Implementing family-centred rounds in paediatrics: A formative study using normalisation process theory

This study aimed to explore acceptability, appropriateness, and feasibility of implementing a nurse-led FCRs model to inform design and adaptation of a pilot intervention.

We conducted a formative qualitative study in two hospitals in Argentina and Uruguay, involving semi-structured interviews with physicians and nurses and focus groups with parents. Analysis was informed by Normalisation Process Theory. Participants were presented with information about proposed model, Batz paediatric guide drafts and I-PASS communication tool.

Twenty-six professionals and 12 parents participated. Most participants recognised communication problems and valued the model's potential to improve coordination and family engagement. Significant barriers were misalignment between proposed rounds and current routines shaped by time pressures and fragmented handovers, hierarchical cultures that marginalise nursing contributions and logistical challenges, including mismatched nurse-physician schedules. The I-PASS tool was viewed positively for structuring interactions and roles. Parents appreciated the prospect of receiving guidance for participation. Parents expressed concerns that documentation requirements in the guide could feel burdensome, prompting revisions. Participants emphasised that successful implementation would require leadership support, mandatory participation, and cultural change to legitimise nursing leadership and family involvement.

Implementing nurse-led FCRs offers a promising strategy to improve communication and collaboration. Our findings highlight that this requires addressing well-established hierarchies and ensuring organisational commitment.

Understanding the perspectives of both providers and parents is essential for adapting and implementing this model effectively. Implementation will require addressing work dynamics and ensuring institutional support. Our findings directly informed adaptation for the subsequent implementation.