy Emotions Reassurance Accompagnement | “I understand, I understand that, I’m not in your shoes of course, but I can still understand what you’re telling me anyway” “You were enjoying her, the last moments of her life, with her in your arms. (Silence 25 s) (mother cries). It’s very brutal what I’m telling you, but things happen so brutally for some infants. it wasn’t really what we thought would happen, it’s not (silence 2 min) (mother cries). Do you want to go out for a while?” “We didn’t really expect this for _child’sname but unfortunately it happened last night.” “I’m really sorry, we’re all, we’re all shocked at, at what’s happening today.” “And you mustn’t blame yourself because you had nothing to do with it, no, but it’s important that I tell you that, for the mother, for you too, you are not responsible, you had nothing to do with it, okay?” “What do I know about children who have these kinds of abnormalities in the neonatal period? Well, the majority, the vast majority are fine, I can tell you that I’m not as pessimistic as I might be in other conditions, surgery, low flow. “The nurses are going to do some care. They’re going to take away all the medical equipment, dress her. And then you have a way to see her dressed in pajamas and not with all these machines and all these tubes. And then, uh, after that she’s going to go to the morgue.” “Absolutely. So, there’s that, there’s talking to her, touching her. As soon as it’s possible, you can take her against you - skin to skin. |