Factors Associated With Parental Participation in Family-Centered Rounds

Abstract

OBJECTIVES: Although families positively perceive family-centered rounds (FCR), factors associated with engagement have been examined in few studies. Our objective for this study was to test the hypothesis that inviting the parent to speak and nurse presence are associated with parent engagement during FCR. METHODS: We conducted a cross-sectional study with English-speaking parents (N = 199) of inpatients on the pediatric hospital medicine service at an academic medical center. We used a standardized checklist to record outcomes of engagement (number of questions asked and participation occurrences), predictor variables (team invited parent to speak, nurse presence), and other encounter-related variables. Parents were surveyed to assess parent and child characteristics and experiences during FCR. We examined parent, child, and encounter characteristic associations with the above outcomes using bivariate analyses and (for those associated in bivariate analyses) Poisson regressions. RESULTS: Inviting the parent to speak was independently associated with the number of questions asked (incident rate ratio [IRR] 1.4; 95% confidence interval [CI] 1.1–1.7). Trusting the medical team was inversely associated with questions asked (IRR 0.8; 95% CI 0.6–0.97). Factors associated with total participation included invitation for the parent to speak (IRR 1.5; 95% CI 1.3–1.6), nurse presence (IRR 1.3; 95% CI 1.1–1.5), white race (IRR 1.2; 95% CI 1.1–1.4), clerkship student presentation (IRR 1.2; 95% CI 1.03–1.3), and parent inclusion in rounding arrangement (IRR 1.5; 95% CI 1.05–2). CONCLUSIONS: Parents present during FCR are more engaged when invited to speak. Nurse presence was associated with total parent participation. Future studies to inform interventions to optimize engagement are warranted.

Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation

“…Parents experience disruptions to their caregiving role during paediatric hospitalization, when they negotiate, seek permission from nurses, and conform to institutional policies to participate (Ames et al., 2011; Balling & McCubbin, 2001; Callery & Smith, 1991; Corlett & Twycross, 2006; Hill et al., 2019). Parental presence and nurses' permission are antecedents of parental participation; literature demonstrates that nurses view presence as necessary for parents to be participatory (Glick et al., 2021; Pineda et al., 2018).…”

“…Participation takes shape through activities performed by parents contributing to the child's health, whether or not nurses are directly involved (see Table 2). These activities encompass: (a) caregiving activities such as feeding, diapering, and comforting (Ames et al., 2011; Coyne, 1996; Craig et al., 2020; Kim et al., 2021; Miles et al., 1999; Neill, 1996b; Power & Franck, 2008) and (b) healthcare activities such as administering tube feeds or medical decision‐making (Coyne, 1996; Evans, 1994; Fisk et al., 2022; Glick et al., 2021; Just, 2005; Kawik, 1996; McGraw et al., 2012; Neill, 1996b; Phiri et al., 2019; Power & Franck, 2008).…”

“…is measured through behavioural observation or report of parents speaking during care planning events (Glick et al, 2021;Gonya & Nelin, 2013;McGraw et al, 2012;Treherne et al, 2017), providing care such as kangaroo care (Kim et al, 2021;Pineda et al, 2018;Rennick et al, 2011), or being at their child's bedside (Pineda et al, 2018).…”

“…Nurses empower parents to participate by fostering respectful twoway communication (Gonya & Nelin, 2013), providing education to facilitate participation (Craig et al, 2020), and actively inviting parents to participate (Glick et al, 2021).…”

“…The science of parental involvement has advanced in the decades since its inception (Franck & O'Brien, 2019). The terms “parental presence,” “parental participation,” and “parental engagement” are used interchangeably or in close connection to describe FCC delivery (Bartz‐Kurycki et al., 2018; Glick et al., 2021; Just, 2005; Miller et al., 2022; Powers et al., 2020; Voo et al., 2020). Where some terms and concepts have undergone prior analysis (Coyne, 1996; Higgins et al., 2017; Mikkelsen & Frederiksen, 2011; Miller et al., 2022; O'Connor et al., 2019; Smith et al., 2015), healthcare delivery is continuously evolving.…”