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roscigno

Cecelia Roscigno, PhD RN CNRN

Assistant Professor

The University of North Carolina at Chapel Hill
School of Nursing
Carrington Hall, CB #7460
Chapel Hill, NC 27599-7460

Office: 532

Phone: 919-966-9416

My research and scholarship have focused on the experiences of families in early acute care hospital settings facing complex life-support and future-care decisions because their child is at risk for death or disability. Communication becomes a critical factor that co-creates meaning for the family; supporting or hindering parents’ decision-making abilities.

Through this research, I became particularly interested in how medical providers’ beliefs about disability could possibly shape how they communicated, and how the very nature of these interpersonal interactions could construct the quality of the subsequent provider-parent relationship. When healthcare providers reflect on the family member’s perspective and practice emotional intelligence skills, they can lessen the likelihood that the family member will ignore them or avoid them in future encounters because the family member feels disempowered, embarrassed, or unsafe. In the particular case of parents, providers in intensive care settings must be considerate of and assist parents to act according to their values as “good parents” for their child (a parent ethical culture). Humanistic and emotionally intelligent behaviors from the providers invite the family member to actively participate in shared decision-making, while also offering them emotional and informational support.

This early research led me to focus in on patient and family-centered communication as a critically important aspect of safe and quality health care. As I move forward, I will be collaborating with other disciplines outside the intensive care units to creatively forge new methods to research, teach, and improve communicative encounters in a variety of healthcare settings. By illustrating how healthcare providers’ communications might be perceived quite differently from how they were intended, I have tried to help providers consider that it is not only their words, but the other communicative factors that are being evaluated by patients and families. These include:

  • paralinguistic factors
    • tone of voice.
    • emphasis on particular words.
    • the rhythm of speaking.
  • non-verbal factors
    • body gestures.
    • body positioning.
    • eye contact.
    • attention and listening.
    • physical contact appropriate to the relationship/context or culture.
    • Sounds that are not words (e.g., a huff, snort, whistle)
  • contextual and organizational factors
    • at what point in time the patient or family members are talked to in relation to a key health event or decision.
    • how frequently the patient or family members are updated.
    • the amount of time given to important discussions, especially relative to the gravity of the decision to be made.
    • who is present and who is absent.
    • what information is discussed and what information is omitted.
    • how the patient or family members are involved in the conversation and how well the provider listens to the patient/family perspective to tailor the conversation to them.
    • whether patients or family members receive contradictory messages from other providers.
    • rules/policies that prevent patients/families from getting information and being involved in decision-making.

Together, these additional interpersonal and organizational communication factors are pooled together by patients and family members and interpreted alongside the provider’s words to make meaning and assign intention. At times non-verbal and paralinguistic factors may be interpreted as contradicting the words said (e.g., “I care about what you have to say,” but the provider is writing in the chart and rolling their eyes at things that are important to the patient). In fact, paralinguistic, non-verbal, and organizational behaviors are often given more weight in interpreting intentions and meaning than any words. In order for providers to become mindful of these other communicative behaviors, they often need to get feedback, reflect on the feedback, and practice becoming mindful of their words, non-verbal, and paralinguistic factors affecting their communication with patients and families.

Other Interests:

  • Organizational and interpersonal communication as a quality and safety indicators.
  • The bi-directional intersection of children’s traumatic brain injury with the family.
  • Narrative medicine and story-telling as ways to help healthcare providers and society become more empathetic and caring.
  • Disability as not only a health condition, but a health experience that is shaped by the responses of the social world.
  • Patients’ and families’ notions of caring in particular contexts.
  • Normal brain development and pathophysiology of neurological and neurosurgical conditions.

Education:

2011 – 2013

Postdoctoral Fellowship, University of North Carolina at Chapel Hill, NINR T32: Interventions for Prevention/Management of Chronic Illness (T32 NR007091).

2010 - Present

Associate Scholar, University of Washington Center for Local Strategies

Research (http://www.localstrategiesresearch.washington.edu).

2009  –  2010

Disability Ethics Scholar, Rehabilitation Institute of Chicago, Chicago, IL.

2009  –  2011

Post-Doctoral Fellow, University of Illinois at Chicago, Irving B. Harris Faculty Initiative Dept. of Women, Children, & Family Health Sciences.

8/2008

PhD, University of Washington, Seattle, WA.

2005  –  2007

Trainee, Leadership in Education and Neurodevelopmental related Disabilities (LEND), Maternal and Child Health Bureau (TG # 6 T73 MC 00041-11-02), University of Washington.

2005  –  2007

Predoctoral Research Fellow, NINR Individual Ruth L. Kirschstein National Research Service Award (NRSA), Children’s Experiences Following Traumatic Brain Injury, (1 F31 NR009599-01).

2002  –  2005

Predoctoral Nursing Research Fellow, NINR Biobehavioral Nursing and Health Systems, (TG# 5 T32 NR07160-04), University of Washington.

2003

National Institute of Nursing Research Summer Genetics Institute, Georgetown University.

2002

MN, University of Washington, Seattle, WA. Advanced Practice Independent Options in Neurosciences.

1996

Bachelor of Science, Nursing (Honors). University of Florida, College of Nursing, Gainesville, Florida

Selected Honors:

2009

Dissertation Award in Nursing Science, School of Nursing, University of Washington.

2008

Carol A. Lindeman Award for a New Researcher, Western Institute of Nursing Research.

2007

Gatzert Child Welfare Fellowship, University of Washington.

2006

Martha E. Brill Scholars Award, American Nurses Foundation.

2005

Ruth L. Kirschstein National Research Service Award, NINR, NIH (1 F31 NR009599-02).

1996

BSN with Honors, University of Florida.

1996

Inducted, Sigma Theta Tau International, Honor Society of Nursing.

1993

Inducted, Golden Key Honor Society.

Selected Publications:

Kavanaugh, K., Roscigno, C.I., Swanson, K.M., Savage, T.A., Kimura, R.E., & Kilpatrick, S.J. (2013). Perinatal palliative care: Parent perceptions of caring in interactions surrounding counseling for risk of delivering an extremely premature infant. Palliative and Supportive Care. Available E-pub ahead of press.

Roscigno, C. I., Grant, G., Savage, T. A., & Philipsen, G. (2013). Parent perceptions of early prognostic encounters following children’s severe traumatic brain injury: “Locked up in this cage of absolute horror”. Brain Injury. Advance online publication. Retrieved from: http://informahealthcare.com. doi: 10.3109/02699052.2013.831122

Roscigno, C. I., Savage, T. A., Grant, G., Philipsen, G. (2013). How healthcare provider talk with parents of children following severe traumatic brain Injury is perceived in early acute care. Social Science and Medicine, 90, 32-39. doi: 10.1016/j.socscimed.2013.04.017.

Roscigno, C. I. (2013). Challenging nurses’ cultural competence of disability to improve interpersonal interactions. Journal of Neuroscience Nursing, 45(1), 21-37. doi: 10.1097/JNN.0b013e318275b23b.

Roscigno, C. I., Savage, T. A., Kavanaugh, K., Moro, T., Kilpatrick, S. J., Grobman, W. A., Strassner, H. T., &. Kimura, R. E. (2012). Divergent views of hope influencing communications between parents and hospital providers. Qualitative Health Research, 22, 1232-1246. doi: 10.1177/1049732312449210

Roscigno, C. I., Swanson, K. M., Vavilala, M. S. & Solchany, J. (2011). Children’s longing for everydayness: Life following traumatic brain injury in the USA. Brain Injury, 25, 882-894. doi:10.3109/02699052.2011.581638

Roscigno, C. I., & Swanson, K. M. (2011). Parents’ experiences following children’s moderate to severe traumatic brain injury: A clash of cultures. Qualitative Health Research, 21, 1413-1426. doi: 10.1177/1049732311410988

Roscigno, C. I. & Van Liew, K. (2008). Pushed to the margins and pushing back: A case study of one adult's reflections on social interactions following a traumatic brain injury sustained as an adolescent. Journal of Neuroscience Nursing, 40(4), 212-221. PMCID: PMC2737729

Vavilala, M. S., Muangman, S., Waitayawinyu, P., Roscigno, C., Jaffe, K., et al. (2007). Neurointensive care; impaired cerebral autoregulation in infants and young children early after inflicted traumatic brain injury: A preliminary report. Journal of Neurotrauma, 24, 87-96.

Vavilala, M. S., Muangman, S., Tontisirin, N., Fisk, D., Roscigno, C., et al. (2006). Impaired cerebral autoregulation and 6 month outcome in children with severe traumatic brain injury: preliminary findings. Developmental Neuroscience, 28, 348-353.

Roscigno, C. I. (2004). Neuronal pathway finding: From neurons to initial neural networks. Journal of Neuroscience Nursing, 36, 263-272.

Roscigno, C. I. (2002). Periventricular leukomalacia: Pathophysiological concerns due to immature development of the brain. Journal of Neuroscience Nursing, 34, 296-302.

Roscigno, C. I. (2002). Addressing spasticity related pain in children with spastic cerebral palsy. Journal of Neuroscience Nursing, 34, 123-133.