Dear Editor,

We are writing in response to the paper by Bramwell et al[1]. Our level 3 neonatal unit, in contrast to the Liverpool unit, does not have an open door policy and parents are not allowed in the clinical area during ward rounds which take place between 8.30am to 10.30am and 4.00pm to 5.30pm. The times of ward rounds are printed in unit parental information booklet and it is explained that the reason for not allowing parents to be present during the ward rounds is to protect the privacy and maintain the confidentiality of all babies and their parents. There are no other restrictions on parental visiting.

We have audited parental attitudes and understanding to the care of their babies 3 times since June 2001 by using a questionnaire with multiple choice questions. The sections included in the questionnaire are discussion before birth and during neonatal admissions; communications on ward rounds, feeding, research studies and facilities; discharge planning and support and overall views. There are 3 areas audited relating to ward rounds and the answers from 164 replies in 3 audits are pooled together for analysis.

Firstly 75% replied that they understood the reasons for not allowing parents to be present during the ward rounds and 91% are aware about the ward round time. Secondly on the reasons parents are not allowed in the ward round, parents chose confidentiality/ privacy (72%), proper assessment of the baby (9%), safety/ space (7%), parents are not distressed (7%) and the use of jargon/medical terms (5%). Thirdly on the feelings not to be present during the ward round, 50% responded positively (happy, reassured), 30% responded negatively (frustrated, left out, worried, suspicious), and 20% replied not bothered.

We aim to provide adequate explanation to parents about when and why they have to leave during ward rounds and have found in this audit that only 50% of parents are happy to do so and 75% understand the reasons behind our policy. We agree that families need to be given more information about ward rounds and feel that whichever policy is adopted on a Neonatal Unit adequate explanation may result in better parent satisfaction. It is also thought that parents may feel more able to speak openly and freely about their babies if they meet members of staff on an individual basis. We have not changed our policy and are currently re- auditing parental attitudes to the care their baby receives by using a modified questionnaire.

Reference:

1. R Bramwell, M Weindling for the FVWR Research Team. Families’ views on ward rounds in neonatal units Arch. Dis. Child. Fetal Neonatal Ed. 2005; 90: F429-F431.

Dear Editor

We read with interest the paper by Bramwell et al.[1] and we would like to add our experience on this issue. Unrestricted visiting policy has been prectised at our NICU since early 80s. Even now, our Unit is the only one practising unrestricted visiting among the 15 NICUs in Greece. Initially parents were present during ward rounds. However several things became apparent.

1. During ward rounds parents present were trying to overhear what was discussed about their baby. It was also evident that they could neither understand medical jargon frequently used or fully appreciate what had been discussed. These had fairly frequently led to misunderstanding regarding their baby's true condition. These erroneous perceptions had to be explained and reverted by the medical staff. Also parents seemed to fixate on numbers of laboratory results mentioned during the ward round which again had led to erroneous perceptions regarding their baby's true condition.

2. Parents had been overhearing medical discussions regarding other babies and sometimes had contacted and informed the parents of the relevant baby. This on some occasions had created problems with the particular parents receiving information in such a way and further explaining had to be undertaken by the medical staff. Also some parents complained that they did not wish other parents to overhear information regarding their baby.

3. Medical and nursing staff had felt that the presence of parents had a restrictive effect on how a baby could or should be discussed. Concluding parents are not any more present during ward rounds. However, we have not formally evaluated this approach. Parents are now formally informed on major issues after the main ward round by the consultant(s) in the presnce of the doctor on duty. On minor issues doctors and nurses inform the parents while the visit their baby.

Reference

1. R Bramwell, M Weindling for the FVWR Research Team. Families’ views on ward rounds in neonatal units Arch. Dis. Child. Fetal Neonatal Ed. 2005; 90: F429-F431.