Research Critique
Dewing, J., & O’Meara, B. L. (2013). Introducing intentional Rounding: a pilot project. Nurs Stand, 28, 37-44.
The study aimed to examine the effectiveness of intentional Rounding and to examine its effects on patient satisfaction and outcomes at the East Sussex Healthcare NHS Trust in England. The study hypothesized that intentional Rounding would lead to improved patient outcomes and satisfaction.
To obtain results, the researchers conducted a two-stage pilot study of intentional Rounding at two public hospitals in the NHS trust. The first stage involved six wards. Of the six wards, three were adult in-patient wards, one was an adult out-patient ward, one was a children’s ward, and another was the maternity ward. The second stage involved all children and adult’s out-patient and in-patient services. Senior nursing and midwifery leaders, as well as matrons in the two hospitals, renamed the term ‘intentional rounding’ to ‘essential care rounds’ for adult rounds and ‘top-to-toe’ care rounds for children rounds. This was because patients had previously not responded well to the term intentional Rounding. The study did not need any ethical approval because the project was perceived as a program to improve service. However, the study adhered to the NHS governing standards. The rounding nurses were given tutorials on intentional Rounding and the necessary resources such as patient leaflets for information, poster, poster, and vital literature for the staff. Testing for the resources was evaluated using critiques from clinical leaders and some team members. Phase one was conducted for four weeks, and phase two of the project ran for eight weeks. Don't use plagiarised sources.Get your custom essay just from $11/page
Results at the end, the two phases showed that intentional Rounding yielded positive results. The services named ‘essential care’ were found to reinforce current care practices and showed improved and regular individualized care. The patients also reported that they liked the regular ward rounds because of the increased midwife and nurse visibility. Patients also reported being able to articulate their feelings to the staff when they were more visible. Family members of the patients also gave positive feedback about the rounds about patients’ fluid intake and diet. Nurses also noted the significance of intentional rounds and expressed their need to incorporate them into their daily routines. Six months after project completion, some nurses were found to have embedded intentional Rounding into their care, while others were not holding them frequently, or had abandoned them altogether.
The study concluded that there is a difference in how nurses perceive intentional Rounding. While others saw it as an essential activity in increasing patient satisfaction and outcome, others saw it as an additional activity to their routine. It further concluded that intentional Rounding in the future ought to focus on aspects such as communication and compassion.
Fabry, D. (2015). Hourly Rounding: perspectives and perceptions of the frontline nursing staff. Journal of nursing management, 23(2), 200-210.
The specific purpose of this study was to analyze the perspectives of direct care nursing staff perceptions of the pre-implementation and post-implementation phases of routine hourly Rounding in the wards. The other objectives were to evaluate the understanding of the nurses about the advantages of routine rounds. It also aimed to obtain information about the factors that enhance or inhibit the acceptance of the rounds. The study was carried out in the Western New York community hospital with a bed capacity of 186. It involved 52 RNs and 15 PCAs. Cross-sectional survey questions were administered to the participants individually and were collected after three weeks. The validity of the tool was tested using individual questionnaires administered to expert teams for review and feedback. Before the study began, the researchers sought approval of the hospital for participation, and participants were given information sheets to act as written consent for their participation. Utmost confidentiality and anonymity were observed during the study as no participant was mentioned by name. Data from the study were analyzed using the 2011 SPSS version and included descriptive statistics of percentages and frequency of agreement. Sub analysis was also conducted according to job category, nurse shift, and level of education.
Study results showed that over 85% of the nursing staff reported having received adequate education and training about routine Rounding, while 87% of the respondents understood how to add the rounds into their daily tasks. About 60% of the nursing staff felt that the training that they had received on hourly Rounding was based on current evidence, while 85% of them felt as though the communication about the benefits of the routine was clear. However, BSNs felt that the communication about the benefits of the practice on the patients was not clear. Over 90% of the staff and about 95% of RNs agreed that hourly rounds produced positive results on patients’ pain, personal needs, and positions, and only 55% of the RN believed that hourly rounds improved pain management. The study concluded that many nurses had received enough education and training on the benefits of hourly rounding though there is a disagreement among them about incorporating the task in their daily duties. From the results, the study also concluded that hourly Rounding resulted in more positive patient care and outcomes. The study was, however, limited because the response rate was less than 50 %, and the sample sizes were too small to generalize.
Flowers, K., Wright, K., Langdon, R., McIlwrath, M., Wainwright, C., & Johnson, M. (2016). Intentional Rounding: facilitators, benefits, and barriers. Journal of clinical nursing, 25(9-10), 1346-1355.
The purpose of the study was to examine the implementation, practice, and sustainability of Intentional Rounding in the aged care clinic and the maternity ward. The researchers used descriptive qualitative designs that were focused on three focus groups of nursing staff within the care settings. The sample subjects included nine nurses who accepted the invitation, and these nurses participated in two focus groups. The third focus group consisted of six current and past nursing educators from the wards included in the study. The data from the focus group was recorded digitally and later transcribed verbatim for analysis. The transcribed recordings were analyzed using the QSR NVIVO Version 9 to determine the latent themes in the data. The researchers obtained ethical approval of the study from the Human Research and Ethics Committee, and the participants were asked to sign the written consent of participation.
Results of the study showed in both wards; intentional Rounding had already been implemented over 12 months before the focus groups. However, communication about the routine was carried out differently. In some wards, nurses were simply instructed to start the routine through word of mouth. In others, nurses were consulted and asked to give their input about the implementation. Regardless of the mode of communication used, all participants in the three focus groups remember seeing posters around the wards but received little education about the benefits of implementation. The implementation of the Rounding was effective as the participants reported to have adopted the routine and made it part of their daily practice within 30 days of implementation. Managers were the main drivers of the IR, and they supervised and carried out spot-checks; and reminded all the nursing staff members of IR. IR was also discussed at staff meetings and during handovers. Challenges on the benefits of IR were also reported about scheduling and education and the time taken by the managers to learn about the process. Nurses also reported that the location of the schedule was important in the ease of undertaking the task. They reported that when the schedule was placed on the patient’s bed, it became easier for them to remember to check on the patient.
The study concluded that nurses in the two care settings were successful in implementing IR into their daily practice. Nurses reported that IR proved effective in obtaining improved patient satisfaction and outcomes. The study made this conclusion following the fact that the units had permanently made the IR part of their task. Therefore, IR improves patient experiences by reducing emergency falls and call bell uses. However, patient outcomes regarding IR depend on the clinical setting.
Kirk, K., & Kane, R. (2016). A qualitative exploration of intentional nursing round models in the emergency department setting: investigating the barriers to their use and success. Journal of clinical nursing, 25(9-10), 1262-1272.
This study purposed to investigate the implementation and use of Intentional Rounding in the nursing practice with a focus on the Emergency Department setting. The study also sought to examine the potential benefits, challenges, and barriers to using IR in the ER, to understand the improvements that could be made regarding feasibility and delivery effectiveness. For the study, ethical approval was obtained from the University of Lincoln ethics committee, and the respondents were also asked to sign consent forms to ascertain their participation.
The study utilized the qualitative research design to learn about the benefits and challenges of using IR. A purposive sampling technique was used to select five nurses who were using IR in their emergency room practice. The study used semi-structured interviews, which were completed within a 30 minute period each for each nurse. Each nurse was interviewed face-to-face in quiet and peaceful settings as selected by individual participants. The interviews were digitally recorded. All recording was transcribed verbatim.
The results of the study identified four key areas that are affected by IR. These areas include improved patient experiences, adaptation to the ER, benefits on achieving quality indicators, and current unmanageability. All respondents expressed that they had observed a decrease in patient care and safety. They, however, believed that IR was better suited to achieve positive and improved patient outcomes. The respondents also felt that the current IR process was unmanageable because of the patient volume. They expressed that a large number of patients in the ER made it almost impossible to cater to every patient in every hour. The respondents also expressed that IR was needed more by older patients and those who were more vulnerable and required immense assistance. Younger patients would receive IR sparingly because they are more capable of taking care of themselves. Finally, patients felt that successful IR implementation would lead to success in meeting quality indicators.
The study, therefore, concluded that IR was needed in obtaining improved patient experiences and outcomes. However, the process needs o to be readjusted because it is difficult to see every patient on a per-hour basis due to patient volume. The priority of IR should be placed among the elderly and more vulnerable patients if IR was to be successful in meeting quality indicators.
Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2017). Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls. Journal of clinical nursing, 26(1-2), 115-124.
This study sought to evaluate the use of specific strategies in the delivery of nursing staff intentional rounding interventions to reduce in-patient falls. The study utilized qualitative research designs to gather accurate and in-depth opinions and observations. Ethical approval was obtained from the hospital management.
The researchers implemented customized Intentional Rounding and evaluated it as part of a nursing staff led quality improvement technique to reduce patient falls in the neuroscience patient ward. IR was instigated using a pre-specified implementation technique, which was made up of communication and engagement, training and teamwork, coaching and support, iterative plan-do-check-act cycle, compliance with hourly Rounding to patients, and the outcome which is incidences of falling. These factors were recorded before and after the intervention. Patient falls were compared with incidence falls across 50 wards in the same Trust.
Results from the recording showed that patient falls reduced by 50% on the wards where nurses conducted IR per-hourly basis as compared to the wards where IR was not conducted on an hourly basis. There was a slight increase of 3.47% in patent falls in the wards where routine IR was not conducted. Generally, IR rounding was found to produce effective and positive patient outcomes as it relates to patient falls in the wards.
The study concluded that programs that were focused on integrating teamwork, training, and staff-led IR were effective in improving patient experiences and outcomes.