Family, nurse, and physician beliefs on family-centered rounds: A 21-site study

Abstract

Background: Variation exists in family-centered rounds (FCR).

Objective: We sought to understand patient/family and clinician FCR beliefs/attitudes and practices to support implementation efforts.

Designs, settings and participants: Patients/families and clinicians at 21 geographically diverse US community/academic pediatric teaching hospitals participated in a prospective cohort dissemination and implementation study.

Intervention: We inquired about rounding beliefs/attitudes, practices, and demographics using a 26-question survey coproduced with family/nurse/attending-physician collaborators, informed by prior research and the Consolidated Framework for Implementation Research.

Main outcome and measures: Out of 2578 individuals, 1647 (64%) responded to the survey; of these, 1313 respondents participated in FCR and were included in analyses (616 patients/families, 243 nurses, 285 resident physicians, and 169 attending physicians). Beliefs/attitudes regarding the importance of FCR elements varied by role, with resident physicians rating the importance of several FCR elements lower than others. For example, on adjusted multivariable analysis, attending physicians (odds ratio [OR] 3.0, 95% confidence interval [95% CI] 1.2-7.8) and nurses (OR 3.1, 95% CI 1.3-7.4) were much more likely than resident physicians to report family participation on rounds as very/extremely important. Clinician support for key FCR elements was higher than self-reported practice (e.g., 88% believed family participation was important on rounds; 68% reported it often/always occurred). In practice, key elements of FCR were reported to often/always occur only 23%-70% of the time.

Result: Support for nurse and family participation in FCR is high among clinicians but varies by role. Physicians, particularly resident physicians, endorse several FCR elements as less important than nurses and patients/families. The gap between attitudes and practice and between clinician types suggests that attitudinal, structural, and cultural barriers impede FCR.

Figure 1

Self‐reported beliefs about the importance of key family‐centered rounds elements by role. There were no differences between families and nurses in most components. Residents rate all rounding components lower than nurses and families except for physician participation on rounds. Bonferroni adjusted p values to account for multiple comparisons. *p < .05; **p < .01; ***p < .001.

Figure 2

Clinician (nurse, resident physician, and attending physician) self‐reported beliefs and practices regarding the importance and practice of family‐centered rounds elements.

Figure 3

Clinician (nurse, resident physician, and attending‐physician) self‐reported practice occurrence of family‐centered rounds. Elements by level of perceived importance for specific elements of FCR. Note that those with “High perceived importance” (those who believe an element of family‐centered rounds is “very” or “extremely” important) are more likely to report in turn practicing a given family‐centered rounds element than those with “low perceived importance” (those providers who did not believe an element of family‐centered rounds was “very” or “extremely” important). The gap between those with “high perceived importance” and “low perceived importance” likely represents attitudinal barriers that may affect adherence to rounding elements. However, even among those with “high perceived importance,” the self‐reported rate of that element “often” or “always” occurring is not 100%. This gap suggests the presence of non‐attitudinal barriers (e.g., lack of availability of family or nurse). Those with “low perceived importance” may similarly have non‐attitudinal barriers as well.