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SC23 Challenging conversations in neonatal intensive care: working with simulated relatives
  1. Kim Edwards1,
  2. Carrie Hamilton2,3,
  3. Marjolein Woodhouse3
  1. 1Health Education England (Wessex), Winchester, UK
  2. 2SimComm Academy, Marchwood, UK
  3. 3University of Portsmouth, Portsmouth, UK


Background Registered nurses are expected to communicate effectively with patients and relatives. To improve this, education programmes are increasingly turning to simulation modalities including scenarios with simulated patients/relatives (SPs) (MacClean et al. 2017). Patient and public involvement has become an integral part of healthcare; SPs play an essential role in being the patient/relative proxy and advocate.

Wessex Network Neonatal Preceptorship Programme has preceptees that are newly qualified child-branch nurses and adult-trained nurses, from nine neonatal units. Research has identified that preceptees are ill-equipped to have challenging conversations (Whitehead et al. 2013). Wessex preceptees corroborated further and identified that they would benefit from simulated training to gain a better understanding from the relatives’ perspective.

Project description Our aim was to incorporate, through simulation, the ‘lived experience’ of relatives of neonates within neonatal intensive care/unit settings. Scenarios were developed with learning outcomes based on relatives’ experiences. SPs from an established SP programme, were selected and then trained to portray the roles; the debrief included the participants, the SP and facilitator.

The scenarios, underpinned by the NHS values and the NMC Code of Conduct, covered:

  • Responding to relatives’ complaints

  • Supporting relatives after unanticipated transfer of patient

  • Patient safety

  • Professionalism and accountability

  • Giving positive feedback.

To ascertain participants’ views and knowledge surrounding communicating in challenging situations before and after training, a questionnaire containing eleven 5-point Likert-format items was utilised. Data were analysed using Wilcoxon singed-ranks or sign tests.

Summary of results Seventeen participants completed the questionnaire; all felt their knowledge had increased following the training. The observed differences between the scores that were given before and after training were statistically significant in all eleven items (all p<0.01). The following elements were noted to be particularly helpful:

  • practicing pacing, silence, clarifying, responding to cues, avoiding jargon and providing support

  • delivering positive feedback

  • being empowered to initiate, participate and lead by example.

The highest score change was observed in participants confidence in changing their personal communication style.

Recommendations Experiential learning is a powerful and effective tool in preparing neonatal intensive care preceptees for challenging conversations. Participants believed this to be an essential component of their professional development. This will run in the region every six months for new cohorts and to maximise impact, our aim is to offer this programme to neonatal units beyond preceptees. The ASPiH standards suggest that there is clear alignment to stakeholders needs, which we believe this programme has responded to.


  1. MacLean S, Kelly M, Geddes F, Della P. Use of simulated patients to develop communication skills in nursing education: An integrative review. Nurse Education Today2017;48:90–8.

  2. Whitehead B, Owen P, Henshaw L, Beddingham E, Simmons M. Supporting newly qualified nurse transition: A case study in a UK hospital. Nurse Education Today2015. Available from: [Accessed: 15 August 2017].

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