Parental presence on neonatal intensive care unit clinical bedside rounds: randomised trial and focus group discussion

Abstract

BackgroundThere are limited data to inform the choice between parental presence at clinical bedside rounds (PPCBR) and non-PPCBR in neonatal intensive care units (NICUs).MethodsWe performed a single-centre, survey-based, crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay >11 days. Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period. At the conclusion of each arm, parents completed the ‘NICU Parental Stressor Scale’ (a validated tool) and a satisfaction survey. After completion of the trial, we surveyed all healthcare providers who participated at least in one PPCBR rounding episode. We also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR.ResultsA total of 72 parents were enrolled in this study, with 63 parents (87%) partially or fully completing the trial. Of the parents who completed the trial, 95% agreed that parents should be allowed to attend clinical bedside rounds. A total of 39 healthcare providers’ surveys were returned and 35 (90%) agreed that parents should be allowed to attend rounds. Nine healthcare providers and 8 parents participated in an interview or focus group, augmenting our understanding of the ways in which PPCBR was beneficial.ConclusionsParents and healthcare providers strongly support PPCBR. NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns.Trial registration numberAustralia and New Zealand Clinical Trials Register number, ACTRN12612000506897.

Parental Satisfaction of Traditional System of Neonatal Intensive Care Unit Services in a Public Sector Hospital in North India

“…The single-family room environment seemed more conducive to the provision of FCC. [19,20] In our study, most of the patients were of low and lower-middle socioeconomic status, and were semi-skilled or unskilled workers with minimal family support. A study conducted in private sector hospitals may result in different levels of satisfaction and different responses.…”

Neonatologists can impede or support parents’ participation in decision‐making during medical rounds in neonatal intensive care units

“…Daily medical rounds, during which the infant's medical care is planned and decided, provide an important opportunity for communication and shared decision‐making by parents and the paediatric healthcare team. Parents can provide their expertise on their infant's daily care and family situation and contribute to treatment decisions . Active participation in medical rounds enhances the parents’ understanding of medical information and increases the amount and quality of their participation in care plan discussions .…”

“…Parents can provide their expertise on their infant's daily care and family situation and contribute to treatment decisions . Active participation in medical rounds enhances the parents’ understanding of medical information and increases the amount and quality of their participation in care plan discussions . Being present during medical rounds has also been reported to improve parents’ overall satisfaction with the hospital care their child receives .…”

“…Professional‐centred care cultures, the expertise required for medical care and parental stress are a few of the factors that may limit parental engagement in shared decision‐making . Healthcare professionals working in neonatal and paediatric hospital settings have expressed concerns that the parents being present may limit their own clinical discussions, curtail resident teaching, unduly lengthen rounds and compromise patient confidentiality . In addition, participation in medical rounds may increase parents’ confusion and anxiety .…”

Parents on neonatal ward rounds

“…Current evidence on this question is poor. Consequently, a Canberra neonatal unit performed a randomised trial involving parents of all infants admitted to NICU and expected to have a prolonged stay . The study had a cross‐over design, and parents and staff were surveyed about their opinion of parental presence on rounds.…”