Cecelia Roscigno, PhD RN CNRN
Children’s Health, Disability Ethics, Healthcare Communication, Pediatric Neurosciences, Research, Traumatic Brain Injury
The University of North Carolina at Chapel Hill
School of Nursing, Family Health Division
Carrington Hall, CB #7460
Chapel Hill, NC 27599-7460
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 and families to improve communicative encounters in the acute care setting. 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.
- paralinguistic factors
- 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)
- non-verbal factors
- 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.
- contextual and organizational factors
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 on their billing sheet and rolling their eyes at things that are important to the patient). In fact, research shows that 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.
|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 StrategiesResearch.|
|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, 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.|
|2002 – 2005||Predoctoral Nursing Research Fellow, NINR Biobehavioral Nursing and Health Systems, 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|
2015Doctoral Faculty Award for Excellence in Mentorship and Education, School of Nursing, University of North Carolina, Chapel Hill, NC.
|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.|
|Roscigno, C. I., Fleig, D. K., & Knafl, K. (2014). Parent management of the school reintegration needs of children and youth following moderate or severe traumatic brain injury. Disability & Rehabilitation, 27; 1-11.doi:10.3109/09638288.2014.933896|
|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. doi: http://dx.doi.org/10.1017/S1478951513000874.|
|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, 27(13-14), 1536-1548. PMCID: PMC3840124. 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.|
|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.|
- Interpersonal Communication in Healthcare.
- Organizational and interpersonal communication as quality and safety indicators.
- The intersection of children’s traumatic brain injury and their social environments (friends, neighbors, school, church, medical system, community, and culture) 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.
- Disability Ethics.
- Patients’ and families’ notions of caring in particular healthcare contexts.
- Normal brain development and pathophysiology of neurological and neurosurgical conditions.