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G634(P) Restoring dialogue with challenging families in highly emotive situations
  1. C Moorhouse,
  2. D Bean
  1. Orgnaisational Development, Nottingham University Hospitals NHS Tust, Nottingham, UK


Aims In healthcare, disagreements can arise between patient and healthcare professionals. Normally, they are minor and are resolved quickly. Increasingly, more significant disagreements and even conflict can arise, some reaching the national and international media. When the patient is a child, the potential for such severe disagreements and conflicts can be even greater.

Method England’s ‘Senior Children’s Nurses’ convened a workshop that took the form of a ‘collaborative enquiry’ aimed at creating new knowledge utilising the ‘Knowledge to Action’ cycle of:

  • Explore participants’ experiences of the issues

  • Share good practice

  • Identify areas where national and local policy could support healthcare professionals and parents in managing conflict

Context Healthcare professionals and the child’s parents or guardians may find themselves in legitimate disagreement over what is in their child’s best interests.

The child’s parents may find themselves in disagreement with each other, exacerbating the challenges faced by healthcare professionals attempting to secure consensus on treatment options.

The healthcare professionals are more likely to have a rational approach that can be viewed by parents as insensitive or even cruel.

Evidence suggests, particularly where children are cared for by the same healthcare professional over a long period of time, the healthcare professional may form an equally powerful emotional attachment to the child which may exacerbate still further any conflicts which arise.

Results The enquiry explored the shared knowledge of these terms:

  • Types

  • Effects

  • Sources of

  • Approaches and Responses

Conclusion All participants identified a need for ‘cultural change’ at a very high level and this could be facilitated by:

  • A need to ‘have conversations differently’, meaning that all healthcare professionals need to be equipped with the skills and the training to listen to parents’ questions and concerns.

  • A need to ‘empower parents’, they should be enabled to understand the care options available to their child, through a meaningful dialogue.

  • A need to ‘support the system’, providers must therefore be equipped with the tools needed to identify where problems are occurring and supported with mechanisms to prevent cases escalating to the point where court action is needed.

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