title: Staff engagement during complex pediatric medical care: the role of patient, family, and treatment variables.
abstract: OBJECTIVE
  To examine the role of patient, family, and treatment variables on self-reported engagement for physicians and nurses working with pediatric complex care patients.
  
  
  METHODS
  Sixty-eight physicians and 85 registered nurses at a children's hospital reviewed eight case scenarios that varied by the patient and patient's family (each cooperative versus difficult) and the length of hospitalization (<30 days versus >30 days). Participants rated their engagement from highly engaged/responsive to distancing/disconnected behaviors.
  
  
  RESULTS
  Nurses were more likely than physicians to engage in situations with a difficult patient/cooperative family but less likely to engage in situations with a cooperative patient/difficult family.Nurses were more likely to consult a colleague regarding the care of a difficult patient/difficult family,while physicians were more likely to refer a difficult patient/difficult family to a psychosocial professional.
  
  
  CONCLUSIONS
  Differences were found for engagement with "difficult" patients/families, with physicians more likely to distance themselves or refer to a psychosocial professional, while nurses were more likely to consult with a colleague.
  
  
  CONCLUSIONS
  Communication between health care team members is essential for optimal family-centered health care. Thus, interventions are needed that focus on communication and support for healthcare teams working with pediatric complex care patients and their families.
authors.affiliation: Children's Hospital of Pennsylvania and University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. meltzerl@email.chop.edu
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Meltzer
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Steinmiller
authors.forename: Steve
authors.initials: S
authors.lastname: Simms
authors.forename: Michael
authors.initials: M
authors.lastname: Grossman
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Li
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D002648:Child; D002673:Child, Hospitalized / Q000523:psychology*; D003142:Communication; D003299:Cooperative Behavior; D005190:Family / Q000523:psychology*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D018802:Patient-Centered Care / Q000458:organization & administration; D010372:Pediatrics / Q000379:methods; D024382:Professional Role / Q000523:psychology*; D011368:Professional-Family Relations; D012929:Psychological Distance; D002666:Psychology, Child; D012017:Referral and Consultation; D011795:Surveys and Questionnaires