title: Family-centered rounds in theory and practice: an ethnographic case study.
abstract: BACKGROUND
  Family-centered rounds (FCR) seek to incorporate principles of family-centered care-including clear and open information sharing, respect, participation and collaboration-into inpatient settings. Although potential models designed to translate these principles into everyday clinical practice have been reported, few studies explore how FCR practices align with principles of family-centered care.
  
  
  METHODS
  We conducted an ethnographic study, observing over 200 hours of FCR on a general pediatrics inpatient service from January to August 2010 (185 distinct rounding events). To complement observation, we conducted interviews with 6 family members. Qualitative analysis entailed applying codes to data from observation and interviews and deriving themes using the principles of family-centered care as an interpretive lens.
  
  
  RESULTS
  Four themes emerged that suggested incomplete alignment between FCR practices and principles of family-centered care. 1) FCR provided a forum for information sharing; nonetheless, medical jargon sometimes limited communication. 2) Medical teams approached families with practices intended to demonstrated respect, but contextual factors served to undermine this intent. 3) FCR gave family members the opportunity to participate in care but did not guarantee their involvement. 4) FCR were a starting point for collaboration around plan making, but did not guarantee that collaboration occurred.
  
  
  CONCLUSIONS
  Although FCR practices may set the stage for family-centered care, they do not necessarily ensure that the principles of family-centered care are upheld. Efforts to more effectively deliver FCR should consider physical, organizational, and cultural factors that influence both patient/family and medical team behavior.
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY. Electronic address: anusubramony@gmail.com.
authors.forename: Anupama
authors.initials: A
authors.lastname: Subramony
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hametz
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
authors.forename: Dorene
authors.initials: D
authors.lastname: Balmer
mesh_terms: D002648:Child; D002675:Child, Preschool; D003142:Communication; D003695:Delivery of Health Care; D005190:Family / Q000208:ethnology*; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D019370:Observation / Q000379:methods; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D010372:Pediatrics; D011368:Professional-Family Relations; D056164:Teaching Rounds / Q000458:organization & administration*
keywords: bedside rounds; communication; family centered rounds; family-centered care; patient centered care