The article/research study I chose to review involved families/patients residing in an intensive care unit and how the initiation of bedside reporting can be extremely beneficial for the healthcare team as well as the families. Scheduled bedside reporting allows the health care team to answer any specific questions family members may have, provide one-on-one education, update families regarding the plan of care etc. One of the great benefits of bedside reporting is they are at scheduled intervals, allowing family members to meet with the primary care nurses and physicians at one time to discuss their loved ones care in detail. Although this study focused primarily on patients/families residing in an intensive care unit, this aspect of care should be provided amongst all acute care setting units. A version of this may already occur in some units however the fact that these were completed at timely intervals is HUGE.
Cody, S. E., Sullivan-Bolyai, S., & Reid-Ponte, P. (2018). Making a Connection: Family Experiences With Bedside Rounds in the Intensive Care Unit. Critical Care Nurse, 38(3), 18-26. Doi: 10.4037/ccn2018128
Quality care has put an emphasis on family centered care. High quality care is “respectful and responsive to individual patient preferences, needs, and values”. In the intensive care unit (ICU) the family is often the communicator as many patients are too able to speak for themselves. Bedside rounding allows the health care team to examine the patient, have relevant clinical information available allowing for patient specific treatment plan can be developed. Having the family involved with rounding allows for participation, develop nurse-family relationship and allow for “shared decision making” (Au, Roze Des Ordons, Soo, Guienguere, & Stelfox, 2017).
Perspectives of families and heath care providers “will be important to consider in developing a model for family participation in ICU rounds”. Heath care provides have expressed concerns of having family members in rounds “citing prolongation of rounds, reduced medical education for trainees, and constraint of candid discussion as potential adverse consequences of patients and their family members joining rounds”. The provider concerns in pediatric research as not been substantiated and currently has not been researched in adult ICUs (Au, Roze Des Ordons, Soo, et al., 2017).
A shared method to develop a model for intensive care units family participation is needed. Family participation in intensive care unit rounds is a recommend guideline but “there has been relatively little research to inform of best practices”. It has been found that families need to be educated on rounding, what their role is “and their preferences for participation be considered when developing protocols for rounding practices in the ICU”. Future studies need to be conducted to determine family participant risks and benefits (Au, Roze Des Ordons, Soo, et al., 2017).
Reference
Au, S. S., Roze Des Ordons, A., Soo,A., Guienguere,S., & Stelfox, H.T. (2017). Family participation in intensive care unit rounds: Comparing family and provider perspectives. Journal of Critical Care, 38, 132-136. https://doi.org/10.1016/j.jcrc.2016.10.020
Both patients and staff benefit from bedside report. There are potential many shift changes during a patient’s hospital stay which represent many opportunities for error, so patient safety is key as well as patient/family satisfaction.
Bedside shift report increases patient’s involvement in their plan of care in many ways. They see and hear from the team of professionals who are providing their care. As a result, they feel more comfortable asking questions or voicing concerns; they are reassured that everyone is receiving the necessary report about what is going on with them; they feel more informed about their care, which makes them less anxious and more compliant with the plan of care; they are more satisfied because they know that things are being monitored throughout the shift; they know who their nurse is on every shift; and bedside shift report reduces the perception that “no one is around” during shift change when sentinel events are more likely to occur. (Baker, 2010) In the case of ICU patients like in your article, who may not be able to participate in their plan of care, involving the family is extremely beneficial. It surprising to me that only 80% of families found this process helpful but perhaps a more standardized process is needed so that all barriers to communication with families is considered.
Bedside shift report is also an excellent way to build employee teamwork, ownership, and accountability. It is good discipline for another nurse to review a new nurse’s documentation, physically see their patients, and review their assessments, medication therapy, and environmental factors. This practice also benefits the nurse as it takes less time and often the nurse has received report, “laid eyes” on the patient and at least assessed them quickly and don’t feel as stressed trying to get report, assess and pass medications all within a short amount of time which always include interruptions.
Baker, S. J. (2010). Bedside Shift Report Improves Patient Safety and Nurse Accountability . Journal of Emergency Nursing, 355-358.
As you mentioned, during a patient’s hospitalization, there are numerous shift changes leading to various nurses/physicians caring for the patient. This can potentially lead to errors or disruptions in the plan of care. Bedside reporting allows the healthcare team and the family to essentially “get on the same page”. The article I reviewed stated that the bedside report process was “…helpful” (Cody, Sullivan-Bolyai, Reid-Ponte, P 18). However in order for the process to be successful, “Two major factors of consistency” must coexist including, “…consistency in information being shared, in when rounds were being held, and in informing families of rounding delays” (P. 18). Essentially in order to prevent errors/delays the healthcare team and family must communicate and work as a team consistently regardless of who is providing care/shift change etc.
Cody, S. E., Sullivan-Bolyai, S., & Reid-Ponte, P. (2018). Making a Connection: Family Experiences With Bedside Rounds in the Intensive Care Unit. Critical Care Nurse, 38(3), 18-26. Doi: 10.4037/ccn2018128
This a good topic and can be tough if patient does not want family involved or maybe to have just little involvement. It is hard for me to imagine that someone would not want their family or just one family member to be there to listen and know what is happening. Unfortunately, there are some patients who do not want their families to know their medical concerns. This could be for reasons such as but not limited to, an elderly patient who does not want their family members to know they have cancer. They may feel this will stress out the family. Or a patient who uses certain medications or drugs they do not want the family to be aware of. I have taken care of both these types of patients who have asked for certain information to be spoken in front of family. It makes it very difficult because I would want to know, but I was not the patient in these instances.
Do not get me wrong, I do believe bedside reporting is great and should be done whenever the patient is agreeable to it. In an intensive care unit, I feel like it’s implied consent. Sometimes family members may find out something the patient was not telling them about in regards to their lifestyles or health when a patient in in ICU. That is not preventable when healthcare providers have not been given consent to speak about patient health concerns when patient is not responding or in critical condition.
The article below speaks about how healthcare providers have to be conscientious about specifically cancer patients wishes to speak about their health concerns in front of others including family members.
Lin, Smith, Feder, Bickell, & Schulman-Green. (2016). P107 Patient and Physician Views About Family Involvement in Goals of Care Conversations. Journal of Pain and Symptom Management, 52(6), E92-E93.
First of all, I love this idea. When my grandpa was sick, we all had to take turns being present at his bedside waiting patiently (or not) for a doctor to come around. For any and all families, this would be so helpful! Not only would this increase patient satisfaction, but it would increase the likelihood that patients and their families would be prepared, with questions that need to be addressed, and decrease the frustration with support staff. In the Cleveland Clinic, bedside rounding can either be done in person or via a phone in the patient room. They say that it has provided clarity and uniformity and minimizes confusion among team members, allows family input and the patients daily schedule is outlined so that everyone knows what to expect (Editor, 2017).
References
Editor, N. (2017, January 23). Physician-Nurse Bedside Rounding Measurably Improves Care. Retrieved from https://consultqd.clevelandclinic.org/physician-nurse-bedside-rounding-measurably-improves-care/
Bedside reporting with a standardized model such as an SBAR provides an opportunity to catch items that may have otherwise been overlook which increases patient safety. The bedside reporting in my facility requires an SBAR report as well as review of medications and review of current infusions. Encouraging patient participation during this time improves patient perception of being involved in care and encourages autonomy. Encouraging involvement of the patient’s support system with the patient’s approval improves the perception of family-centered care. Implementing this reporting technique builds upon the culture of safety and patient involvement in care.
Many times during my work as an RN on a local Med-Surg unit I have taken report from a nurse that didn’t want to do bedside report. I prefer it and its the policy of the unit. Many times during bedside report the patient has chimed in. More times than not, the information is relevant and has been helpful to either me or the incoming day nurse.
Likewise, in our homes for the elderly, I require the staff to do “walking rounds” at shift change during their report. During one report the oncoming shift insisted on doing walking rounds even though the day shift didn’t want to and wanted to “finish tidying up the med room.” One day during report in one of the rooms the outgoing CNA told the incoming CNA that the resident refused her bath. The resident perked up and said “you never came to get me for my shower! I’m ready!” Its become quite the story when one of the staff refuses walking rounds. LOL! Case in point.