Many barriers to providing patient-centered care and communication during nurse-patient interactions emanate from healthcare institutional practices or the healthcare system itself. Some of these factors are implicated in healthcare policy or through management styles and strategies. Crawford T, Candlin S, Roger P. (2017). New perspectives on understanding cultural diversity in nurse-patient communication. Collegian, 2017 Feb 1;24(1):63 – 9. https://doi.org/10.1016/j.colegn.2015.09.001. One of the duties of a nurse, as part of the ethical conduct, is to function as the patient's advocate (Balwin, 2003; MacDonald, 2007). Nurses also have four essential responsibilities: promoting health, preventing illness, restoring health, and alleviating suffering, which are quality requirements for Swedish registered nurses (Swedish National Board of Health and Welfare, 2005, p. 17). Furthermore, a part of a nurse's work is to ensure that the patient's pain is minimized (McCabe, 1997), and in the case of a child, one additional important aspect is to relieve the child's anxiety and worry because these experiences can intensify their feelings of pain (Wood, 2002). Koh Y, Hegney D, Drury V. Nurses’ perceptions of risk from emerging respiratory infectious diseases: a Singapore study. International journal of nursing practice. 2012;18(2):195–204. pmid:22435984 Liu W, Manias E, Gerdtz M. Medication communication during ward rounds on medical wards: Power relations and spatial practices. Health 2012 Mar. 2012;17(2):113–34. doi: https://doi.org/10.1177/1363459312447257.

Sitting next to a patient while talking, even for a brief period, can help improve patient satisfaction scores, for example. A 2017 studyfound that nurses who asked to sit beside their patients while talking improved hospital patient satisfaction scores from the 9th percentile to the 43rd percentile. In addition to forming connections with patients, nurses are in charge of ensuring patients understand, and therefore are engaged in, their care plans. In 2018, the American Academy of Nursing reaffirmed patient education as a core part of nursing work. This study was undertaken to describe the lived experience of supporting children during NRMP, from the perspective of nurses. The analysis resulted in the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief; and the discussion will focus on some of these findings. Sethi D, Rani MK. Communication barrier in health care setting as perceived by nurses and patient. Int J Nurs Educ 2017 Oct. 2016;9(4):30. doi: https://doi.org/10.5958/j.2320-8651.2.1.001. Nursing care practices that promote patient-centered communication will directly enhance patient-centered care, as patients and their caregivers will actively engage in the care process. To enhance patient-centered communication, we propose person-centered care and communication continuum (PC4) as a guiding model to understand patient-centered communication, its pathways, and what communication and care practices healthcare professionals must implement to achieve person-centered care. In this PC4 Model, we emphasize the person instead of the patient because they are a person before becoming a patient. Moreover, the PC4 Model is supposed to apply to all persons associated with patient care; thus, respect for the dignity of their personhood is crucial.Nurse-patient communication is anchored by strong interpersonal relationships. Meaningful relationships will allow nurses to carry out their clinical jobs more easily while keeping patients engaged in their care. BATHE uses open-ended conversations between patients and nurses to build strong relationships that can often go beyond clinical needs. Understanding who the patient is as a person helps the nurse connect with the patient and make her feel more comfortable during a potentially tumultuous care encounter. Clinicians really do leverage their communication skills and they have to focus on that and be more intentional because they are going to lose any of the subtle body language cues that they would get in an in-person setting,” she explained. Knowledge of cultural competence, sensitivity, humility, and interpersonal communication skills will help achieve and implement the PC4 Model. As Cuellar [ 37] argues, “[h]umility is about understanding and caring for all people [and] being empathetic.“ Cultural competence is a “dynamic process of acquiring the ability to provide effective, safe, and quality care to the patients through considering their different cultural aspects” [ 38]. The concept of cultural competence entails “cultural openness, awareness, desire, knowledge and sensitivity” during care [ 39]. It demands that care providers respect and tailor care to align with patients’ and caregivers’ values, needs, practices, and expectations, based on care and moral ethics and understanding [ 39]. Active listening and showing compassion as therapeutic relationship-building skills are essential, and continuous education and mentorship will be crucial to developing these skills among healthcare providers. Supporting children requires an adjustment to the amount of information the children should receive, based on their age, illness, degree of participation, experience, fear, and ability to focus. Younger children at the age of 3 to 4 years, with no prior experience of NRMP, will thus receive limited information; similarly children with more experience will be getting more detailed information. Nurses also explain that children who are anxious receive less information while open and curious children can be given more explanation.

Karen J. Supportive holding or restraint: Terminology and practice. Paediatric Nursing. 2010; 22(6):24–28. [ PubMed] [ Google Scholar] The NRMP included in the study were skin tests for allergy, blood sampling (venous or capillary), intravenous cannula insertion (IV), needle insertion in a central vein port, and injections into the joint. All children were given standard therapy for NRMP which includes some form of topical anesthesia, apart from capillary blood sampling and skin tests for allergy. The topical anesthesia was applied at least 1 h prior to the NRMP. Standard therapy was also used with inhalation/sedation, N 2/0 2, for children who underwent injections into the joint and for those who had a needle phobia. However, some research has indicated that small changes to existing workflows can help circumvent those time constraints. Some nurses may encounter hiccups when patients do not want to turn their cameras on during the telehealth encounter. Many patients have technical reasons for not turning on their cameras, like wifi or device limitations. Nurses and patients and their caregivers have noted that limited time affects nurse-patient interactions, communication, and care quality. Besides, Yoo et al. [ 22] reported that limited visiting hours affected communications between caregivers and nurses in a tertiary hospital in Seoul, Korea. Since the caregivers had limited time to spend with patients, they had little knowledge about the intensive care unit and distrusted the nurses.We express our gratitude to the first author’s doctoral committee members for their valuable comments, suggestions, and critique of an earlier version of this paper. We are also grateful to the anonymous reviewers for the insightful comments and suggestions that have helped us improve the study’s quality. Authors' information Henly SJ. Health communication research for nursing science and practice. Nurs Res [Editorial] 2016:257–8. doi: https://doi.org/10.1097/NNR.0000000000000171. International Council of Nurses. ICN Code of Ethics for Nurses; 2012. Available from www.icn.ch/images/stories/documents/about/icncode_english.pdf. Accessed 20 Dec 2020.

Parents are first and foremost the children's representatives, but if the parents are unable to do this, the nurses will take the responsibility for supporting children during NRMP.

OVERVIEW

Lindeke L. Capturing children's voices for quality improvement. MCN: The American Journal of Maternal Child Nursing. 31(5):290–295. quiz 296–297. [ PubMed] [ Google Scholar] Coming from a place of empathy, clinicians who feel they have an established baseline of trust and rapport with patients can explain why having the camera on helps improve the clinical care they can provide. Consistent with the findings of a previous study [ 25], facing social stigma and discrimination, mainly rejection by others related to COVID-19 care found in this study, are common issues for nurses worldwide [ 26]. Stigma has led to label nurses as ‘disease carriers’ [ 24] and limited social interaction and isolation among nurses. The stigma associated with COVID-19 is a predictor of compassion satisfaction, burnout, and compassion fatigue among health workers [ 25]. The present study reported not only the behaviour of the general public but also the behaviour of staff who did not work in the COVID-19 frontline contributed to stigmatisation and discrimination. To minimise the possible stigma and discrimination, improving public awareness needs to be expanded. Ramaci T, Barattucci M, Ledda C, Rapisarda V. Social Stigma during COVID-19 and its impact on HCWs outcomes. Sustainability. 2020;12(9):3834. https://doi.org/10.3390/su12093834

While the nurses prefer using the word “brave” the two concepts appear to be used randomly, without distinguishing their specific meanings. To be brave implies that the children have coped with something unpleasant: So, you were so brave, you still did it despite being sad and not wanting to do it before, and you did it anyway. I think it's important to communicate this so the principle of being good does not prevail [principles described by nurses]. Kim Y. Nurses’ experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea. American journal of infection control. 2018;46(7):781–7. pmid:29502886In outpatient settings, BATHE has been found to improve patient satisfaction without significantly increasing time spent per office visit,” the research team added. That webside manner builds on the interpersonal skills they have always used to connect with patients in person, according to Jessica Dudley, MD, the chief clinical officer at Press Ganey.