Editor's Choice

Abstract

Parents have been bombarded with unfounded, negative and confusing messages about childhood vaccination, in particular the measles, mumps and rubella vaccination. When scientists and doctors argue in public and plant the seed of uncertainty in parents’ minds, it is inevitable that the work of children’s public health nurses in delivering vaccination programmes is made far harder. Much of what children’s nurses do is also hidden and often undervalued. Effective interventions such as preprocedural preparation using play and child focused talk are frequently viewed as supportive parenting activities rather than planned nursing care. As a clinical nurse I have been followed by a management consultant with a clipboard for entire shifts on a children’s ward. The purpose of this exercise was to make recommendations about the effective use of expensive nursing time and consider opportunities for role substitution by non-qualified assistants. I was horrified to learn that the management consultant considered an hour spent teaching a mother to make up and then give a fortified milk feed to her resisting baby was labelled as ‘domestic’ and not ‘nursing’ activity. All the finding out, observing, teaching, and checking, and supporting talk, cooing noises, gestures and positioning that I used to engage the baby and his mother whilst he resisted and reluctantly sucked failed to register as a ‘nursing intervention’. I was therefore delighted to read Plumridge et al.’s conversation analysis of nurse and parent interactions during childhood vaccinations in this issue of Journal of Advanced Nursing (pp. 1187–1194). The study examined partnership and communication between nurses and parents during ten actual immunization events. The methods are well described particularly to those not familiar with conversation analysis. The results of this study, undertaken in New Zealand in 2005, cannot necessarily be generalized, but they do provide a lens on some of the very important and hidden activity that happens between nurses, young children and parents. The study helps to legitimize the ways in which partnership is made in vaccination events and the crucial role nurses have in using non-verbal and verbal communication with preverbal children and their parents. Most importantly, during vaccination events nurses and parents were seen to prioritize communication with the child and not on each other. The researchers report that in this small sample the type of communication pattern was key. Where pain was recognized as inevitable and there was no stress on stoicism and progress towards completion, the child displayed more distress and began crying before the injection. So what can nurses, healthcare professionals and management consultants learn from this small study? Primarily that ‘small talk’ is important and what happens at the micro-level of turn taking and the rhythm of spoken language, including stress and intonation can have an impact on outcomes – both for the child and parent. Plumridge et al. conclude that ‘small talk’ is of major importance as a practical professional skill in which nurses not only align with parents but simultaneously cue both mother and child about how the immunization should be conducted. Whilst acknowledging this study has limitations regarding generalizability, it would be very interesting to see whether doctors, and other healthcare professionals such as physiotherapists and phlebotomists engage in similar communication styles with children and their parents/carers? The key message to children’s nurses is keep engaging in ‘small talk’ when vaccinating small children – there is evidence to suggest that children and parents benefit! Nonetheless, ‘small talk’ is a skilled activity that needs to be delivered in a specific way to gain maximum benefit. I look forward to reading further research in different settings and scenarios.