Exploring nursing students' perspectives on communicating with hospitalized children: A qualitative study using mind map-based interviews

In the quiet, often overwhelming corridors of a children's hospital, a nurse's most vital tool is not a syringe or a stethoscope, but the ability to connect. When a child is sick, the world shrinks to the size of a hospital room, filled with strange smells, unfamiliar faces, and procedures that can feel terrifying. For nursing students learning to care for these young patients, the challenge is immense: they must bridge the gap between their clinical training and the unique, often fearful, inner world of a child. This requires more than just medical knowledge; it demands a deep understanding of how to build trust, how to speak a language a child understands, and how to navigate the complex relationship between the child and their anxious parents. The goal is to turn a frightening experience into one where the child feels safe, heard, and respected, a process that relies heavily on the student's ability to communicate with empathy and skill.

A team of researchers in Iran set out to understand exactly how nursing students navigate this delicate terrain. They gathered seventeen students, mostly in their early twenties, who had just finished a six-week clinical rotation in a pediatric hospital in Tehran. Instead of asking them to fill out standard surveys or answer a rigid list of questions, the researchers invited the students to draw. Each student was given a blank sheet of paper and colored pencils and asked to create a mind map—a visual diagram that connected their thoughts, feelings, and experiences regarding how they spoke with the children they cared for. This creative approach allowed the students to organize their complex memories in their own way, using shapes, colors, and symbols to represent their journey. Once the drawings were complete, the researchers sat down with each student for a conversation, asking them to explain what they had drawn, why certain elements were important, and what specific moments from their time in the hospital had shaped their understanding.

The conversations revealed that the students did not see communication as a single act, but as a layered process that begins long before a nurse speaks a word. One of the most striking realizations for the students was that a child and their mother are not two separate people to be managed, but a single unit. The students learned that trying to talk to a child while ignoring the mother, or vice versa, often led to failure. They found that the mother acts as a bridge; when a nurse builds trust with the mother, the child feels safer and is more willing to engage. This connection is fragile, however, and must be built slowly. The students described a step-by-step approach: first, they would enter the room and stand at a distance, offering a smile to let the child get used to their presence. Only after the child seemed comfortable would they move closer, perhaps engaging the mother in conversation first, before finally turning their attention to the child, often using toys or simple, friendly words as a way to break the ice.

The study also highlighted that the physical environment plays a silent but powerful role in communication. Students noticed that a hospital room designed with bright colors, cartoon characters, or even a play area could make a child feel less threatened before a nurse even said hello. Conversely, sterile, intimidating equipment could cause immediate fear. The students learned that play and art were not just distractions, but essential languages. Drawing with a child or playing a game was a way to enter their world and lower their defenses. They found that for a toddler, a game might be the only way to explain a medical procedure, while for an older child, a conversation that respected their growing independence was key. The students realized that their words had to be simple and free of medical jargon, and that their body language—kneeling to be at eye level, nodding, and maintaining a gentle expression—was just as important as what they said.

When it came to actual medical procedures, like drawing blood or administering medicine, the students discovered that communication was a continuous thread that ran through the entire experience. They learned that preparing a child honestly, without lying about pain but explaining it in a way they could understand, was crucial. They saw that having the mother present during a procedure provided a sense of safety that made the task easier for everyone. Afterward, the work wasn't done; a small reward, a sticker, or a moment of play could help the child recover emotionally from the stress of the procedure. The students understood that their role was not just to perform a task, but to protect the child's emotional well-being, recognizing that a harsh or careless interaction could leave a lasting psychological scar.

Despite these insights, the students also faced significant hurdles. Many admitted to feeling insecure because they lacked knowledge about specific childhood diseases or the daily routines of the pediatric ward. They worried that parents would ask questions they couldn't answer, which made them feel untrustworthy. They also noted a difference in how they were perceived based on their gender; female students often found it easier to connect with mothers and young children, while male students sometimes felt an extra layer of distance. Perhaps most importantly, the students felt they lacked good role models. They observed that some experienced nurses were too busy or too formal to demonstrate the kind of warm, patient communication they hoped to learn. They relied heavily on each other, sharing tips and watching how their instructors handled difficult moments, but they expressed a strong desire for more structured guidance and mentorship to help them build confidence.

The researchers concluded that learning to communicate with hospitalized children is a dynamic process that cannot be rushed. It is not a skill that is simply taught in a classroom, but one that is forged through real experiences, reflection, and the support of mentors. The study suggests that for nursing students to become truly competent, their education must go beyond technical skills to include structured opportunities to practice these relational skills, learn from positive examples, and understand the deep emotional responsibility they hold. By recognizing the child and parent as a team, using play and art as tools, and building trust step by step, students can transform the hospital experience from a source of fear into a space of care and healing.