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

Abstract

© 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.

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

“…Compassionate behaviors ( Straughair, 2019 ) are taught through pedagogy ( Hendry, 2019 ), learning objectives ( Lown, 2016 ; Sinclair et al, 2021 ; Wang et al, 2022 ) assessment ( Lown et al, 2016 ), and skills sets such as reflective listening ( Braillon and Taiebi, 2020 ; Su et al, 2021 ). Healthcare research has examined compassion from the perspective of: the predictors of compassion in healthcare professionals ( Fernando and Consedine, 2014 ; Bleiker et al, 2020 ; Pavlova et al, 2022 ); how care environment and organizational culture affect compassion ( Casagrande, 2016 ; Ali and Terry, 2017 ; Dev et al, 2019 ; Tehranineshat et al, 2019 ; Wiljer et al, 2019 ; Ali et al, 2022 ); compassion-maintaining strategies and interventions ( Blomberg et al, 2016 ; Terry et al, 2017 ; Flores and Brown, 2018 ; Baguley et al, 2020 ; Hopkins et al, 2021 ; Malenfant et al, 2022 ); compassionate leadership ( Dewar and Cook, 2014 ; de Zulueta, 2015 ; Lown et al, 2019 ; West et al, 2020 ); and regulation of compassionate caregiving ( Harris et al, 2019 ; Pedersen and Roelsgaard Obling, 2019 ). Culturally and critically informed perspectives of compassion highlight that different societies, professional groups, cultures, and generations hold different expectations and views about compassion ( Koopmann-Holm and Tsai, 2017 ; Sundus et al, 2020 ) which change over time ( Salvador Zaragozá et al, 2021 ).…”

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

“…Lastly, previous studies have reported frequent incorrect execution of the rounds, specifically with the final sentence “Is there anything else I can do for you? I’ll be back in …” [ 32 ]. If the healthcare professional does not return after the promised time, the patient may lose confidence in the healthcare professional and in the experimental intervention, thus triggering a sense of anxiety which leads to more frequent calls for assistance [ 31 ].…”

“…. " [32]. If the healthcare professional does not return after the promised time, the patient may lose confidence in the healthcare professional and in the experimental intervention, thus triggering a sense of anxiety which leads to more frequent calls for assistance [31].…”

Nurses' perceptions of hourly rounding in Jordanian hospitals: A national survey

“…Nursing staff in our study reported that completion of documentation is considered as an indication that hourly rounding is being completed, while nurses in another study thought that documentation of hourly rounding is a waste of time and irrelevant (Francis et al, 2019). Documentation of hourly rounding can be seen by nursing staff as a tick exercise that affects the fidelity of the intervention (Harris et al, 2019). Also, it is used to make sure that care has been delivered as known in the inherited attitude in nursing practice, ‘if it is not documented, it is not done’ (Sims et al, 2020).…”

“…According to nurses' perception in our study, hourly rounding effectively addressed patients' basic needs. (Harris et al, 2019) reported that nurses see hourly rounding as fundamental care and 'nothing new' and it is what nurses have always done with added documentation. This is important in the persuasion stage in identifying the early adopters or champions of the project to help facilitate the diffusion of the initiative to their peers (Fabry, 2015).…”