Participation of family members in ward rounds: Attitude of medical staff, patients and relatives

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Abstract

Objective

To assess the attitude of medical staff, patients and their relatives to the presence of FMs in WRs.

Methods

This prospective study was performed in an Internal Medicine Department in Israel. WRs were conducted without (phase 1) and with (phase 2) the presence of FMs. Questionnaires were completed by staff members (N = 26, 23), patients (N = 26, 35) and FMs (N = 32, 40) during phases 1 and 2, respectively.

Results

82.6%, 96% and 96.7% of staff, patients and relatives, respectively, expressed a positive attitude towards the participation of FMs in WRs. Staff members became significantly more positive about the concept after having undergone the experience. Patients believed it contributed to a better understanding of their disease and FMs felt it provided them with an opportunity to participate in medical decision-making.

Conclusion

Hospitalized patients would like their FMs to participate in WRs. Staff members were reluctant at first, but developed a more positive attitude towards the idea after the experience.

Practice implications

Incorporating FMs into WRs is plausible, though adjustment of WRs’ routine to the change will be needed. This move might increase patients’ satisfaction from WRs.

Introduction

Bedside rounds are a corner-stone of patient-doctor interaction and are conducted by teams of health professionals on a daily basis in hospital wards throughout the world. In the classic description of ward rounds (WRs) a senior physician surrounded by a group of students talks and examines the patient while teaching a chapter in the art of medicine [1]. Despite the fact that these descriptions are 300 years old, there have been few changes to the manner in which WRs are conducted nowadays. Patients usually express an overall satisfaction from WRs, mainly due to their informative and educative values [2], [3]. Yet, criticism includes a use of medical terminology, a lack of comprehensible explanations and a focus on medical education rather than on medical care [4], [5], [6].

Family members (FMs) are a major source of support to patients during hospitalization, primarily assisting in the recovery and rehabilitation process [7], [8], [9]. FMs think that they are helpful to their relatives, and that their involvement contributes to the wellbeing of their relatives in the hospital setting [10]. Not surprisingly, spouses’ anxiety level has been shown to correlate with patients’ ability to adjust to their illness [11]. Yet, FMs would like to get more medical information from the staff [12], [13]. Despite the major impact of family involvement on the course of hospitalization and its outcome, FMs’ presence in WRs has scarcely been studied before [12], [13], [14].

Currently, in the Israeli health practices FMs are usually requested to leave the patient's room during WRs and are able to obtain medical information at a later stage in the doctor's office.

The aim of this study was to investigate the attitude towards the participation of FMs in WRs by medical staff, patients and their relatives before and after having undergone the experience in an Internal Medicine Department setting.

Section snippets

Setting

This prospective study was conducted at the Meir Medical Center, a secondary referral University Hospital in Kfar-Saba, 30 min from Tel Aviv. The hospital serves a Jewish and Arab population from the surrounding areas, mostly Israeli born with a minority of newcomers from all over the world. The Internal Medicine Department employs 15 physicians at different stages of professional training and 35 nurses, 80% of whom are registered (most nurses are permanent employees while physicians are

Staff

Twenty-six and 23 staff members completed the questionnaires at phases 1 and 2, respectively. 38.5% and 39.1%, at phases 1 and 2, respectively were physicians and the remaining were nurses. 53.8% and 82.6% of the staff members expressed a positive attitude towards FM attendance at WRs before and after having participated in the process (P = 0.039). However 96% and 78.3% of staff members, at phases 1 and 2, respectively, believed that the attendance of FMs at WRs would increase their duration (P = 

Discussion

Although most patients describe WRs as a positive instructive experience many do feel frustrated by their inability to fully understand medical explanations (2–6). FMs’ presence in WRs can help patients cope with such a situation and, indeed, our study shows that patients do desire FMs participation in WRs. Patients usually prefer the closest FM, their partner or child, though a third of the patients mentioned more than one relative as an option. Patients feel it will help them communicate

Acknowledgments

The authors would like to thank the medical team of Department of Medicine E, Meir Medical Center, Kfar-Saba for their cooperation. We would also like to thank Mrs. Margalit Kantor R.N.M.A. for her helpful discussions. This work was partially presented at the 12th annual meeting of the Israeli Society of Quality in Medicine, May 2005, Tel-Aviv, Israel.

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