Current Caregiver Perspectives and Effects of Demographics on Family-Centered Rounds

Abstract

The 2010 Pediatric Research in Inpatient Settings survey stated that 44% of pediatric hospitals practiced family-centered rounds (FCRs). We aimed to study caregivers' opinions of FCRs and determine if there are demographic associations with these opinions. A cross-sectional survey of caregivers who attended FCRs was conducted at a tertiary-care general pediatrics unit. The survey contained Likert-type scale and qualitative questions. Fisher's exact test was used to test demographic associations. Only English proficient caregivers were included. Almost all (99%) caregivers liked being present during rounds, 19% felt that there were too many people present during rounds and 15% felt that medical jargon was used. Significant demographic associations were found including older caregivers being less comfortable asking questions as well as more neutral responses from African Americans and those with less education. Opportunity exists to customize FCRs and tailor rounding according to demographics, opening the door for future quality improvement projects.

Implementing Family-Centered Rounds in Hospital Pediatric Settings: A Scoping Review

“…Although some families place a high value on participating actively in FCRs, 28 that is not true for all families. 3,32 The timing of rounds in most organizations remains physician driven, on the basis of their availability, and may change with little advance notice.…”

“…48,49 In more complex approaches, researchers outlined clear roles for participation for physicians, nurses, and families and what should be done before, during, and after rounds, the content, and order of presentation on rounds and artifacts generated from the rounds experience. 1,28,34,55,68,69 In engineered solutions, researchers often included active intervention to increase nurse and family attendance and participation as well. 47,48,[67][68][69] The schedule and education goals for rounding remain largely physiciancentered and not family-centered by design.…”

“…The aggregate estimated sample count was 4000 (range: 2-1224) clinicians and 9500 (range: 5-3106) patients. At least 15 studies (28%) were limited to Englishspeaking families only, 3,23,[28][29][30][31][32][33][34][35][36][37][38][39][40] with 3 studies (6%) limited to Spanish-speaking families alone. [41][42][43] The study characteristics are summarized and referenced with the 4 study aims in Table 1: clinician attitudes and perceptions regarding FCRs, family attitudes and perceptions regarding FCRs, general barrier identification, and implementation strategy development for FCRs.…”

“…Frequency of Explicitly Detailed FCR Elements in Studies (N = 36 Studies) -3,23-26,28-35,38-41,43,51-59,61,65,67-71 (100)Physician trainees and students[1][2][3][23][24][25][26][28][29][30][31][32][33]35,[38][39][40][41]43,[51][52][53][54][55][56][57][58][59]65,[67][68][69][70] (97)Nurse[1][2][3][23][24][25][26][28][29][30][31][32][33][34][35][38][39][40]…”

“…a Family preferences integrated into care plan1,2,23,24,26,[29][30][31]33,34,[38][39][40]43,[51][52][53]55,56,58,59,61,65,67,69 (69)Opportunities for the nurse to participate during rounds 1,26,28-31,33-35,38-40,51-57,59,61,65,67-69,71 (72) Bedside teaching of trainees occurs during rounds 1,2,24,25,29-31,33,35,39,40,43,51,52,55-59,61,65,67 (63*) Daily care plans developed and presented during rounds (eg, daily goals, discharge plans, or orders placed) 1-3,23-26,28-35,38-41,43,51-59,61,65,67-71 (100) Rounding process: after rounds Postrounding activities (eg, follow-up with family during the day or midshift huddles) 1,26,35,55,67,69 (17) Delivery methods Use of plain language explicitly by the care team emphasized 1,2,26,29-31,35,40,43,55,58,61,69,70(39)Teach-back to residents and/or family used for understanding explicitly referenced1,26,31,69 (11)Process artifacts Written version of daily care plan and/or goals made available to family (eg, paper or whiteboard)1,28,30,31,33,38,41,51,55,56,68,70 …”