Establishing the Relationship
In introducing yourself to the family/child, identify key caretakers and decision makers.
Endeavor to understand parent preferences regarding communication; for example:
Some parents may expect frequent updates with a high level of detail.
Other parents may prefer a less detailed summary with updates only for big changes.
Endeavor to understand parent framework for medical decision making.
Some parents rely almost exclusively on physician recommendations.
Other parents are quite autonomous and prefer to receive all of the information and make decisions independently when the clinical situation allows.
Provide a framework for expectations that parents can have around communication.
Reassure parents that someone is always available to answer urgent questions and concerns.
Considerations in Communicating During an ICU Stay
Be sensitive to where the parent may wish to have medical conversations (i.e., in the presence of the child or not).
When communicating new information, always allow time for parents to process information and reflect on it and/or ask questions.
Family-centered rounds are often insufficient to meet daily communication needs for families of critically ill children.
Involve existing outpatient/inpatient providers in discussions with parents when appropriate, particularly in family meetings (see later) or for difficult, big-picture conversations.
Parental Preparation Prior to Rounds
Orientation
Have a designated provider (RN or MD) discuss timing, structure, and goals of family-centered rounds prior to first morning rounds.
Clarify the role of the parent in morning rounds based on your unit preferences.
Invitation:
Extend a neutral invitation to rounds, and assess parent preference regarding participation.
It can be helpful to note that rounds are only one of several options for communicating with MDs in the PICU.
Team Preparation for Rounds
Identify all relevant participants—besides parents—for rounds and ensure their presence at the appointed time.
Consider primary subspecialists (e.g., oncologists, primary surgeon), respiratory therapist, social worker, nutritionist, etc.
On occasion, it may be necessary to “pre-round” as a team to discuss sensitive issues or challenging management decisions prior to presentation to the family.
Attempt to incorporate bedside RN and other relevant rounds participants into this “pre-round” if possible.
Conducting Family-Centered Rounds
Introduction of Team/Rounds
Presenting provider should introduce himself or herself to the family member(s).
It can be helpful to reiterate a short overview of the format of rounds, for example, “I’ll be talking about what brought Susie into the hospital, what we have done for her, and what our plans for today will be.”
It may be appropriate to encourage parents to clarify details of the history or interval events.
Patient Presentation
Be familiar with the preferred practice of your PICU with regard to use of lay language during presentations.
Some PICUs will use exclusively medical terminology and provide a lay summary of the assessment and plan for the parent at the conclusion of the presentation.
Other PICUs encourage the use of lay terminology throughout the presentation.
Recognize that parents want the opportunity to advocate for their children, especially as a plan for the day is being generated.
Teaching During Family-Centered Rounds
With sensitivity to the particular patient and his or her family and circumstances, pauses for teaching should be encouraged.
Clarify educational moments for parents: knowing that the team is not specifically discussing their child may decrease the potential for misunderstanding or anxiety.
Concluding Rounds
It is generally appropriate to ask the parent if they have any questions about the information and plan that have been presented.
If a parent has several questions or concerns, a member of the team should specify a time after rounds at which they will return to address them.
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