Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation

Structured interactions between nurses and patients through intentional rounding: A scoping review

AIM

To synthesize existing literature describing the impact of intentional rounding on patient outcomes among hospitalized adults.

BACKGROUND

Intentional rounding has been described as purposeful therapeutic communication between nurses and patients during regular checks with patients using standardized protocols. Despite the widespread adoption of intentional rounding, the current understanding of the benefits of these structured interactions between nurses and patients is limited.

INTRODUCTION

The critical role of nurses in ensuring high-quality and safe care in acute hospitals is often noted only when things go wrong. This was highlighted by investigations into the reasons for the failures in patient care at the Mid Staffordshire National Health Services.

METHODS

A scoping review was performed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines.

FINDINGS

Sixteen studies were included in the final review. Various rounding models were noted among different clinical settings; four studies reported a significant reduction in falls, and a further three reported a decrease in pressure injuries. Two studies reported a reduction in call bell usage. Significant improvements in patients' satisfaction with intentional rounding were reported in three studies.

DISCUSSION

Promoting intentional rounding without solid evidence of its acceptability, feasibility, and suitability in different clinical settings could compromise nurses' ability to provide safe care.

CONCLUSION AND IMPLICATIONS FOR NURSING

There is weak evidence of the effectiveness of intentional rounding on patient outcomes because of the diversity of methods employed and methodological limitations in many studies. Our findings identify the need for robust studies to explore the acceptability and feasibility of a rounding protocol that can be implemented in different clinical settings.

Contextual factors and intentional rounding in acute hospitals: understanding what works, for whom, in what settings: a realist synthesis protocol

Background

This study aims to understand and explain the influence of contextual factors on the implementation of Intentional Rounding in acute hospitals using the realist synthesis methodology.Falls of hospital admitted patients are one of the most frequent concerns for patient safety in the acute hospital environment. The reasons why people fall are complex. International guidelines recommend a multifactorial assessment and effective prevention and management of identified risk factors in order to reduce the number of falls. Intentional Rounding (IR) is one approach for delivering this. IR is an umbrella term, understood as a structured process whereby nurses or care staff carry out regular checks with individual patients using a standardised protocol to address such issues as positioning, pain, personal needs and placement of possessions.

Methods

This study will use realist synthesis to understand what works, for whom, in what circumstances, and in what settings. Realist synthesis is a theory driven interpretive approach to evidence synthesis. It is our intention to analyse IR as an intervention, which aims to enhance patient care and safety in hospital settings. The synthesis forms part of a larger implementation study examining interventions that reduce the number of falls that occur in hospitals. Search terms will include intentional rounding, purposeful rounding, comfort rounding and hourly rounding and will encompass search terms beyond IR and falls rates to avoid limiting the synthesis. This synthesis will conform to the RAMESES (realist and meta-narrative evidence synthesis group) publication and reporting quality standards.

Conclusions

The findings will inform the next phase of an implementation study on IR in acute hospital settings, to address evidence informed enablers and barriers to IR. The results will be disseminated in a peer-reviewed journal and through presentations.

Untangling a complex skein on ward round terminologies, purposes, and main features through a rapid review

AIM(S)

To increase conceptual clarity in the field of nursing regarding terms, purposes, and main features of rounding as investigated to date.

DESIGN

A Rapid Review according to the Cochrane Rapid Reviews Protocol.

REVIEW METHODS

These were: (a) set the research question; (b) establish the study eligibility criteria; (c) search the databases; (d) select the studies; (e) extract the data; (f) assess the risk of bias; and (g) provide a synthesis using three methodologies, namely a qualitative content analysis, a thematic and a framework synthesis.

DATA SOURCES

MEDLINE (PubMed), Cumulative Index of Nursing and Allied Health databases and grey literature from 2014 to 2022.

RESULTS

A total of 72 studies were included; 88 different terminologies are used to describe the rounding from one up to five words. "Preparing the care by ensuring an effective care plan, team and environment", "Delivering tailored and timely nursing care" and "Promoting the quality of care" are the three main purposes of the rounding, including several specific aims. Regarding the main features, these emerged from highly structured/prescriptive to low structured/prescriptive approaches to rounding intervention.

CONCLUSION

The word "round" alone seems to be not sufficient to communicate and describe the intervention, suggesting that this field of research is entering within the complex intervention framework. The different aims of the rounding have been conceptually categorized into three main purposes whereas the intervention features may range from simple to very complex, where several options regarding who to involve, how and when to deliver are expressed.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This rapid review followed by three data analysis methodologies have resulted in three main frameworks that may be useful to address the research, the clinical practice and the education regarding the terminologies, the different purposes and the main features of the rounding. No Patient or Public Contribution.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution in the conduct of this study.

Nurse manager intentional rounding and outcomes: Findings of a systematic review

AIM

To summarize the evidence available on Nurse Manager Intentional Rounding (NMIR) describing the main characteristics and methodological quality of studies available, the features of rounding and the outcomes as measured to date.

DESIGN

A systematic review.

DATA SOURCES

Electronic databases, including MEDLINE-EBSCHOST, PubMed, CINAHL, Scopus, Cochrane, Clinicalkey, ScienceDirect, OVID, Sage Journals and Web of Science, were searched up to June 2021.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline was used to summarize methods and report findings. The Joanna Briggs Institute Critical Appraisal tools were used to evaluate the methodology quality of the studies included.

RESULTS

Seven studies were included with pre-post-test (n = 3), longitudinal, two-group post-tests, quasi-experimental, and retrospective study designs (n = 1, respectively). In five studies, the nurse managers were trained to conduct the rounding, which was shaped according to three main features: a structured (n = 4), a semi-structured (n = 1) and an unstructured rounding (n = 2) delivered from high (twice a day 7/7) to low intensity (once a day, 5/7). Two main outcomes have been measured to date, the patient satisfaction and some aspects related to the care quality. Five studies reported that the satisfaction scores of patients who received rounding were significantly higher than that perceived by patients not receiving rounding. About the other aspects of the quality of care, two studies documented significant improvements as a consequence of the NMIR (e.g. information accessibility, discharge instructions, coordination of care after discharge).

CONCLUSION

Studies available report in general a low methodological quality, mainly due to their pragmatic nature as quality improvement projects. Therefore, transforming this field of research by establishing a methodological rigour and a theoretical foundation in both interventions and outcomes and by designing experimental approaches, might expand the evidence available on the effects of nurse managers intentional rounding.

Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study

The aim of the study was to explore the effects of Intentional Rounding, a regular-based proactive patient monitoring, on falls and pressure ulcers in internal medicine units. This is a cluster-randomised controlled study, where units were assigned (1:1) to Intentional Rounding (intervention group) or Standard of Care (control group). The primary outcome was the cumulative incidence of falls and new pressure ulcers. These events were considered separately as secondary endpoints, together with the number of bell calls and the evaluation of patient satisfaction. Primary analyses were carried out on the modified intention-to-treat population (hospitalisation of at least 10 days). Recruitment occurred between October 2019 and March 2020, at which time the study was prematurely closed due to the COVID-19 pandemic. Enrolment totalled 1822 patients at 26 sites; 779 patients were included in the modified intention-to-treat analysis. The intervention group had a lower risk of falls (adjusted incidence rate ratio 0.14; 95% confidence interval, 0.02–0.78; p = 0.03). There were no statistical differences in new pressure ulcers or the cumulative incidence of both adverse events. Mean bell calls for each patient were 15.4 ± 24.1 in the intervention group and 13.7 ± 20.5 in the control group (p = 0.38). Additionally, patient satisfaction in the intervention group was almost at the maximum level. Our study supports the usefulness of Intentional Rounding in a complex and vulnerable population such as that hospitalised in internal medicine units.

Nurses' Perceptions of Hourly Rounding in Jordanian Hospitals: A National Survey

AIM

To explore nurses' perceptions of hourly rounding in Jordanian hospitals.

BACKGROUND

Hourly rounding is a standardized and systematic process conducted by nurses to anticipate and address needs in hospitalized patients. The evidence on hourly is mixed, and research is needed to affirm the benefits of implementing hourly rounding across different contexts.

METHOD

A cross-sectional correlational design was used. A convenient sample of 1378 nurses was recruited from one Military hospital, two university-affiliated hospitals, four governmental hospitals, and four private hospitals in Jordan. The Hourly Rounding Questionnaire was used to collect data. Descriptive statistics, T-test, one-way ANOVA, and Kruskal-Wallis H test were used to analyze the data.

RESULTS

The highest agreements between nurses were on the items related to the implementation of hourly rounding in terms of preventing patient falls" 1211(87.9%), "preventing hospital-acquired pressure ulcers" 1201(87.2%) and addressing patients' position" 1199(87%). The lowest agreements between nurses were on the items related to the involvement of nurses in the decision-making process and sense of ownership 268(19.4%), and the availability of continued support and resources 239(17.3%). Female nurses, nurses who often work on a shift rotation, nurses working in private hospitals and respiratory units had a positive perception of hourly rounding.

IMPLICATIONS FOR NURSING PRACTICE

Findings will inform nursing leaders and policy developers about the implementation of hourly rounding from nurses' perspectives. A protocol should accompany hourly rounding for robust evaluation to measure the impact of this process change with the involvement of nurses in the decision-making process.

The delivery of compassionate nursing care in a tick-box culture: Qualitative perspectives from a realist evaluation of intentional rounding

BACKGROUND

Compassion is integral to professional nursing practice worldwide and a fundamental value in healthcare. Following serious care failures at a healthcare provider in the United Kingdom, a government commissioned report (the Francis Report) made several recommendations for strengthening compassion in nursing care and consequently 'intentional rounding' was incorporated into nursing practice in the United Kingdom. Intentional rounding is a structured process implemented primarily in the United Kingdom, North America and Australia, whereby nurses conduct 1-2 hourly checks on every patient using a standardised protocol and documentation.

OBJECTIVES

To examine the role of intentional rounding in the delivery of compassionate nursing care in England from multiple perspectives.

METHODS

This paper reports qualitative findings from one phase of a realist evaluation of intentional rounding which used a mixed-methods approach. Individual, semi-structured interviews were undertaken with 33 nursing staff, 17 senior nurse managers, 34 patients and 28 family carers from three geographically spread case study hospital sites in England. Interviews elicited detailed reflections on the contexts, mechanisms and outcomes of intentional rounding and how it impacted the interviewee and those around them.

RESULTS

This study found little evidence that intentional rounding ensures the comfort, safety or dignity of patients or increases the delivery of compassionate care. The systematised approach of intentional rounding emphasises transactional care delivery in the utilisation of prescribed methods of recording or tick boxes rather than relational, individualised patient care. It has the potential to reduce the scope of nursing care to a minimum standard, leading to a focus on the fundamentals as well as the prevention of adverse events. Its documentation is primarily valued by nursing staff as a means of protecting themselves through written proof or 'evidence' of care delivered, rather than as a means of increasing compassionate care.

CONCLUSIONS

This large-scale, theoretically-driven study of intentional rounding - the first of its kind - demonstrates that intentional rounding prioritises data collection through tick boxes or a prescriptive and structured recording of care. Thus, intentional rounding neither improves the delivery of compassionate nursing care nor addresses the policy imperative it was intended to target. This study raises questions about the role, contribution and outcomes from intentional rounding and suggests a need for a wider, international debate within the nursing profession about its future use. If an intervention to increase compassionate nursing care is required, it may be better to start afresh, rather than attempting to adapt the system currently implemented.