Delphi Survey of Barriers and Organizational Factors Influencing Nurses' Participation in Patient Care Rounds

Each year in the United States, 195 000 individuals die as a result of medical mistakes. Communication among health care providers is repeatedly cited as the core principle in effecting patient care outcomes. Regrettably, well-intentioned nurses in the neonatal intensive care unit (NICU) often fail to speak up during patient care rounds (PCRs). The purposes of this study were to determine the perceived barriers and organizational factors that influence nurses' participation in PCRs and to determine the health care team member's perceptions of the nurses' contributions to patient management decisions within these rounds. A descriptive study using the Delphi technique that involves a series of surveys to develop group consensus was used to identify barriers, organizational factors, and contributions of nurses during PCRs. A convenience, all-inclusive sample of interdisciplinary health care team members who routinely participate in PCRs in the NICU in one large tertiary care urban hospital located in the southwestern United States was recruited to participate in the study. Eighty-seven health care team members participated in the final round of the study. Data demonstrated that nurses tend to be indifferent regarding satisfaction with their presence and level of contributions during PCRs. Data suggest that physicians tend to be dissatisfied if nurses are not physically present during rounds, but when nurses are present, they are satisfied with their level of participation and contributions to PCRs. The 2 most important barriers to nurses' participation in PCRs were other patient responsibilities and lack of a standard time for PCRs. For optimal participation, data demonstrated that PCRs should occur at the bedside, the nurse must be available to participate, and the nurse must feel that his/her input is valued and respected. Data demonstrated that more than 98% of participants agreed that nurses make important contributions to PCRs including the infant's response to interventions/medications, feeding issues, and patient advocacy. These data constitute the first step in understanding the barriers and organizational factors that would positively influence nurses' participation in PCRs. The long-term aim of this study is to help health care providers in the NICU engage more effectively and hold crucial conversations in PCRs that ultimately improve patient outcomes and expand staff and organizational effectiveness.

Keywords: Delphi technique, Nurse-physician relationships, Patient care rounds, Neonatal intensive care, Communication