Pediatric nurse perspectives on patient- and family-centered rounds: A qualitative study.

Abstract

Background: Patient- and family-centered rounding (PFCR) models are used widely in pediatric hospitals and have been associated with better communication and fewer errors. Although model fidelity and sustainability are well-documented challenges reported by physicians and families, nurse perspectives are less known.

Objective: Our objective was to identify benefits for nurses and describe barriers and facilitators to nurse involvement in a PFCR model.

Methods: We used a qualitative descriptive approach to conduct and analyze focus group data. Focus group participants were nurses from sites participating in the Patient- and Family-centered (PFC) I-PASS Safer Communication on Rounds Every Time (SCORE) study, a hybrid effectiveness implementation study of a PFCR model at 21 US pediatric hospitals.

Results: Twenty-nine nurses from 14 study sites participated in four focus groups. We identified multiple benefits, barriers, and facilitators of nurse participation in PFC I-PASS rounds. Benefits included better communication, time savings and efficiency, conveying that nursing is a contributing part of the team. Barriers included competing demands of nurses' workload, lack of fidelity during rounds, and uncertainty about whether nurses are welcome by other care team members. Facilitators key to supporting nurse participation and engagement in rounds included clear nursing role in rounds, predictable rounding schedule and format, attending physicians fostering a welcoming environment, and strategies for when a nurse is not available.

Conclusions: Nurses report many benefits of PFC I-PASS rounds. Increasing and sustaining nurse participation in PFC I-PASS requires specific, nurse-informed implementation strategies targeting both structural and interprofessional aspects of rounds.