Patient Service-Nursing / Patient Rounds / Structured Method of Sharing Information / BESt 060
Discussion/summary of evidence
Although there were no studies identified that directly examined structured methods for communicating information from rounds, several studies identified the importance of communication between inpatient pediatric healthcare providers and the parents/guardians of patients.
Rotman-Pikkielny, Rabin, Amoyal, Mushkat, Zissin, and Levy (2007) [4b], conducted a longitudinal study on the attitude of staff and family members about families being present on rounds. Questionnaires were given at the end of rounds to staff, patients, and family members. In phase one, family members were not included on rounds. In phase two, family members were included. Once staff experienced family inclusive rounds, they saw the value of family being present (53.8% vs. 82.6%). Families expressed strong preferences about participating in decision-making (73.3% before being present on rounds vs. 92.5% after being present on rounds), and patients felt strongly the staff attitude towards them improved following family participation in rounds (66.7% vs. 91.4%).
Latta, Dick, Parry and Tamura, 2008, (4b) conducted a descriptive study interviewing parents about what they wanted from rounds. Several themes were described, including wanting an exchange of information, having the plan of care explained, and feeling included and invited in rounds.
Scott, 1998 (4a) conducted a descriptive study describing the needs of the parents of critically ill patients. The nurses and parents agreed on the general concepts of concern, but the specific value of the concerns differed. For instance, there was one concern that the parents “feel that hospital personnel care” which was ranked first with parents but tenth with nurses. Concerns included talking to the same physician and the same nurse, having questions answered honestly, and receiving information once a day tie into the process of rounds.
Three articles revealed information regarding communication between patients/families and healthcare providers. Wanzer et al., 2004 (4a) reported that patient centered communications (PCC) strongly related to patient satisfaction in patient surveys.
McGilton et al., 2006 (4a) published a longitudinal study which showed that the use of a communication enhancement tool improved nurses’ job satisfaction and relationship with patients.
Teare and Smith, 2004 (2b) used focus groups to identify what parents of hospitalized children valued in their communication with the staff. The themes described included the importance of being listened to, staff recognizing the stress of staying at the hospital (away from home), feeling safe, partnering with staff and waiting with their child. The authors found that getting parents to focus groups was more challenging than they anticipated. Parents did not want to leave their child nor did they want to take what limited time they had at the hospital to do something other than being with their child and getting information from the staff/doctors.
Four additional articles provide insight into mechanisms to improve rounds from the parents’ perspective. Birtwistle et al., 2000 (4b, conducted a descriptive study of physicians, nurses, parents and patients, using a questionnaire to ask each group about their satisfaction with the present format for rounds on three inpatient units . The study concluded that all parties believed the present format for rounds needed to changed, with specific concerns including that rounds were too time-consuming for staff and too intimidating for families and patients.
Elisa Sobo, 2004 (5) described a rapid cycle improvement project which developed a parent communication preference form they entitled PIINT-patient/parent information and involvement assessment tool. Parents filled out this form on how they wanted information and how they wanted to be involved in the decision making process.
Maisels and Kring, 2005 (2a) described a randomized controlled trial with the use of a patient facilitator for the intervention group, and no facilitator for the comparison group. The facilitator met with the patient/families daily to respond to any questions the family might have. Patient satisfaction was significantly raised for the intervention group versus the comparison group with both nursing and physicians in survey results at the time of discharge, or after discharge, On a 5 point scale, patient satisfaction had a
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