Journal of Neonatal Nursing (2015) xxx, xxxexxx

www.elsevier.com/jneo

ORIGINAL ARTICLE

An Effective Communication Initiative:

Using parents’ experiences to improve the
delivery of difficult news in the NICU
Kristy Macdonell, MSW, RSW, Social Workera,b,*,
Danielle Omrin, MSW, RSW, Social Workera,b,
Kasia Pytlik, MSW, RSW, Social Workera,b,
Sam Pezzullo, A parent that had a baby in the NICUa,
Marianne Bracht, RN, RSCN, Parent Resource Nursea,
Yenge Diambomba, MD, FRCPC, Clinican/Teachera

a
Neonatal Intensive Care Unit, Mount Sinai Hospital, 600 University Avenue,
Toronto, ON M5G 1X5, Canada
b
Social Work Department, Mount Sinai Hospital, 600 University Avenue, Toronto,
ON M5G 1X5, Canada

Available online - - -

KEYWORDS Abstract Objective: Enhance the quality of communication between parents and
Infant; neonatal intensive care unit (NICU) staff.
Premature; Methods: Parents of preterm infants and staff designed and implemented in-service
Neonatal intensive training regarding the parent perspective on the impact of poor communication in the
care unit; NICU. Gaps in the experience/needs of staff around delivering bad news were exam-
Communication; ined using a questionnaire and addressed by improving unit procedures.
Parents; Results: Most NICU staff, regardless of their role, years in healthcare, and experi-
Family-centered care; ence/confidence with delivering difficult news to families, indicated a need for more
Bad news support and training. Improvements to unit procedures included holding family meet-
ings soon after an infant’s birth, including all members of the infant’s healthcare team
in family meetings, providing clinical fellows with training on delivering bad news, and
documenting discussions in family meetings for everyone’s reference.

Abbreviations: NICU, neonatal intensive care unit.

* Corresponding author. Social Work Department, 600 University Avenue, Toronto, ON M5G 1X5, Canada. Tel.: þ1 416 586
4800x5213.
E-mail address: kmacdonell@mtsinai.on.ca (K. Macdonell).

http://dx.doi.org/10.1016/j.jnn.2015.01.002
1355-1841/ª 2015 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002
2 K. Macdonell et al.
Conclusion: Incorporation of parent experiences of communication in the NICU is
effective in addressing challenges associated with delivering difficult news.
ª 2015 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Introduction
The environment of the neonatal intensive care
unit (NICU) is extremely overwhelming, especially
for parents who are already under stress and
grieving due to their infant’s unexpected admis-
sion, critical illness, or difficult start to life. As
such, the use of a family-centered care approach
that directly involves parents in their infant’s care
is a critical component of NICU care (Gooding
et al., 2011). One of the cornerstones of family-
centered care is effective communication and in-
formation exchange, which facilitates mutual un-
derstanding and collaborative decision making
between parents and medical professionals, and
ensures that care is responsive not only to the
family’s unique needs, circumstance, and values,
but to the infant’s best interests (Gooding et al.,
2011; Bruns and Steeples, 2001; Carter and
Maroney, 2003). Effective communication is
particularly important in the delivery of difficult
news as poor communication can add significantly
to parents’ feelings of grief (Armentrout and
Cates, 2011; Laing and Freer, 2008). Unfortu-
nately, training and strategies for effective
communication with families are inconsistently
implemented and many physicians feel poorly
prepared to deliver bad news in the NICU (Harrison
and Walling, 2010).
As a NICU that aspires to provide the best in
family-centered care, this article describes how
we developed and implemented an ‘Effective
Communication Initiative’ in our unit to enhance
the level of care and quality of communication
between parents and staff in our facility.
Principles of effective communication in the
NICU
The first step in developing the Effective Commu-
nication Initiative was the formation of a working
group of parents and healthcare professionals
interested in creating collaborative strategies for
delivering difficult news to families. All parents
involved had the experience of having an infant in
the NICU (i.e., veterans) and were part of our
Parent Advisory Committee (a parent-led group
with staff support that provides parents with the
Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002
opportunity to become partners in the planning,
development, and evaluation of programs to
address ongoing NICU issues). From the initial
meeting, it was evident that the quality of
communication between healthcare professionals
and parents and even among healthcare pro-
fessionals themselves needed to be improved.
Based on the concerns that veteran parents raised,
healthcare professionals felt that they were at
times unequipped to deliver difficult information
to families. Further, the nursing staff felt inade-
quately equipped to support families at the
bedside and expressed that this was largely a
result of not being consistently included in family
meetings where medical updates are discussed
with parents, primarily by the staff physician.
These concerns reinforced the necessity of an
Effective Communication Initiative working group
to improve and foster more effective communi-
cation practices in the NICU.
The Effective Communication Initiative working
group then reviewed the existing literature to
better understand the principles of effective
communication in the NICU. Many of the recom-
mendations were developed by understanding
parents’ perspectives and what they perceive to
be helpful or not during end-of-life care (Bruns and
Steeples, 2001; Armentrout and Cates, 2011;
Wocial, 2000). Overall it has been found that how
information is communicated greatly influences
parent’s perspectives of their interactions with
providers and their confidence and trust in the
care they are receiving (Wocial, 2000; Ptacek and
Eberhardt, 1996). In times of distress, parents
often recount that being surrounded by calm pro-
fessionals who displayed empathy and genuine
emotions was appreciated because it signified that
their baby was valued and had an effect on other
lives (Armentrout and Cates, 2011; Wocial, 2000;
Henley and Schott, 2008). Parents report that
they want information to be delivered in a
comprehensible and consistent manner and they
want to be included in the decision-making process
and end-of-life care (Armentrout and Cates, 2011).
Respect and responsiveness to the family’s well-
being, preferences, and cultural values is also
imperative when delivering services under the
family-centered model, as it provides an oppor-
tunity to develop a trusting and respectful
Communication with families in the NICU
relationship (Bruns and Steeples, 2001; Lundqvist
et al., 2002).
Memories related to dissatisfaction with the
care received have been found to remain for a
lifetime (Laing and Freer, 2008; Lundqvist et al.,
2002) and influence future relationships with
health professionals (Bruns and Steeples, 2001).
Giving parents limited information and choices, as
well as communicating ineffectively, prevents
parents from perceiving themselves as in control
and involved in their infant’s care, thereby
furthering their distress levels (Armentrout and
Cates, 2011), feelings of powerlessness
(Lundqvist et al., 2002), and fear of not meeting
their obligations as parents (Wocial, 2000). On the
other hand, receiving support, encouragement,
and empathy from the health care team can foster
feelings of empowerment in parents and confi-
dence to make decisions about the care of their
child (Lundqvist et al., 2002).
Despite recommendations on how to deliver bad
news in the NICU, studies indicate that many staff
physicians and neonatology fellows receive little
training on effective communication (Boss et al.,
2009; Dube et al., 2003; Rider et al., 2008). For
example, Boss et al. (2009) assessed the level of
training in interpersonal and communication skills
that graduating neonatology fellows received (83%
were from accredited US programs), as well as
their perceived competence in facilitating
decision-making conversations with parents. While
the majority of fellows indicated that they
received “a lot of training” in the medical man-
agement of extremely preterm (96%) or dying in-
fants (89%), 41% reported that they did not receive
formal training in communication skills and 75%
never participated in relevant role plays or patient
simulations. Fellows also reported that they felt
inadequately trained to resolve conflicts around
goals of care. Difficulty with conflict resolution
raises concern around achieving collaborative
decision-making, which is a core principle of
family-centered care (Cooper et al., 2007), since it
plays a key role in building trust with families and
improving their overall satisfaction with the level
of end-of-life care (Brosig et al., 2007).
Researchers have also found that lack of edu-
cation in effective communication contributes to
the difficulty that physicians experience when
delivering difficult news by heightening feelings of
anxiety, fear, or stress in anticipation of conveying
the information, particularly with regards to the
physician’s previous experiences, their perception
of the severity of the news, and whether they
think they are responsible (Ptacek and Eberhardt,
1996). Further, if stress levels become too high,
Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002
3
then the delivery of information may be delayed or
the level of care the next patient receives may be
negatively impacted (Statham and Dimavicius,
1992). However, when education and training on
communication is specific to the NICU setting,
professionals often provide self-evaluations that
demonstrate their improved perceptions of confi-
dence, preparation, and communication skills,
regardless of their discipline, years of experience,
or previous learning opportunities (Meyer et al.,
2011). This demonstrates the significant impact
that specialty-specific training on communication
and relational capacities has on members of a
health care team (7), not only for learning pur-
poses, but also to positively influence individual
and team practice models related to family-
centered care.
In-service training to stimulate discussion of
effective communication
Following the literature review, the working group
discussed how difficult news was delivered within
our NICU and elicited input from the NICU care
team and other parents. This discussion produced
a collection of stories and narratives gathered
from the veteran parents on the Effective
Communication Initiative working group and other
parents in the NICU that was used to develop in-
service training. Within the training, role-plays,
story-telling, and pictures/video were used to
dramatize real parent experiences in the NICU and
provide an opportunity for NICU healthcare pro-
fessionals to understand the parent perspective.
The in-services lasted approximately one hour and
included a twenty-five minute sharing of the fam-
ilies’ experiences followed by an open group dis-
cussion. The discussion entailed exploring
different methods of delivering difficult news with
clarity and empathy, as desired by parents. The in-
services were held every other month over 18
months and attendance regularly reached more
than 40 staff members.
Feedback regarding delivering difficult news
and the in-service training
During the development of our Effective Commu-
nication Initiative, it became apparent that phy-
sicians and allied health members in our NICU had
similar concerns and anxieties about the delivery
of difficult news to those often reported in the
literature. It was also apparent that a sustainable
effective communication program was required
that was responsive to the needs of the healthcare
4 K. Macdonell et al.
professionals in the NICU. Following provision of
the in-service training, we distributed question-
naires to all members of the healthcare team to
identify gaps in their experiences and their needs
with regards to delivering bad news. The ques-
tionnaire included questions on how much experi-
ence (None/Some/Lots/Extensive) and how
confident (Not at all/Somewhat/Very/Extremely)
staff members were in providing difficult or bad
news to families, the level of previous training
received in delivering bad news (hours and method
of delivery), how helpful staff thought it would be
to receive more training (Not at all/Somewhat/
Very/Extremely), and feedback on the in-service
training.
All of the staff physicians, allied healthcare
professionals (e.g. social workers, lactation
consultant, infection control practitioner, clinical
care manager, dietician), and respiratory thera-
pists responded to the questionnaire along with
over 50% of the nurses. The responses to the
questionnaire identified that the majority of staff,
regardless of their role, number of years spent
working in health care, and level of experience
and confidence with delivering difficult news to
families, indicated that it would be ‘very’ or
‘extremely’ helpful to receive more support and
training in this area. This included 7 out of 8 (88%)
staff physicians, 17 out of 20 (85%) medical resi-
dents and fellows, 25 out of 26 (96%) allied health
professionals and 67 out of 77 (87%) nurses who
responded to the questionnaire. While 14 out of 20
(70%) medical residents and fellows had received
prior training in delivering difficult news, only 4
out of 8 (50%) staff physicians, 5 out of 25 (20%)
allied health professionals and 23 out of 77 (30%)
nurses had received any prior training.
The level of experience and confidence with
delivering bad news also varied by role within the
NICU team. All the staff physicians reported ‘lots’
or ‘extensive’ experience and being ‘very’ or
‘extremely’ confident in delivering bad news. As
would be expected, the level of experience for
residents and fellows was less and ranged from
‘none’ to ‘lots’. Confidence was also lower and
ranged from ‘not at all’ to ‘very’ with only 6 out of
the 20 (30%) respondents indicating they were
‘very’ confident with delivering bad news. For al-
lied health professionals, confidence was depen-
dent on role, with 5 out of the 6 (83%) social
workers but none of the respiratory therapists
indicating they were ‘very’ or ‘extremely’ confi-
dent in delivering bad news. Approximately 40% (31
out of 77) of the nurses indicated they were ‘very’
or ‘extremely’ confident in delivering bad news.
Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002
Feedback on the in-service training indicated
that the expressive role-plays, parent involve-
ment, and candid dialogue and exchange of in-
formation between parents and professionals were
well received. As reported by one staff member,
the role-plays allowed staff to experience first-
hand the impact they can have on families: “[The
in-service] gave me a lot of insight about what it is
like to be a parent in the NICU. Every nurse should
attend this session.” Another comment summa-
rized the fact that the sessions also provided par-
ticipants with a rich experience to truly feel and
empathize with the parent’s portrayal of their
experiences as emotions could be felt and heard:
“.seeing [the parents’] emotions helps me to put
my care and priorities e family-nurse relationship
e into perspective.” The training also offered a
means for professionals to reflect on their practice
and consider how they can improve their future
interactions by using the recommendations from
parents and the ideas that arose out of the dis-
cussions: “It is very sobering listening to parents’
experiences and their interpretation of the in-
formation that we convey/share with them. All
staff members can learn from these powerful
sessions no matter how long they have been
practicing.”
Our intention was to also provide a means for
parents to feel empowered and to further
strengthen parent-professional partnerships within
our NICU. Veteran parents who participated posi-
tively gained from it because it gave them a
chance to contribute and become involved with
something that was very tangible and true to their
hearts. The positive feedback the parents
received further validated their efforts and prac-
tical contribution to the medical field; such that
other NICU parents in the future may have better
experiences around receiving difficult news as a
result.
Development of a framework and tools for
delivering difficult news
The high attendance and feedback from the in-
service training along with the results of the
questionnaire indicated the need for a more
formal and sustainable process and tools to aid
NICU staff in effective communication and deliv-
ering difficult news. The Effective Communica-
tions Initiative team worked with the NICU
leadership to incorporate the lessons learned from
the in-service and questionnaire into practice
within the NICU. Discussion around effective
communication was integrated into medical
Communication with families in the NICU
Table 1 Framework for delivering bad news.
1.Establish a therapeutic relationship with parents
before the need to deliver difficult information.
2.Arrange a time and place that is comfortable for
the parents to ensure that parents feel well sup-
ported, respected, and provided with enough
privacy.
3.Ensure both parents or another significant sup-
port person is present when delivering difficult or
bad news.
4.Disclosure of information should be given as soon
as possible in a compassionate yet factual manner.
Explore what the family already knows about the
medical condition or diagnoses to appropriately
modify the language used and amount of detail
provided. Ensure that parents have ample time to
ask questions and offer the services of an inter-
preter if the family does not understand or speak
English fluently.
5.Support and encourage the expression of feel-
ings, being mindful of individual and cultural dif-
ferences in reacting to bad news and in grieving.
6.Provide meaningful statistics to support expla-
nations and offer patient-friendly handouts or
drawings that can be referred to at a later time.
7.Establish a “next steps plan” and be sure to
follow through to ensure that parents continue to
be informed and supported.
rounds on a more regular basis and a framework
was created to assist health care professionals in
delivering difficult news (see Table 1).
Key aspects of the framework include building a
relationship with parents before the need to
deliver difficult information arises, ensuring that
any family meeting includes both parents/and or a
support person and is held in a place that affords
privacy with enough time for a full discussion. This
also provides an opportunity to deliver news
compassionately with full explanation and sup-
porting information sources that can be referred to
later by parents. This framework was formalized
by creating a template document for family
meetings that sets out how a family meeting
should be conducted and the way in which infor-
mation should be delivered and recorded to pro-
vide optimal support.
Use and evaluation of the Family Meeting
Template
The Family Meeting Template was used consis-
tently at family meetings for 3 months and staff
were then asked to complete a questionnaire
regarding the usefulness of the template. The
template includes information around the infant’s
Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002
5
medical status, parent’s participation in the care
of their infant and engagement in parent pro-
grams, as well as space for each core member of
the infant’s care team to write an update/plan
moving forward. The family receives a copy of the
document at the end of the meeting so that they
have a written summary of the main areas of dis-
cussion. All of the staff physicians (10), clinical
fellows (4), Nurses (20) and allied health pro-
fessionals (7) involved in family meetings over that
time period responded to the questionnaire. The
majority of staff, regardless of their profession,
found the Family Meeting Template to be effective
at meeting healthcare professionals’ and families’
needs around improved communication and facil-
itation of family meetings. Specifically, staff indi-
cated that they either ‘strongly agreed’ or
‘agreed’ that the Family Meeting Template stan-
dardizes the information provided to parents
based on baby’s medical needs (medical team 78%,
nursing 74% and allied health 86%); assists with
developing an appropriate plan moving forward
(medical team 71% nursing 74% and allied health
100%); fosters easier communication between
health care professionals and families (medical
team 57%, nursing 76% and allied health 86%);
benefits parents, medical professionals and allied
health professionals by providing written docu-
ment of the information shared at family meetings
(medical team 100%, nursing 98% and allied health
100%); and is an effective and time-efficient
method of completing documentation (medical
team 100%, nursing 100% and allied health 100%).
Additional feedback received confirmed these
answers and provided additional information on
the staff response to the template. Some of the
themes that emerged included comments such as
“using this format assists with ensuring that all
families are receiving consistent communication”
and “having family meetings documented in this
format assists with continuity of care.” Another
comment summarized the fact that “the template
allows professionals to access information easily
as all documentation is recorded on one form.”
Based on the positive reviews received, the Family
Meeting Template is now a formal and legal
document in our NICU, which is used consistently
when facilitating family meetings.
Putting what we learned into practice
In addition to the Family Meeting Template, new
communication guidelines were created and
implemented based on the suggestions from
healthcare professionals and parents. One recom-
mendation is that family meetings should be
6 K. Macdonell et al.
scheduled within two weeks of an infant’s birth so
that families can meet the team and receive med-
ical updates regardless of their infant’s condition.
In addition, family meetings can provide clinical
fellows and residents with a learning platform to
gain practical knowledge and skills around effective
and empathic patient interactions and more confi-
dence around delivering difficult information to
parents. As such, clinical fellows are encouraged to
lead and facilitate family meetings with the staff
physician supervising.
NICU nurses in our unit are also now strongly
encouraged to attend family meetings and the
schedule of the infant’s primary nurse is taken into
account when a family meeting is organized. Dur-
ing morning medical rounds, the charge nurse is
now required to take note of all the family meet-
ings scheduled for that day to ensure that nurses
attend and that nursing coverage is provided in
their absence. When the primary nurse is unable to
attend, they are required to read the family
meeting document to receive a concise overview
of the discussion that took place.
In addition to the infant’s physician and nurse,
other allied healthcare professionals in the in-
fant’s care team are strongly encouraged to
advocate for, schedule and/or attend routine
family meetings as needed. This includes respira-
tory therapists, who are encouraged to participate
in family meetings so that they can observe how
information is communicated, increase their level
of interaction with families, and provide informa-
tion about their role, the infant’s lung develop-
ment, breathing support, and so forth. Once a
family meeting has been scheduled, a “Family
Meeting note” must be placed at the baby’s
bedside to alert other team members of the
meeting details (i.e., date and time). During
weekly psychosocial rounds, time is also allocated
to discuss the outcomes of the family meetings,
which ensures that everyone is updated and
informed.
Discussion
The development and implementation of our
Effective Communication Initiative has increased
our awareness of the importance of providing
educational support around effective communica-
tion to the medical and allied health teams. Our
primary objective in this endeavor was to prevent
any feelings of hesitancy or dissatisfaction felt by
parents. As difficult conversations are frequent in
the NICU (Meyer et al., 2011), we feel that sup-
porting our staff around the improvement and
development of effective communication skills not
Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002
only serves to promote confidence around this
challenging and often neglected teaching area,
but reflects our commitment to supporting families
through collaboration and integration. Improve-
ments to the delivery of difficult news is thus a
necessary starting point to ensure that medical
staff are well-informed of the parent’s point of
view (Ptacek and Eberhardt, 1996) and feel confi-
dent in themselves to both communicate effec-
tively and appropriately to support parents during
crises and difficult times.
NICU veteran parents played a crucial role in the
implementation and delivery of the Effective
Communication Initiative. As ‘graduates’ of the
NICU, veteran parents are invaluable contributors
by providing their unique perspectives and insight
around effective communication, including their
firsthand interactions with the health care team
during both good and difficult situations. The in-
service by the veteran parents was an opportunity
for us to integrate pragmatic and realistic compo-
nents into training while enabling staff to receive
immediate feedback from parents; strategies that
have been found to be effective in helping to address
communicative challenges associated with deliv-
ering difficult news in the NICU (Meyer et al., 2011).
Since a major component of effective communica-
tion is providing clear and concise information to
families, this initiative also prompted us to design an
interactive curriculum that is connected to a formal
structure that emphasizes ongoing effective
communication using veteran parents and their ex-
periences. The design and implementation of inno-
vative practice standards and tools, such as the
Family Meeting Template and parent information, is
hoped to initiate a stronger foundation upon which
effective communication can be taught and rein-
forced among the healthcare team. This includes
emphasizing collaborative support for both staff and
patients during difficult discussions, for example,
encouraging all team members (including nurses) to
be present during the provision of difficult news to a
family, and enabling fellows and residents to take
leading roles in such discussions to improve their
comfort levels with having these discussions.
Future opportunities
The information we received from nurses specif-
ically is that they often do not receive any training
on delivering bad or difficult news to families,
which we believe is a gap in the system since
nurses spend considerable time at the bedside and
frequently interact with families. Since nurses
work alongside the medical team, interprofes-
sional collaboration and the enhancement of care
Communication with families in the NICU
for patients can likely be improved if nurses are
better equipped with the knowledge to support
families during difficult and emotional times. With
that said, nurses can also support physicians and
other members of the healthcare team. Since poor
communication is a major source of stress for staff
(Davidson et al., 2007), raising awareness about
effective communication and enabling all mem-
bers to improve their communication skills may
reduce unwarranted stress in an already
demanding environment and strengthen the
team’s ability to work together towards patient-
and family-centered care.
In the future, we hope to have ongoing sessions to
continue supporting staff (both existing and new) to
enhance learning and communication skills in this
challenging domain. Through ongoing efforts, we
hope to increase confidence in this area and create
a fostering environment where staff members can
feel confident in themselves, be able to
support each other, and thus support patients and
families. We feel that continuing this initiative will
garner an even more collaborative environment,
strengthening levels of comfort between staff,
which will hopefully transfer to families so that they
feel supported and confident that their infant is
receiving quality care. As a teaching hospital we
also wish to provide students with ongoing support
to supplement the learning they receive in medical
or professional schools with training and appro-
priate skill-building specific to the NICU.
Conclusion
The fast-paced and demanding NICU environment
presents many challenges to the entire health
team, specifically the need to demonstrate
empathic and effective communication when
conveying bad news to families. Through our
Effective Communication Initiative we have taken
the first steps towards building a more supportive
environment within our NICU that provides training
for staff members through the integration of vet-
eran parent experiences into training sessions and
practical tools.
Conflicts of interest
The authors have no conflicts of interest to
declare.
Funding source
No external funding was secured for this study.
Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002
7
Financial disclosure statement
The authors have no financial relationships to
disclose.
Acknowledgments
The authors would like to thank the Effective
Communication committee; our veteran parents,
in particular Paul and Lori O’Leary, Lauren Michie,
Zak and Michelle Goldman, Leslie Donaldson-Reid,
Kristen Christie, and Nigel and Monica Wheatley;
and the staff of the Neonatal Intensive Care Unit,
in particular Dr. Karel O’Brien, Sandy Sculac,
Melissa Cooper, and Helen Cross. We would also
like to thank Dr. Ruth Warre of the Maternal-Infant
Care Research Centre for providing editorial
support.
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Please cite this article in press as: Macdonell, K., et al., An Effective Communication Initiative: Using parents’ experiences to
improve the delivery of difficult news in the NICU, Journal of Neonatal Nursing (2015), http://dx.doi.org/10.1016/
j.jnn.2015.01.002