Parents on NICU rounds

Does your neonatal unit have parents present when you’re doing medical rounds? Would that be a good thing? (Or if you already do it, is that a bad, limiting thing?) Could the presence of parents inhibit honest medical discussion? Could it compromise confidentiality? May the opportunities for bedside teaching be severely reduced? Could the stress of hearing the discussions be excruciating to the parents? Will the inclusion of parents into a ward round discussion bring about a greater trust, and make it truly inclusive? Will it allow for a deeper understanding of the dilemmas faced on both sides? And how much will it vary between parents?

Thinking about all those possibilities makes the idea of trying to investigate the question “Should parents be present on neonatal ward rounds?” rather difficult to frame. For instance, what outcomes are important, and how could they be measured?

Well, one such approach could be to look at a cohort of parents who took up that sort of opportunity, and compare that to those who didn’t. This type of study design leaves open all sorts of potential problems with causation though; were those who are going to undertake this be fundamentally different than those who would prefer not to take part? May their children be more or less ‘well’? May the parents be from a different social group, and other explanations for differences be possible instead?

Another, more scientifically rigorous approach would be to undertake a randomised study; looking at the experiences of parents who had / did not have the opportunity to be on rounds. This was done by a team in Australia. They undertook a crossover trial, with the same parents experiencing both versions. They measured a validated ‘parental stressor’ score, and parent satisfaction, and supplemented this with an in-depth qualitative focus group study. This explored the themes of communication, philosophy, teaching and stress further. There was widespread agreement that the opportunity to be involved was a “right” and despite difficulties, it should be encouraged.

Is this reasonable? Is this a conclusion drawn from the social setting of a focus group, where dissent would have been socially unacceptable. Is any group that was prepared to trial it always going to come to this conclusion? Or was this study a waste of time and everyone’s effort as it’s frankly unacceptable to exclude parents who want to be involved?

Any thought?

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