A systematic review: barriers to hourly rounding

Toole, Nicole; Meluskey, Tamara; Hall, Norma

doi:10.1111/jonm.12332

Cited by 24 publications

(25 citation statements)

References 17 publications

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“…A list of potential 'backdrops' believed by authors to influence IR and a list of potential outcomes reported to arise from it were, however, identified and are highlighted in Appendices 1 and 2. The findings of this synthesis echo those of a systematic review of the barriers to effective implementation and sustainment of IR on medical and surgical wards, 62 as well as identifying additional barriers. In Table 3, the theories by which IR may work are made explicit, and CMO configurations that are to be tested and refined in later phases of the study are summarised.…”

Section: Box 3 the Cmo Configuration Associated With The Absence Of Tsupporting

confidence: 54%

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

Harris

Sims

Leamy

et al. 2019

Health Serv Deliv Res

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© Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0 © Queen’s Printer and Controller of HMSO 2019. This work was produced by Harris et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. 2013 2019 Crown copyright Queen’s Printer and Controller of HMSO Background The government response to the care failures at the Mid Staffordshire NHS Foundation Trust led to the policy imperative of ‘regular interaction and engagement between nurses and patients’ (Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013. © Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0) in the NHS. The pressure on nursing to act resulted in the introduction of the US model, known as ‘intentional rounding’, into nursing practice. This is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round. Objectives The study aims were to examine what it is about intentional rounding in hospital wards that works, for whom and in what circumstances. Design A multimethod study design was undertaken using realist evaluation methodology. The study was conducted in four phases: (1) theory development; (2) a national survey of all NHS acute trusts in England; (3) in-depth case studies of six wards, involving individual interviews, observations, retrieval of routinely collected ward outcome data and analysis of costs; and (4) synthesis of the study findings. Setting The study was conducted in acute NHS trusts in England. Participants A total of 108 acute NHS trusts participated in the survey. Seventeen senior managers, 33 front-line nurses, 28 non-nursing professionals, 34 patients and 28 carers participated in individual interviews. Thirty-nine members of nursing staff were shadowed during their delivery of intentional rounding and the direct care received by 28 patients was observed. Review methods A realist synthesis was undertaken to identify eight context–mechanism–outcome configurations, which were tested and refined using evidence collected in subsequent research phases. Results The national survey showed that 97% of NHS trusts had implemented intentional rounding in some way. Data synthesis from survey, observation and interview findings showed that only two of the original eight mechanisms were partially activated (consistency and comprehensiveness, and accountability). The evidence for two mechanisms was inconclusive (visibility of nurses and anticipation); there was minimal evidence for one mechanism (multidisciplinary teamwork and communication) and no evidence for the remaining three (allocated time to care, nurse–patient relationships and communication, and patient empowerment). A total of 240 intentional rounds were observed within 188 hours of care delivery observation. Although 86% of all intentional rounding interactions were observed to be documented, fidelity to the original intervention [i.e. the Studer Group protocol (Studer Group. Best Practices: Sacred Heart Hospital, Pensacola, Florida. Hourly Rounding Supplement. Gulf Breeze, FL: Studer Group; 2007)] was generally low. Limitations Intentional rounding was often difficult for researchers to observe, as it was rarely delivered as a discrete activity but instead undertaken alongside other nursing activities. Furthermore, a lack of findings about the influence of intentional rounding on patient outcomes in the safety thermometer data limits inferences on how mechanisms link to clinical outcomes for patients. Conclusions The evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care. Future work It is suggested that the insights and messages from this study inform a national conversation about whether or not intentional rounding is the optimum intervention to support the delivery of fundamental nursing care to patients, or if the time is right to shape alternative solutions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Box 3 the Cmo Configuration Associated With The Absence Of Tsupporting

confidence: 54%

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

Harris

Sims

Leamy

et al. 2019

Health Serv Deliv Res

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“…• However, a number of barriers to effective hourly rounding have been reported. A systematic review [7] reported that competing tasks and priorities, limited time, and the workload in medical-surgical units were considered to interfere with consistent hourly rounding. Further, staff thought that the documentation associated with rounding was irrelevant and a waste of time.…”

Section: Introductionmentioning

confidence: 99%

Nurses’ Experiences and Perceptions of Hourly Rounding: A Private Australian Catholic Hospital Single Case Study

Francis¹,

Kurtsev²,

Walter³

et al. 2019

Int Arch Nurs Health Care

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Aim: This research paper reports on nurses' experiences and perceptions of hourly rounding undertaken at private Catholic acute care regional hospital in Australia. Background: Evidence suggests that structured nursing rounds are associated with positive outcomes. However, a number of barriers to effective hourly rounding have been reported. Rounding practices were implemented in a medical/surgical ward at a regional hospital in Australia, in 2014, aiming to reduce the risk of patient falls and enhance the patient experience. Methods: A qualitative, exploratory descriptive single case study design was utilised. Fifteen (15) nurses participated in the study and data were generated using Hermeneutic phenomenological interview technique. Transcriptions of each interview were analysed using both content and thematic analysis approaches. Results: The experiences and perceptions of the nurse participants involved in the study were found to centre on the following themes and subthemes: 1. Support for rounding practice 2. Barriers to rounding practice a) High workload and time-pressure b) Documentation Conclusion: The implementation of rounding was perceived to be useful and overall supported by the participants. Relocating nursing documentation and reviewing the model of care were highlighted as recommendations to improve compliance and support ongoing sustainability of rounding.

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“…The implementation of intentional rounding (IR) in acute healthcare settings has recently gained prominence as an intervention to improve patients’ safety, outcomes and satisfaction (Fitzsimons, Bartley, & Cornwell, ; Flowers et al., ; Toole, Meluskey, & Hall, ). IR is defined as “regular checks of individual patients carried out by health professionals at set intervals to proactively enquire into care they may need” (Harrington et al., , p. 523).…”

Section: Introductionmentioning

confidence: 99%

Intentional rounding in acute adult healthcare settings: A systematic mixed‐method review

Christiansen

Coventry

Graham

et al. 2018

Journal of Clinical Nursing

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A systematic review: barriers to hourly rounding

Abstract: Leaders can utilise this information to analyse and create successful options to overcome these barriers before, during and after the implementation process. Further studies are needed to identify targeted strategies to alleviate these barriers.

Cited by 24 publications

References 17 publications

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

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

Nurses’ Experiences and Perceptions of Hourly Rounding: A Private Australian Catholic Hospital Single Case Study

Intentional rounding in acute adult healthcare settings: A systematic mixed‐method review

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