Recent Publications
Hillier M, Luff D, Meyer EC. Innovative communication learning: Combining TED talks and reflective writing for nursing students. Creative Nursing 2020; 26(3): 182-188.
Thiel MM, Luff D, Kerr E, Robinson MR, Meyer EC. Healthcare professionals’ reflections on their learning as spiritual generalists and integration into practice. Journal of Continuing Education in the Health Professions 2020; 40(4): 228-234.
Marron JM, Meyer EC, Kennedy KO. The complicated legacy of Cassandra Callender: Ethics, decision-making, and the role of adolescents. JAMA Pediatrics 2020; doi:10.1001/jamapediatrics.2020.4812
Borghi L, Meyer EC, Vegni E, Osteri R, Almagioni P, Lamiani G. Twelve years of the Italian Program to Enhance Relational and Communication Skills (PERCS). International Journal of Environmental Research and Public Health 2021; 18(2): 439.
Selected Publications
Meyer EC, Ritholz MD, Burns JP, Truog RD. Improving the quality of end-of-life care in the pediatric intensive care unit: Parents’ priorities and recommendations. Pediatrics 2006; 117(3):649-657.
This widely cited publication reports the findings of a qualitative study that documents parents’ priorities and recommendations for end-of-life care in the pediatric intensive care unit. Parents identified six priorities including honest and complete information, ready access to staff, communication and care coordination, emotional expression and support by staff, preservation of the integrity of the parent-child relationship, and faith. The article was among the first to present actual quotations from family members whose children had died, to bring parents’ voices and perspectives to bear when conceptualizing quality of care standards, and to delineate parent-generated clinical implications. As such, the work has influenced the quality and delivery of end-of-life care in pediatric critical care setting. The work also served as the impetus for my decision to devote a good part of my career to educating interprofessional clinicians to feel more capable and confident when holding necessary, challenging healthcare conversations with families.
Browning DM, Meyer EC, Truog RD, Solomon MZ. Difficult conversations in health care: Cultivating relational learning to address the hidden curriculum. Academic Medicine 2007; 82(9):905-913.
In this article the pedagogy of the Program to Enhance Relational and Communication Skills (PERCS) are reviewed and described. Central to the learning are patient and family perspectives of the illness experience, interprofessional learning in which traditional medical hierarchy is eased, and incorporating the ethics of everyday clinical encounters. Realistic enactments with professional actors are featured in the workshops where clinicians have the opportunity to practice as teams and receive thoughtful feedback about their communication and relational skills from the actors, family faculty, and fellow learners. The actors are conceptualized as "ethical understudies" for patients and family members to deepen the learners' appreciation and approaches to ethical issues.
Meyer EC, Sellers DE, Browning DM, McGuffie K, Solomon MZ, Truog RD. Difficult conversations: Improving communication skills and relational abilities in health care. Pediatric Critical Care Medicine 2009; 10(3):352-359.
This article describes and documents the efficacy of the Program to Enhance Relational and Communication (PERCS) simulation-based one-day workshops. Interprofessional learners who participated in the workshops reported greater preparation, confidence, communication skills and relationship-building capacity when holding difficult healthcare conversations, as well as less anxiety. The workshops resulted in significant learning regardless of discipline and years of experience. Those learners who had the lowest baseline appraisals of their communication skills made the greatest improvements.
Meyer EC. Little sparrow- Discovering the healing value of a garden sanctuary. American Journal of Nursing 2019; 119(2): 72.
Poignant and memorable, this narrative piece captures one family's story in discovering the timeless, healing value of a garden sanctuary during a time of medical crisis.
Meyer EC, Carnevale F, Lillehei C, Uveges M. Widening the ethical lens in critical care settings. AACN Advanced Critical Care 2020; 31(2): 210-220.
The majority of healthcare clinicians learn about principle-based ethics including respect for autonomy, beneficence, nonmaleficence and justice. The article is organized around a pediatric surgical case in which the child suffers Jeune’s Syndrome and is undergoing uncommon, as yet unproven surgical approach. The reader is introduced to an expanded lens of ethical approaches, beyond principle-based ethics, from which to understand and address ethical tensions including narrative ethics, relational ethics and virtue ethics. A helpful table comparing and contrasting the ethical approaches is provided to guide the reader.
Curley MAQ, Broden EG, Meyer EC. Alone, the hardest part. Intensive Care Medicine 2020; https://doi.org/10.1007/s00134-020-16145-9.
Amid the COVID-19 pandemic, it is currently commonplace for patients to die alone in healthcare settings, without the comforting presence of family or loved ones. This situation engenders considerable concerns for the dying person, family members, and clinical staff. Family members are unable to say goodbye as they might expect or wish, fulfill duties and responsibilities, or partake in customary religious and/or cultural rituals that can promote healthy grieving and bereavement. For their part, clinicians can feel unprepared, inadequate, and/or emotionally overwhelmed when finding themselves responsible for orchestrating end-of-life virtual visitation. This article draws on practices prevalent in pediatric critical care to suggest an alternate path forward to meet the needs of patients, families, and staff members during these stressful, uncertain times.
Waisel DB, Ruben MA, Blanch-Hartigan D, Hall JA, Meyer EC, Blum RH. Compassionate and clinical behavior of residents in a simulated informed consent encounter. Anesthesiology 2020; 132: 159-169.
This manuscript examines the communication and relational approach of anesthesia residents when they undertake the important duty of obtaining informed consent. In a simulated encounter, we examined whether, when and how the residents responded to and treated the patient’s pain during the informed consent process, explained the anesthetic plan including benefits and potential complications, focused on the form signing, and solicited questions to promote the patient’s understanding of the anesthesia care.
Rachwal C, Langer T, Trainor B, Bell MA, Browning DM, Meyer EC. Navigating communication and relational challenges of everyday clinical practice: an innovative approach to team education promoting professionalism and self-care. Critical Care Nurse, 2018; 38(6): 15-22.
This manuscript reports on the pedagogical approach, topics, format and usefulness of an innovative monthly support and educational rounds for staff to promote professionalism and good self-care.
Bell SK, Pascucci RC, Fancy KM, Coleman K, Zurakowski D, Meyer EC. The educational value of improvisational actors to teach communication and relational skills: Perspectives of interprofessional learners, faculty, and actors. Patient Education and Counseling 2014; 96:381-388.
This work examined the broad educational value of improvisational actors as integral to simulation-based communication training and helped to position me as a thought leader in the field of simulation. For the simulation world, the article tackled salient questions of whether actors are educationally superior to role-playing with colleagues and worth the additional expense and effort. Findings suggest that, yes, particularly for training around sensitive topics and ethically challenging issues, actors bring significant value added to communication training. The work concluded that improvisational actors can offer unmatched realism, depth of emotion, practice opportunities and formative feedback that can change clinicians’ attitudes and approach to communication and, subsequently, influence the quality of care.
Carter BS, Brown JB, Brown S, and Meyer EC. Four Wishes for Aubrey. Journal of Perinatology 2012; 32, 10–1.
In the critical care environment, what begins as cure-oriented and life- extending treatment may become unsuccessful in overcoming the patient’s increasingly complex pathophysiology. A case from the neonatal intensive care unit is presented and used to elaborate upon care transitions toward palliative and supportive care that can be rendered in the hospital, at home or in a hospice facility. Successful transitions may rest upon anticipatory guidance by the primary physician and team, or a consultant, to facilitate and enable parents and team members alike in addressing the hard realities that cure, or even successful ICU discharge, is unlikely. A simple mechanism of addressing and accommodating a family’s wishes is provided.
Meyer EC. Courage, Brains and Heart: Lessons from the Wizard of Oz for difficult healthcare conversations. Australian Critical Care 2012.
Despite proficiency in technical skills and subspecialty practice, healthcare providers can feel poorly prepared and ill-equipped to hold vital though challenging conversations in healthcare. This article describes the useful Wizard of OZ metaphor and approach to challenging conversations in healthcare. Conjuring the Lion, Scarecrow and Tin Man, the reader is reminded of the important ingredients for successful conversations- courage, brains and heart. The article emphasizes the need for balance amongst the three ingredients and provides several illustrations of communication and relational skills that are generalizable to a range of healthcare situations.
Further Reading
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“The only gift is a portion of thyself. ”