Determinants of parental satisfaction in nurse–parent communication during pediatric hospitalization: a systematic review

Abstract

Background

Children with complex medical conditions require frequent interactions with the healthcare services and multidisciplinary teams. During pediatric hospitalization, effective nurse-parent communication is essential to family experience and satisfaction.

Objectives

To provide a synthesis of the available evidence on parental satisfaction with nurse-family communication during pediatric hospitalization, and to identify reported barriers, measurement approaches and strategies aimed at improving communication.

Methods

A systematic review was conducted in PubMed, Web of Science, and CINAHL, including articles between 2014 and 2024. The PRISMA2020 guidelines were followed, and was registered in PROSPERO (CRD42024518043). Methodological quality was appraised using CASPe, with additional sensitivity assessment using MMAT for selected study designs. Owing to heterogeneity in designs, interventions, and outcome measures, findings were synthesized narratively.

Results

Nine records were included, comprising heterogeneous study desings and hospital contexts. Overall, findings suggested interventions such as beside communication tools, structured communication strategies and interactive eHealth tools resources were generally associated with higher parental satisfaction and improved perceived understanding. Frequently reported barriers included lack of staff identification, use of technical language, and environmental noise. However, interpretation is limited by heterogeneity and predominance of non-randomized studies with moderate/high risk of bias.

Conclusions

Evidence suggest that parents of hospitalized children generally report positive experiences withnurse-parent communication, although relevantareas for improvement remain. Strategies such as structured bedside communication, visual aids and digital tools appear promising, However, the predominance of non-randomized and heterogeneous studies limits causal inference and generalizability, and stronger empirical evidence is needed before their effectiveness across settings can be established.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-05417-x.

Introduction

Children with complex medical situations frequently suffer from chronic illnesses and severe health conditions that require support from healthcare services [1, 2]. These needs require frequent interactions with multiple members of the healthcare team. Paediatric patients with medical complexity experience repeated hospitalization and have a higher risk of readmission after discharge, which can involve fragmented and uncoordinated care, with multiple transitions within and between care centres [3].

In cases involving children, it is essential to have channels of clinical communication between patients and medical team, but also between parents and medical team. This context requires us to take care of both channels of communication, with particular emphasis on clinical communication with the parents, as they can mediate in the understanding and ultimate satisfaction of the children [4].

The European Hospital Morbidity Database of the WHO (2009–2012) compared hospital admission rates and bed-days in paediatrics among seven European Union countries with universal healthcare coverage (Ireland, Austria, Hungary, Belgium, Spain, Germany, and France). Of these, Spain reported the lowest admission rates (9.41/100 person-years) and bed-days (52.50/100 person-years), while Germany showed the highest admission rates (19.59/100 person-years) and bed-days (135.44/100 person-years). General paediatrics and neonatology led the clinical volume in all countries [5].

Prolonged hospitalizations and changes in the health conditions of paediatric patients often lead to changes in the care approach and the care team, even within the same day, as happens with nursing staff with each shift change. This can induce anxiety in both the child and their caregivers, which requires constant adaptation [6].

Effective clinical communication between healthcare staff and patients is an important contribution to satisfaction with healthcare services. With hospitalized children, this communication can be ineffective due to factors such as the patient’s age, the complexity of the process, and the use of intermediaries like parents or caregivers [7].

Effective nurse–parent communication in pediatric hospitalization extends beyond information exchange and constitutes a therapeutic relational process. In this context, parental satisfaction represents a multidimensional construct encompassing perceived clarity, emotional support, trust, cultural sensitivity, and relational continuity. While several validated instruments assess family experience or global hospital satisfaction, relatively few focus specifically on nurse–parent communication as a distinct relational domain within pediatric inpatient care [6]. Communication items are often embedded within broader satisfaction scales, limiting the identification of specific relational barriers and improvement strategies attributable to nursing practice (6–8].

Conceptually, this review is grounded in Peplau’s Interpersonal Relations Theory, which frames nurse–family interaction as a dynamic therapeutic process evolving through orientation, identification, exploitation, and resolution phases [9, 10]. Parental satisfaction can thus be interpreted as a reflection of successful progression through these relational stages [9]. Additionally, Leininger’s Transcultural Nursing Theory underscores the importance of culturally congruent communication and individualized meaning-making in care relationships, particularly relevant in pediatric settings where parents mediate the child’s experience [10]. Together, these frameworks support examining nurse–parent communication satisfaction as both a relational and culturally embedded construct, guiding the identification of barriers and strategies for improvement.

Within this framework, parental satisfaction was understood not merely as a global evaluation of care, but as a relational outcome shaped by clarity, emotional support, trust, continuity, and cultural sensitivity in nurse-parent communication.

The primary objective of this systematic review is to synthesize the available evidence regarding parents’ satisfaction with nurse-family communication in the context of hospitalized pediatric patients. Barriers, measurement approaches, and improvement strategies were considered secondary outcomes aimed at contextualizing and explaining variability in satisfaction findings.

Secondary objectives include

• Describing the main barriers parents encounter in achieving effective communication.

• Detecting the measures used to evaluate this communication.

• Identifying the strategies used to improve this communication.

Methods

Evidence acquisition

For this systematic review, the PRISMA2020 guidelines [11] (Systematic Reviews and Meta-Analyses) were followed for protocol development and result reporting. This review was registered in PROSPERO (registration number CRD42024518043).

Eligibility criteria

The following inclusion criteria were applied in the review: (a) publications from the last ten years (2014 to 2024); (b) quantitative, qualitative, and pilot studies; (c) articles in English or Spanish; (d) studies with humans; (e) publications evaluating aspects related to family communication; (f) articles discussing communication with patients aged 0 to 16. Excluded from this review were: (a) publications prior to the indicated date; (b) articles that do not deal with the communicative process; (c) systematic reviews and meta-analyses.

The search was limited to the last 10 years in order to prioritize evidence reflecting contemporary pediatric care models, family-centered practices, and current communication resources, including digital and eHealth-based interventions.

The primary outcome was parental satisfaction with nurse–parent/family communication during paediatric hospitalisation. Secondary outcomes included reported barriers to effective communication, instruments/measures used to assess communication-related satisfaction or experience, and strategies/interventions aimed at improving communication.

Databases

A comprehensive search strategy was employed, using the following databases: PubMed, Web of Science, and CINAHL. Results related to the search were obtained from all of these except CINAHL. The search was conducted between September and December 2024.

Search strategies

Publications were identified using the PICO search strategy, combining relevant keywords: ((nurse OR nursing) AND (paediatric OR pediatric) AND parents) AND (“patient communication” OR “communication skills”) AND satisfaction AND (“evaluation instrument” OR “assessment tool” OR “outcome measures”).

Database search strategy available in Appendix A.

Study selection

In the preliminary screening phase, titles and abstracts of all retrieved records were independently screened by two reviewers to assess eligibility. Full-text articles were subsequently assessed against the predefined inclusion and exclusion criteria. Any disagreements between reviewers were resolved through discussion and consensus. Formal inter-rater agreement statistics, such as Cohen’s kappa, were not calculated.

One protocol paper was retained as it described a relevant communication intervention in detail. However, it was used only for contextual description of planned strategies and was not considered as outcome-generating empirical evidence in the interpretation of effectiveness or satisfaction findings.

Data extraction

The data extraction process was conducted in accordance with the PRISMA 2020 guidelines [11] to ensure transparency and reproducibility. The data extractions process was carried out independently by two reviewers, using a standarised template. Discrepancies were resolved through discussion or by consulting a third reviewer. For each included study, the following information was recorded: (a) author and year of publication; (b) characteristics of participants; (c) eligibility criteria; (d) study groups; (e) description of the intervention; and (f) main outcomes. The extraction process was supported by a predefined form to maintain consistency. The selection of articles was based on methodological quality, which was assessed using the Critical Appraisal Skills Programme (CASPe) scale [12]. Only studies that scored ≥ 7 were included in the analysis. Given the heterogeneity of designs (qualitative, quantitative, and mixed methods), we additionally conducted a sensitivity appraisal using the Mixed Methods Appraisal Tool MMAT, version 2018, for non-randomized, quantitative descriptive and mixed-methods studies. MMAT ratings were used to check the consistency of the methodological judgments and did not lead to changes in study inclusion or in the overall interpretation of the synthesis. The completed MMAT grid is provided as Supplementary Material.

The summary of the articles can be found in Table 1 (supplementary material).

Table 1.

Characteristics of included studies

Author (year)	Title	Country	Study desing	Methods for data collection	Sample size n	Domains explored	Outcome measures	Main results
Justice LB et al. (2016) 1	Improving Communication During Cardiac ICU. Multidisciplinary Rounds Through Visual Display of Patient Daily Goals Justice LB, Cooper DS, Henderson C, Brown J, Simon K, Clark L, et al. Improving Communication During Cardiac ICU Multidisciplinary Rounds Through Visual Display of Patient Daily Goals. Pediatr Crit Care Med. 2016 Jul;17(7):677–683. doi: https://doi.org/10.1097/PCC.0000000000000790.	USA (Ohio)	Quasi-experimental study (Pilot project)	Likert-type surveys	not specified	Communication between healthcare team and parents in PICU	Rounds Effectiveness Assessment and Communication Tool (REACT) Parent satisfaction survey (based on EMPATHIC 30)	Three modifications to the initial process were necessary to obtain improvements in the process satisfaction scores of healthcare personnel and parents. After these changes, professionals’ satisfaction with the process increased by 18,4%, and that of parents by 25,3%.
Kadivar M et al. (2016) 2	Effectiveness of an internet-based education on maternal satisfaction in NICUs Kadivar M, Seyedfatemi N, Mokhlesabadi Farahani T, Mehran A, Pridham KF. Effectiveness of an internet-based education on maternal satisfaction in NICUs. Patient Educ Couns. 2017 Mar;100(3):567–573. doi: https://doi.org/10.1016/j.pec.2016.11.005.	Iran	Quasi-experimental case-control study	Likert-type surveys	n = 80 (40 in cases and 40 in control group)	Effect of internet-based education on the satisfaction of the mothers of the preterms neonates in the NICU	Demographic variables, internet use, previous studies on neonatal care, days of hospitalisation, diagnosis. WBPL-Revised Educational online program	Educational program: the satisfaction of the mothers increased in both groups after the intervention. The satisfaction of the mothers in the case group increased significantly following the intervention (P < 0.001).
Rao -Gupta S et al. (2018) 3	Leveraging interactive patient care technology to improve pain management engagement Rao-Gupta S, Kruger D, Leak LD, Tieman LA, Manworren RCB. Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement. Pain Manag Nurs. 2018 Jun;19(3):212–221. doi: https://doi.org/10.1016/j.pmn.2017.11.002.	USA (Illinois)	Quasi-experimental study (Pilot project)	Likert-type surveys	2014 = 470 2015= 713 2016 = 800 n total = 1983	Using interactive patient care technology to engage paediatric inpatients and their families in pain management	Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS)	Patients and their relatives were taught to re-evaluate their pain. The information about non-drug pain relief was considered helpful. Proportion of positive responses from patients and parents on the Hematology/Oncology Unit significantly increased from fiscal year 2014 (FY14) to fiscal year 2015 (FY15) (p ¼ 0.036) and from FY14 to fiscal year 2016 (FY16) (p ¼ 0.028); but there was no difference in the proportion of positive responses from FY15-FY16 (p ¼ 0.87) or for each year compared with the CHA benchmark (FY14 p ¼ 0.255, FY15 p ¼ 0.32, FY16 p ¼ 0.26). There was no significant difference in the proportion of positive responses from patients and families on the Pediatric Surgical Unit (FY14-FY15 p ¼ 0.8, FY14-FY16 p ¼ 0.11, FY15-FY16 p ¼ 0.44); or for each year compared with the CHA benchmark (FY14 p ¼ 0.73, FY15 p ¼ 0.91, FY16 p ¼ 0.63). Finally, there was no significant difference in the proportion of positive responses from the combined patients and parents of the two pilot units for each year compared with the CHA benchmark (FY14 p ¼ 0.52, FY15 p ¼ 1, FY16 p ¼ 0.49); or from FY14- FY15 (p ¼ 0.2) and FY15-FY16 (p ¼ 0.27). However, the positive responses from the combined patients and parents of the two pilot units significantly increased from FY14-FY16 (p ¼ 0.006).
Zurca AD et al. (2019) 4	Racial minority families preferences for communication in pediatric intensive care often overlooked Zurca AD, Wang J, Cheng YI, Dizon ZB, October TW. Racial minority families’ preferences for communication in pediatric intensive care often overlooked. J Natl Med Assoc [Internet]. 2020;112(1):74–81. Available from: https://doi.org/10.1016/j.jnma.2019.09.005	USA (Pensilvania)	Observational retrospective cohort study	Likert-type surveys	n = 107	Focusing on interactions with bedside nurses, this study compares the communication experiences and preferences of racial/ethnic minority and non-Hispanic white families in the PICU.	A survey was developed and validated to investigate communication experiences between providers in the PICU and families. Demographic variables.	There were no statistically significant differences in how ethnic minority and non-Hispanic white families responded. Ethnic minority families prefer to receive information at the bedside or in private, rather than in meetings with other families. Despite this, their preference is rarely respected.
Sakonidou S et al. (2019) 5	Better use of data to improve parent satisfaction (BUDS): protocol for a prospective before-and after pilot study employing mixed methods to improve parent experience on neonatal care Sakonidou S, Andrzejewska I, Kotzamanis S, Carnegie W, Nakubulwa M, Woodcock T, et al. Better Use of Data to improve parent Satisfaction (BUDS): protocol for a prospective before-and-after pilot study employing mixed methods to improve parent experience of neonatal care. BMJ Paediatr Open. 2019 Jun;3(1):e000515. doi: https://doi.org/10.1136/bmjpo-2019-000515.	UK (London)	Protocol for a prospective before-and after pilot study	Survey: Parents’ experiences of communication in neonatal care (Likert-type and open-ended questions), and 3-question open-ended survey. Interviews with parents.	n = 90 parents of hospitalised babies, and nurses and doctors of the neonatal intensive care unit (number not defined)	Use existing data from UK neonatal registration systems (EPR) to assess the impact of sharing information on these children with their parents and measure their satisfaction using a validated questionnaire (pre and post intervention)	A template for parent communication ‘My Baby’s Summary Report’ was designed. The primary outcome is parent satisfaction ‘with communication of clinical information and involvement in care’ and will be measured by a self-administered Parents’ Experiences of Communication in neonatal care survey (PEC)	No results (study protocol)
Bumpers B, Dearmon V, Dycus P (2019) 6	Impacting the patient´s experience in a children´s hospital using a communication bundle strategy Bumpers B, Dearmon V, Dycus P. Impacting the Patient’s Experience in a Children’s Hospital Using a Communication Bundle Strategy. J Nurs Care Qual. 2018 Jun;33(2):86–90. doi: https://doi.org/10.1097/NCQ.0000000000000336.	USA (Alabama)	Descriptive qualitative study	Telephone surveys and direct patient interviews were used.	n = 47 (33 nurses, 5 resident nurses and 9 auxiliary nurses). Number of participating children-families not shown.	Standarized communication between nurses and families	Communication bundle	Improved scores for communication with nurses, but no improvement in satisfaction with the hospital
Wennberg-Capellades L, Feijoo-Cid M, Llaurado-Serra M, Portell M (2021) 7	Feeling informed versus being informed: mixed methods analysis of family perceptions and behaviour following a pediatric emergency departament Wennberg-Capellades L, Feijoo-Cid M, Llaurado-Serra M, Portell M. Feeling Informed Versus Being Informed: Mixed-Methods Analysis of Family Perceptions and Behavior Following a Pediatric Emergency Department Visit. J Pediatr Nurs. 2021 Sep;60:e87-e95. doi: https://doi.org/10.1016/j.pedn.2021.03.005.	Spain (Barcelona)	Mixed method (quantitative study-phase 1, and qualitative study-phase 2)	3 questionaries (phase 1) Likert-type questions. Structured interview guide comprising 10 questions (phase 2)	n = 385 adult relatives in fase 1 n = 37 parents in phase 2	To examine perceptions of family-centered care, satisfaction, and quality of communication with health professionals during a pediatric emergency department visit, and to evaluate the perceived usefulness of the information received and whether provider treatment recommendations were followed after discharge.	Phase 1: questionnaires exploring perceptions of family-centered care, satisfaction (CSQ-8z, Family-Centered Care Questionnaire), and quality of communication with professionals (ad hoc instrument). Phase 2: Structured telephone interviews	The families expressed satisfaction with the emergency department and the information provided (96.1%), but suggested that the quality of service could be improved. While they were content with the family-centred care, they were disappointed that they did not know the name of the professional attending to them (55.3%). The information provided was well received. However, after six days, many parents expressed concern about the progress of the process and treatment (54.1%).
Tcharmtchi J, Coss-Bu J, Hossein Tcarmtchi M (2024) 8	Enhancing family experience in the paediatric intensive care unit thorught the adoption of the family care journal: a single center study Tcharmtchi J, Coss-Bu JA, Tcharmtchi MH. Enhancing family experience in the paediatric intensive care unit through the adoption of the family care journal: A single-center study. Nurs Crit Care. 2024 Jan;29(1):45–52. doi: https://doi.org/10.1111/nicc.13029.	USA (Texas)	Mixed method, single-centre quasi-experimental design	Likert-type surveys + open-ended questions	n = 366	Satisfaction with communication with NICU attending staff, level of comfort during NICU stay, level of family-centred care	To develop a process using family care journals (FCJ) to systematically evaluate family experience in the PICU and identify needed supportive resources that will enhance their critical care stay.	77% of parents considered the FCJ as a good means of communication with the PICU team. Open-ended responses revealed opportunities for improvement in communication, as well as language barriers and comfort/noise during the NICU stay.
Boztepe, H., Çınar Özbay, S., Akçam, A., & Kanbay, Y (2023) 9	The pediatric provider communication skills assessment scale Boztepe H, Çınar Özbay S, Akçam A, Kanbay Y. The pediatric provider communication skills assessment scale. J Pediatr Nurs. 2023;58:45–52. doi: https://doi.org/10.1016/j.pedn.2023.01.005.	Turkey (Ankara)	Mixed method, methodological investigation desing	Likert-type surveys + open-ended questions	n = 325	Communication with a child, medical communication, and communication skills	Phase 1: development of a pilot study with 35 subjects. Phase 2: constructing the trial form. Phase 3: administering the trial form to the sample.	After eliminating 2 questions, statistical tests determined the validity and reliability of the scale.

Risk of bias assessment of individual studies

The risk of bias for each included study was assessed following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0) [13]. This evaluation considered six domains of potential bias: (a) selection bias; (b) performance bias; (c) detection bias; (d) attrition bias; (e) reporting bias; and (f) other sources of bias. Each domain was judged as “low risk,” “high risk,” or “unclear risk” based on the methodological details reported in the study. Two reviewers independently performed the assessment, and any disagreements were resolved through discussion or consultation with a third reviewer. This process ensured a transparent and systematic appraisal of internal validity across all included trials.

It was not possible to assess reporting bias because most studies did not have published protocols.

The bias analysis information can be found in Table 2.

Table 2.

Risk of bias assessment for included studies (PRISMA Guidelines)

Study	Selection bias (random sequence generation / allocation concealment / sampling)	Performance bias (blinding of participants & personnel / deviations from intended intervention)	Detection bias (blinding of outcome assessment / measurement bias)	Attrition bias (incomplete outcome data)	Reporting bias (selective reporting)	Other bias (contextual/implementation issues; specify)
Improving Communication During Cardiac ICU (Justice et al., 2016)	High	High	Moderate	Low	Low	Protocol changes during study
Internet-based Education on Maternal Satisfaction in NICUs (Kadivar et al., 2017)	Moderate	High	Moderate	Low	Low	Internet access limitations
Interactive Patient Care for Pain Management (Rao-Gupta et al., 2018)	High	High	Moderate	Low	Low	Technology adoption bias
Racial Minority Families’ Preferences (Zurca et al., 2020)	High	High	High	Low	Low	Cultural bias, tool validation limits
Better Use of Data – BUDS Protocol (Sakonidou et al., 2019)	Moderate	High	Moderate	Low	Low	Non-randomized, contamination risk
Impacting the Patient’s Experience (Bumpers et al., 2018)	High	High	High	Low	Low	Incentive-linked motivation
Feeling Informed vs. Being Informed (Wennberg-Capellades et al., 2021)	Moderate	High	Moderate	Low	Low	Convenience sampling, phone interviews
Enhancing Family Experience in PICU (Tcharmtchi et al., 2023)	Moderate	High	Moderate	Low	Low	Non-standardized questionnaire, single-center
Pediatric Provider Communication Skills Scale (Boztepe et al., 2023)	Moderate	High	Moderate	Low	Low	Self-report, initial validation only

Own elaboration

It should be considered that much of the available evidence on communication interventions between paediatric nurses and families comes from non-randomised, quality improvement, observational and mixed-method designs. In these designs, it is often not possible to blind participants, and context-specific implementation influences outcomes. Consequently, studies were not excluded based on a “high” or “moderate” risk of bias in multiple domains. Instead, inclusion was determined based on the relevance of the study to the review question (communication strategies and outcomes of family-centered implementation), the provision of empirical data on experiences/implementation, and sufficient methodological transparency to allow assessment. Risk of bias assessments were used to interpret the strength of the evidence (qualifying conclusions, highlighting areas most likely to influence outcomes, and avoiding causal statements where confounding and performance biases were likely to exist). This approach is consistent with the review’s focus on implementation and empirical outcomes rather than clinical efficacy, while explicitly acknowledging that the certainty of the evidence is limited by non-randomised designs and contextual heterogeneity.

Synthesis methods

The synthesis of evidence in this systematic review was conducted following PRISMA 2020 recommendations [11]. Studies were included based on predefined eligibility criteria and assessed for methodological quality using the CASPe checklist [12]. In line with MMAT guidance, we did not compute an overall MMAT score; instead, item-level MMAT ratings were used to support a sensitivity assessment of the narrative conclusions.

A predefined threshold was applied in order to exclude any reports that did not meet the required methodological rigor or transparency for inclusion in the synthesis. Due to heterogeneity across study designs, settings, interventions, and outcome measures, findings were synthesized narratively. This synthesis focused on identifying patterns in intervention strategies, communication approaches, and reported outcomes related to family experience and satisfaction. Where reported, we extracted and presented effect measures (e.g., odds ratios, mean differences, Cohen’s d, and 95% confidence intervals); however, substantial heterogeneity precluded meta-analysis.

Using a pragmatic GRADE assessment for the primary outcome (parental satisfaction), the certainty was judged low/very low due to predominantly non-randomized/QI designs (risk of bias and confounding), heterogeneity across interventions and measures (inconsistency/ indirectness), and limited precision in several studies. Publication bias was not formally assessed given the small and heterogeneous evidence base; therefore, conclusions were framed as associations rather than causal effects.

The quality of the studies included can be found in Table 3.

Table 3.

CASPE SCALE

QUALITATIVE STUDIES
QUALITATIVE STUDY		ARTICLE
		Justice LB et al. (2016)	Bumpers B, Dearmon V, Dycus P (2019)
Are the results of the study valid?
	1. Were the research objectives clearly defined?	yes	yes
	2. Is the qualitative methodology consistent?	yes	yes
	3. Is the research method appropriate for achieving the objectives?	yes	yes
	4. Is the participant selection strategy consistent with the research question and the method used?	yes	yes
	5. Are the data collection techniques used consistent with the research question and the method used?	yes	yes
	6. Has the relationship between the researcher and the research subject been considered (reflexivity)?	yes	yes
	7. Have ethical considerations taken into account?	no	yes
What are the results?			yes
	8. Was the data analysis rigorous enough?	yes	yes
	9. Are the results clearly presented?	yes	yes
Are the results applicable in your environment?		yes	yes
	10. Are the research findings applicable?	yes	yes
SCORE		9	10
CLINICAL TRIAL
CLINICAL TRIAL		ARTICLE
		Kadivar M et al. (2016)	Rao -Gupta S et al. (2018)	Sakonidou S et al. (2019)	Wennberg-Capellades L et al. (2021)	Tcharmtchi J et al. (2023)
Are the results of the trial valid?
	1. Is the trial focused on a clearly defined question?	yes	yes	yes	yes	yes
	2. Was the allocation of patients to treatments randomised?	yes	no	no	no	no
	3. Were all patients who entered the study adequately considered until the end of the study?	yes	yes	yes	yes	yes
	4. Was blinding maintained for: - Patients. - Clinicians. - Study staff.	no	no	no	no	no
	5. Were the groups similar at the start of the trial?	yes	yes	yes	yes	yes
	6. Apart from the intervention under study, were the groups treated equally?	yes	yes	yes	yes	yes
What are the results?
	7. Is the effect of the treatment very large?	moderate	yes	yes	yes	yes
	8. How accurate is this effect? (Confidence intervals)	moderate	not reported	not reported	positive and statistically significant association	not reported
Can these results help us?
	9. Can these results be applied to your local environment or population?	yes	yes	yes	yes	yes
	10. Were all clinically important outcomes taken into account?	yes	yes	yes	yes	yes
	11. Do the benefits outweigh the risks and costs?	yes	yes	yes	yes	yes
SCORE		8	8	7	9	9
COHORTES
COHORTES	ARTICLE
		Zurca AD et al. (2019)
Does the study focus on a clearly defined topic?		yes
Was the cohort recruited in the most appropriate manner? BIASES
	1. Is the cohort representative of a defined population?	yes
	2.Were all those who should have been included in the cohort included?	yes
	3. Was exposure measured accurately in order to minimise potential bias?	yes
Was the result measured accurately in order to minimise potential bias?
	1. Do the measures adequately reflect what they are supposed to measure?	yes
	2. Has a reliable system been established to detect all cases (e.g., to measure cases of disease)?	no
	3. Were all subjects in the exposure group classified using the same treatment?	yes
	4.Were the measurement methods similar across the different groups?	yes
Have the authors considered the potential effect of confounding factors in the study design and/or analysis?		yes
Was the follow-up of the subjects sufficiently long and comprehensive?		yes
What are the results of this study?
	1. What are the net results?
	2. Have the authors given the rate or the proportion between those exposed and those not exposed?	yes
	3. How strong is the association between exposure and the result (RR)?	medium
How precise are the results?		accurate
Do you find the results credible?
	1.Could it be due to chance, bias or confusion?	yes
	2. Are the design and methods of this study sufficiently flawed to make the results unreliable?	no
Do the results of this study coincide with other available evidence?		no
Can the results be applied in your environment?		yes
Will this change your clinical decision?		no
SCORE		12
Own elaboration

The review of the quality of evidence according to the GRADE tool is attached as supplementary material.

Results

The search identified 107 records across the selected databases. Following the removal of 13 duplicates, a total of 94 records were screened by title and abstract, resulting in the exclusion of 18. A total of 76 full-text articles were assessed for eligibility, and 67 were excluded after full-text review, leaving 9 records included in the final synthesis. The search process is outlined in Fig. 1.

Fig. 1.

PRISMA Flow diagram. Own elaboration

Study characteristics

Of the nine selected articles, one constituted a study protocol, two were pilot studies, there was one quasi-experimental case-control study, one was an observational cohort study, one was a qualitative descriptive study, and three were mixed-method studies. The protocol study was retained only to describe planned communication interventions and was not used to derive outcome conclusions [19].

The geographical distribution of the studies included the United States (n = 5), England (n = 1), Iran (n = 1), Spain (n = 1), and Turkey (n = 1). The publication years ranged from 2016 to 2024, and the studies were conducted in emergency departments, neonatal and paediatric intensive care units, and paediatric medical and surgical wards.

Primary outcome: parental satisfaction

A review of the empirical studies suggested that communication-focused interventions were generally associated with improved parental satisfaction, perceived involvement, and understanding of their child’s care. However, the strength of this pattern should be interpreted cautiously due to the heterogeneity of designs, measures, and implementation contexts.

Research that employed interactive eHealth tools yielded favourable outcomes, enhancing parent satisfaction with communication with healthcare staff, and reinforcing their knowledge related to their child’s health [15]. These findings should be interpreted cautiously, as most contributing studies were non-randomized or quality-improvement designs.

Similarly, studies where a package of measures were applied to improve communication apparently increased parent satisfaction levels with nurses, but not with the full-service hospital care.

Quantitative and improvement/implementation studies reported quantifiable changes in satisfaction and family experience. In one mixed-method design incorporating questionnaires and telephone follow-ups, satisfaction was significantly associated with the perception of family-centered care (B = 0.25; 95% CI 0.20–0.29; p < 0.001), and satisfaction increased with a moderate effect size (d = 0.51; mean difference 1.85; 95% CI 1.49–2.21; p < 0.001). In the study on communication preferences in paediatric intensive care units, minority families reported less agreement between their preferred environment and the one they received (adjusted OR = 0.32; 95% CI 0.11–0.91), and there were differences in perceived nursing communication time (67% vs. 85%; p = 0.03). In an improvement intervention implemented during rounds, greater clarity around daily objectives was associated with higher team alignment (team agreement: 62% → 85%, with subsequent maintenance), along with an improvement in family satisfaction. Finally, interactive technologies were associated with a significant increase in positive responses regarding satisfaction with pain management (p = 0.006).

Measures used to assess satisfaction/communication

Most studies used surveys and interviews with families to assess satisfaction and perceived communication during hospitalization. The measures employed included Likert-type surveys, open-ended questions, and structured interviews with parents (both direct and telephone).

One study developed a communication skills assessment scale; however, this was a provided self-report instrument completed by physicians and nurses and therefore did not capture parent- or family-rated communication quality [22].

Secondary findings: barriers and contextual factors

Even though all of the included studies satisfied the stipulated quality criteria, a variety of biases were identified, including limitations in terms of design, reporting and sampling.

Regarding barriers, parents reported that communication and the information received were satisfactory but could be improved. In special care settings, communication difficulties have been reported as a result of two main factors: the absence of knowledge regarding the name of the child’s carer and environmental noise.

Families belonging to ethnic minorities expressed preferences for being informed about their children’s situation and prognosis in private or at the bedside.

Secondary findings: strategies/interventions

About strategies employed to enhance communication, two studies implemented interventions with interactive eHealth tools to reinforce information provided during hospitalisation and discharge. Another study implemented bedside boards to reflect the most relevant information about patients’ progress. A further study implemented a multifaceted intervention comprising bedside nurse shift changes, room boards, and scripting to standardise these activities, with the aim of enhancing satisfaction with communication.

In terms of robustness, several studies reported methodological elements such as the use of validated instruments, models adjusted for relevant covariates, and measures of implementation/fidelity (e.g., comprehensive staff education and high adherence to bundle components). In family participation interventions with journals in paediatric intensive care units, there were quantitative increases in specific items and open comments identifying areas for improvement (communication, environment, delays). Finally, when measurement tools were evaluated, high internal reliability and explained variance were reported, supporting the consistency of measurement in research on communication skills.

Discussion

When a child becomes seriously ill and needs to be hospitalized, family also often experiences substantial emotional and social consequences [8]. In this context, clear communication may help reduce uncertainty and support family involvement during care and discharge planning [24].

Overall, the included studies suggest that parents generally reported positive experiences of nurse-parent communication, and value nurses’ accessibility. However, they also identify important areas for improvement, such as not knowing staff members’ names, nurses using overly technical language, and environmental noise, particularly in acute and intensive care settings [14, 17, 18, 20]. Although, these findings should be interpreted cautiously given the methodological limitations of the evidence based.

The findings are consistent with the early ‘orientation’ phase of Peplau’s Interpersonal Relations Theory, when families require role clarification and a clear plan of care, together with clear information and supportive communication to reduce uncertainty and facilitate engagement in care [10]. Structured bedside rounds and visible daily goals/room boards may support this process by making the plan explicit and creating opportunities for questions. However, barriers such as not knowing staff members’ names and the use of technical language may hinder trust and understanding.

In line with Leininger’s Transcultural Nursing Theory [23], satisfaction is dependent not only on the information provided, but also on culturally congruent communication – how and where it is delivered. The fact that minority families prefer to receive sensitive information privately or at the bedside highlights the importance of adapting communication to meet cultural expectations, privacy norms and family language needs.

Across the included studies, parents valued communication practices that promoted trust, opportunities to ask questions, and the use of clear, non-technical language. To facilitate this process, it is essential to establish a climate of trust and to optimise communication through active listening by nursing staff. It is necessary for nurses to be able to address parents’ concerns and doubts, thereby creating an environment in which they can express their fears and feelings about the process and its progression. Clear uncomplicated language, with technical jargon at a minimum, should be used.

Decision-making about paediatric patient care should directly involve parents, respecting their preferences whenever possible. This collaborative approach assigns parents an active role and improves their sense of control over their children’s health process. Methods such as joint rounds and the use of room boards were associated with better perceived communication and may help structure nurse-parent interactions more clearly [16, 18, 20, 21].

It is essential to remember that many children will need home care after discharge from hospital. Nurses are the health agents responsible for teaching paediatric patients and their parents the best way to carry out these care tasks, procedures, or treatments and administer medication. In such cases, as observed in studies conducted in paediatric intensive care units and emergency departments [24, 25], eHealth-based support appears to be a promising strategy for reinforcing information and reducing uncertainty among families. Parents indicated that access to follow-up telephone calls or home visits by nurses was perceived as helpful during the transition from hospital to home. The use of short text messages has also been documented in some studies as a reinforcement method of information received by families during the hospital stay and has been positively valued as a useful strategy to improve communication between parents and healthcare staff [25]. These results are consistent with those reflected in other studies that applied telemedicine in post-discharge follow-up in paediatric populations. In these cases, families expressed a preference for in-person assistance, yet these technological solutions have been perceived as beneficial and have enhanced their satisfaction with the care received [26, 27, 28].

The apparent usefulness of digital tools in improving satisfaction can be interpreted through two complementary mechanisms. Firstly, they reduce uncertainty by providing clear, on-demand information, which is especially relevant in high-pressure environments such as NICUs. Parents frequently report information gaps and staff workload can limit face-to-face education. Secondly, effective tools do not function independently of care, but rather provide a framework for communication within clinical workflows. These tools can include features such as prompting questions, structuring nurse-parent conversations, and reinforcing bedside communication through the use of visual cues and documentation pathways.

It is also important to consider equity and context, as some interventions rely on internet access and a minimum level of digital literacy, potentially limiting feasibility for families with limited connectivity or lower confidence using digital resources. Similarly, tools available only in one language may reduce accessibility in linguistically diverse settings. Across studies, digital tools appear more useful when they provide understandable information that can be revisited at the family’s own pace, support two-way clarification, and are embedded within routine nurse-family communication rather than functioning as stand-alone resources.

Finally, it is important to consider the influence of cultural or religious beliefs on the efficacy of communication, particularly given that the included studies were conducted in different countries and healthcare contexts, which may partly explain variations in family needs and expectations. Nurses should therefore strive to be sensitive and respectful in their interaction with patients and families. A private uninterrupted for bedside information-sharing may facilitate communication in these contexts [18].

The limitations of this systematic review are rooted in the heterogeneity of the studies, as the articles that met the inclusion criteria employed a range of methodologies and perspectives for approaching the primary objective and measuring outcomes. A further limitation is the restriction of publication to English and Spanish.

The overall risk of bias assessment indicates that most included studies present high or moderate risk in the domains of selection and performance bias, primarily due to non-randomized designs and the impossibility of blinding in quality improvement interventions. Detection bias was generally moderate, as outcomes relied on subjective measures such as satisfaction surveys, although the use of validated instruments in some studies mitigates this limitation. Attrition and reporting bias were consistently low, suggesting that data completeness and transparency were maintained. Despite these methodological constraints, the studies provide valuable insights into communication strategies and family-centered interventions in pediatric and neonatal care. Their inclusion is justified given the review’s focus on implementation and experiential outcomes rather than clinical efficacy. A sensitivity check using MMAT (2018) yielded consistent study-level judgments and did not alter the conclusions drawn from the narrative synthesis.

Even though the extensive documentation of care team–patient/family interaction as a quality domain, research specifically focused on paediatric inpatient contexts remains limited. While a study did develop a communication skills assessment scale for paediatric healthcare providers, it was a self-report questionnaire completed by physicians and nurses. As a result, it does not capture the quality of communication from parents or family members. This suggests an important measurement gap in parent-reported assessment of nurse–parent communication in pediatric inpatient settings [29].

This study explores the significance of establishing effective clinical communication with families of paediatric patients. The interaction between nursing staff and family members of paediatric patients appears highly relevant to caregivers’ satisfaction, and may also influence the broader care experience and emotional well-being, although direct clinical effects were not thwe primary focus os most included studies Taken together, the findings are better interpreted as indications of potentially beneficial communication strategies than as definitive evidence of effectiveness.

The scarcity of research in this field suggests that it is still in an early stage that requires more attention from the scientific community. However, the available data so far suggest that nurse-parent communication is an important component of family experience and satisfaction with care. Further research in the field would also contribute to the enrichment of the extant body of knowledge in this context, the improvement of the training of nursing teams, and the implementation of preventative measures against professional burnout. This review could be a starting point for identifying opportunities for improvement. Exploring these areas could provide new insights into developing strategies and skills to prevent emotional distress in families of paediatric patients.

This review should be interpreted considering several limitations. The available evidence was methodologically heterogeneous and was largely based on non-randomized, quality-improvement, observational, and mixed-methods studies. This limits the extent to which causal relationships can be inferred from the reported findings. In addition, differences in intervention design, outcome measures, clinical settings, and implementation approaches reduce comparability across studies and may limit the generalizability of the results. Most studies focused on parent-reported satisfaction or experience rather than objective clinical outcomes. One of the included records was a study protocol and therefore contributed contextual information only, without providing empirical outcome data. Finally, five of the nine studies were conducted in the United States, and communication practices may vary according to healthcare organization, staffing models, cultural expectations, and approaches to family-centered care. Taken together, these limitations indicate that the findings should be interpreted as suggestive of potentially beneficial communication strategies rather than as definitive evidence of effectiveness across settings.

Conclusions

The available evidence suggests that parents of hospitalized children generally report positive experiences with nurse-parent communication, while also identifying relevant areas for improvement, particularly regarding staff identification, use of understandable language, and environmental conditions. Commonly reported barriers include lack of staff identification, excessive use of technical language, and environmental noise, particularly in emergency and intensive care settings. Strategies such as creating private and trusting environments, using visual or digital tools, providing bedside explanations, and conducting follow-up calls appear promising in enhancing parental satisfaction.

However, the current evidence base remains limited by methodological heterogeneity, the predominance of non-randomized desings, and moderate to high risk of bias. These limitations restrict both causal inference and the generalizability of the findings across healthcare settings and populations. The communication strategies identified in this review should therefore be regarded as potentially beneficial rather than definitively effective. Further high-quality, multicenter studies, including randomized designs where feasible, are needed to strengthen the evidence base and to assess their impact on both relational and clinical outcomes.

Implications for nursing practice

Nurse–parent communication should be recognized as a core component of therapeutic care rather than solely as an exchange of information. The findings of this review indicate that higher levels of parental satisfaction are consistently associated with clear, empathetic, and culturally sensitive communication practices in pediatric inpatient settings. Importantly, inadequate communication often remains underrecognized and insufficiently addressed within clinical environments, despite its potential negative repercussions on care quality, parental well-being, and the overall therapeutic climate.

Although most included studies primarily assessed satisfaction outcomes rather than objective clinical indicators, improved communication was frequently perceived by parents as facilitating understanding, trust, and involvement in care decisions. These relational dimensions may contribute to better care experiences and potentially support adherence and continuity of care, although further research is required to confirm direct clinical effects.

Communication strategies should explicitly address cultural and linguistic diversity, as several studies identified these factors as barriers to satisfaction. Interventions such as structured information delivery, active listening techniques, and consistent nurse assignment emerged as promising strategies, though the level of evidence varies.

Based on the findings, integrating structured communication training into pediatric nursing education appears warranted. However, such initiatives should be implemented with awareness of the current evidence limitations. Future research should prioritize evaluating the impact of communication interventions on both satisfaction and objective clinical outcomes, as well as developing validated instruments specific to nurse–parent communication in pediatric contexts.

Supplementary Information

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Author contributions

The research was carried out thanks to the collaboration of a multidisciplinary team:- Noemí Mayoral-Gonzalo (ORCID: 0000-0001-8902-8939): Conceptualization, methodology, data curation, formal analysis, project administration, validation, investigation, resources, writing – original draft, writing – review and editing, visualization.- Leticia León-Mateos (ORCID: 0000-0001-7142-0545): Conceptualization, methodology, data curation, formal analysis, investigation, resources, writing – review and editing, visualization- Celia Ibáñez del Prado (ORCID: 0000-0001-8795-6870): Conceptualization, methodology, data curation, formal analysis, validation, resources, writing – review and editing, visualization- David Pérez-Manchón (ORCID: 0000-0001-6625-7771): Conceptualization, data curation, investigation, resources, writing – review and editing, visualization- Cayetana Ruiz-Zaldibar (ORCID: 0000-0002-9930-4092): Conceptualization, data curation, investigation, resources, writing – review and editing, visualization- Raquel Moreno Sánchez (ORCID: 0000-0002-2642-1562): Conceptualization, data curation, investigation, resources, writing – review and editing, visualization- Marina Gómez de Quero Córdoba (ORCID: 0000-0002-2494-3324): Conceptualization, methodology, data curation, formal analysis, investigation, resources, writing – review and editing, visualization.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethical considerations

ethical approval was not required.

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Consents to participate

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Competing interests

The authors declare no competing interests.