This research study set out to determine if hourly nurse rounding is an effective strategy for improving satisfaction and safety levels of hospitalized patients. A controlled clinical trial involving a group of 150 patients staying in a hospital ward was conducted to achieve the objectives of the study.
Understanding the significance of nursing care roles
Need to increase the engagement of nursing practitioners
A Look at epidemiological data
Data collection techniques
Findings of the study
Implications for nursing practice
Conclusion and way forward
References: a comprehensive list of 14 academic and scholarly material will be used for the study.
Nurse Rounds: Do Hourly Nurse Rounds Increase Patient Satisfaction and Safety?
The practice of hourly rounding is not uncommon in nursing care. It requires all nursing care providers to check in on hospitalized patients on an hourly basis and record the interaction or observation. This research paper set out to study the hypothesis that hourly nurse rounds increase satisfaction and safety levels among hospitalized patients sought to address the question: “Do Hourly Nurse Rounds Increase Patient Satisfaction and Safety?” The main purpose of the study was to initiate and pursue the process of clinical inquiry by studying the effectiveness of hourly nurse rounding as a measure of reducing falls. A controlled clinical trial involving a group of 150 patients staying in a hospital ward at the Arroyo Vista Health Center in Los Angeles, California. The experimental sample receives regular nursing rounds on a per hour basis for four weeks after which they were interviewed and asked to fill self-administered questionnaires together with the nursing staff. Based on the analysis of data collected from the study participants, it was revealed that patient satisfaction and safety levels increase when nurse engage in hourly rounding.
Understanding the significance of nursing care roles
Because nurses play an essential role in patients’ experience while under hospital care, patient satisfaction and safety with nursing care encompasses a substantial part of the overall satisfaction level and the quality of service offered. According to Virginia Ulanimo and Narda Ligotti (2011, p.1) “Routine purposeful rounding is when a nurse goes to a patient’s room every one to two hours to assess and meet the patient’s needs”. Indeed, several researchers have indicated that overall satisfaction with the quality of nursing care is the most important factor of consideration in measuring patient satisfaction with the complete set of services provided (Negarandeh, Bahabadi, & Mamaghani, 2014). In the nursing profession, hourly rounding refers to a well-coordinated, proactive evidence-based intervention driven by nurses to anticipate and meet the needs of hospitalized or admitted patients (Fritts, 2013).
Marie Hutchings (2012, p.13) says, “The main focus of caring around the clock is to make the interactions between the patients and stuff meaningful.” The main challenge for many nurse managers is how they can implement the hourly rounds system or program to enhance patient outcomes while integrating it into the already overstretched capacity of today’s nursing staff. Several studies have revealed that hourly rounding increases patient satisfaction and safety (Saleh, B., Nusair, Zubadi, Shloul, & Saleh, S., 2011). Some researchers also reveal an overall increase in staff satisfaction and productivity, possibly because nursing care staff feel they enjoy greater control over their patients. In spite of these benefits, hourly rounding is a system yet to be implemented consistently and effectively (Gottier, 2013). An essential aspect of ensuring the effective implementation of hourly rounding is to make sure that nurse staff are actively engaged to see the value in its adoption.
Need to increase the engagement of nursing practitioners.
Different ways to improve the participation and commitment of nursing staff in hourly rounding programs have been suggested. One way to increase engagement is to involve them from the planning to the implementation phases of the programs so they can understand its benefits and provide the assistance required to develop a feasible plan (Hutchings, 2012). Recording and posting data reflecting positive patient outcomes such as increased patient satisfaction rates and reduced falls and pressure ulcers to allow nurses see the impact they are making in their patients’ stay at the hospital will make hourly rounding effective (Melnyk & Fineout-Overholt, 2011). What is more, the nursing staff will eventually see greater benefits as more time is committed to patient care (Massachusetts General Hospital, 2011). As staff continue to play more significant role in the hourly rounding program, it will indeed turn into a success for both patients and the staff.
Routine hourly rounding and increased caregiving duration at the bedside are important aspects of the nursing profession, both of which can be traced back to the ‘mother’ of modern nursing care, Florence Nightingale (Ulamino, 2011). Nursing hourly rounds enable nurses to spend more time with patients, listen and respond to their worries and work on improving the unsatisfying conditions (Saleh et al., 2011). A patient’s acuity of the quality of nursing attention given largely relies on the nurse’s ability to address the patient’s needs. In-hospital patients usually need help with some basic tasks, such as eating and using the toilet, and often communicate their needs by making use of the call light (Saleh, B., Nusair, Zubadi, Shloul, & Saleh, S., 2011).
A look at epidemiological data.
Studies have indicated that hourly rounding reduces call light usage and noise levels in the hospital facilities, increases patient satisfaction, and lessens cases of falls (Cairns, Wolff, Rack, & Dudjak, 2010). It is estimated that about 30 to 48% of these falls lead to injury; 5 to 10% of them cause serious injury (Kalman, 2015). Hospital falls affect all patients indiscriminately regardless of age and many of them arise when the patient is alone and needs some assistance to do a self-care task (Gulanick & Myers, 2007). Falls that cause injury may culminate in prolonged hospitalization and increased treatment bills. Research shows that patients who fall and suffer serious injury end up incurring huge hospital bills by more than $4,200 as compared to those who do not fall; however, hourly nursing rounds have been reported to reduce fall accidents by approximately 52% (Kalman, 2015).
Research aimed at measuring patient satisfaction and safety by measuring views on nursing care quality has included both the ‘humanistic’ qualities and the more ‘concrete’ behavior (Paul, 2013). Many studies have assessed patient viewpoints of nursing care and found that things such as kindness, humor, reassurance, and gentle handling are extremely important to make the patient happy (National Association for Healthcare Quality, 2014). Therefore, nurses should possess the ability to expect the patient’s needs. These essentials of care largely influence whether a patient will be happy with a care given to them. In an age where positive healthcare policies are being developed, the importance of patient satisfaction and safety is gaining more ground each day (Melnyk & Fineout-Overholt, 2011).
So, how can nurses and their associates ensure that patients remain satisfied and safe continuously? One way is through the implementation of routine hourly rounding, which is deeply-rooted in the nursing profession’s history (Nelson, 2006). This strategy has become more important than ever to increase patient satisfaction and safety scores and minimize such things as patients falling from their hospital beds (Ulanimo, 2011). Routine hourly rounding takes place when a nurse or nursing assistant walks to a patient’s room after every one to two hours to check on the condition of the patient and address their needs; hence, emphasize the importance of nursing presence and good communication.
The study design comprised a controlled clinical trial in which a group of 150 patients staying in a hospital participated. The experimental sample received regular nursing rounds within an interval of every one to two hours for four weeks. The primary task of conducting hourly rounds was performed by nurses and registered clinical support personnel, even though all trained support staff was expected to help out when necessary.
Clinical associates did hourly rounding on all patients between 0700 hours and 2100 hours. During the night, rounding was limited to every two hours to allow patients enjoy sufficient sleep. Patients were not disturbed when sleeping between the hours of 2100-0700 hours, but rounding was carried out if patients woke up. Nurses and the clinician associates were coached on the hourly rounding program using the trainer-trainee model. The training was conducted two weeks before the beginning of the hourly nurse rounding program and lasted for three days.
Data collection techniques.
The self-administered questionnaires were filled by the sample group using pen and paper and submitted to the hospitals survey box. For the purpose of ensuring patient satisfaction and safety, the following questions were asked to rate nurse rounding services on the basis of friendliness, quickness to respond to calls, level of skills, attitude towards requests, attention to needs, pain alleviation, timely administration of medication, and overall efficiency. Nursing staff and associates, on the other hand, took part in weekly interviews to talk about how they coped up with the increased workload and what they needed to stay motivated.
The data collected was analyzed using descriptive statistics to determine the percentage scores that patients gave to the nurses when asked about specific variables of interest.
Findings of the study.
Based on the data collected, it was found that 60% of the participants in the experimental sample were male while the remaining 40% were female. Of the total participants, 54% were aged 21-30 years and the remaining 46% were above the age of 30. In general, more than three-quarters of the patients gave the nurses a score of more than 80% when it came to level of skills, attention to needs, pain alleviation, timely administration of medication, and overall efficiency. However, they reported that more effort needs to be put in improving friendliness, quickness to respond to calls, and attitude towards requests where more than a half of the patients gave them a score of below 50%. On the other side, nurses engaged in the hourly rounds said that they had greater workloads during the four weeks, but indicated that with better education and training and regular staff meeting to discuss emerging challenges, they would be better-equipped for the program.
Implications for nursing practice.
Implementing the hourly nurse rounds had a positive effect on the satisfaction and safety of the participating patients. Hence, the program has the potential to improve patient-nurse relationships and boost the quality of nursing care provided to patients. Regular well-coordinated rounding by both nursing staff and their associates can be instrumental in making sure that hospitalized patients stay safer and more satisfied. As a result, it should be considered as part of the greater interventions that enhance patient safety and comfort. Patients’ hospital encounters depend largely on the nursing presence and availability; purposeful hourly rounding reassures patients that their nurse or nursing associates will routinely check on them to provide for their every need. According to Cairns et al., (2010) “One way to improve engagement is to include the staff in the planning and implementation programs so they can learn about its benefit and help develop a workable plan.” Since this lowers anxiety and boosts confidence in nurses, patient satisfaction scores in hospital facilities are likely to increase.
Conclusion and Way Forward.
Curbing the barriers to regular purposeful hourly rounding requires the support of the management team. For instance, management may consider allowing nursing staff to apply their well-thought-out convictions when communicating with some patients. Nursing staff values, view of the work setting, and workload are a few indicators that can be used to measure just how well introducing new quality improvements can be successful. Such improvements may also require the full backing of management. Promoting the participation of nursing staff in new initiatives, including routine hourly rounding, can help nursing caregivers to prosper in this age of greater transparency. Sadly, however, routine hourly rounding cannot constantly be implemented because of such things as the inadequacy of health care resources or the overwhelming number of hospitalized patients.
Since hourly rounding is one of numerous quality improvement strategies that can be employed today, it can be combined with other mechanisms such as in-service education seminars to help boost patient satisfaction and safety levels. It is essential that nurse leaders to have a common desire for high-quality, timely, and patient-centered nursing care. Nurse managers and front-line nurses should be encouraged to conform to a credible management style and make sure their objectives are streamlined with front-line nursing staff and their associates. If not, any effort to improve nursing service delivery systems will remain in vain; be it through a purposeful hourly rounding or any other quality improvements.
Cairns, L. L., Wolff, K. K., Rack, L. L., & Dudjak, L. A. (2010). From our readersHourly rounding benefits patients and staff. American Nurse Today, 5(12). Retrieved from http://www.americannursetoday.com/from-our-readershourly-rounding-benefits-patients-and-staff/
Fritts, M. (2013). Fall prevention in skilled nursing facilities. Phoenix, AZ: Grand Canyon University.
Gottier, B. (2013). Scripted hourly rounding to improve patient satisfaction and fall rates. Phoenix, AZ: Grand Canyon University.
Gulanick, M., & Myers, J. L. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis, MO: Mosby.
Hutchings, M. (2012). Caring around the clock: Rounding in practice. Nursing Times,108(49), 12-14. Retrieved from http://www.nursingtimes.net/Journals/2012/11/29/o/c/e/121204-rounding-in-practice.pdf
Kalman, M. (2015, June 4). Effects of nursing rounds on patients fall rates. Retrieved from https://clinicaltrials.gov/ct2/show/NCT00632944
Massachusetts General Hospital. (2011). Hourly safety rounds tool kit. Retrieved from http://www.mghpcs.org/eed_portal/Documents/SafetyRounds_Toolkit.pdf
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
National Association for Healthcare Quality. (2014, July 31). Study assesses impact of hourly nursing rounds on patient safety and satisfaction. Retrieved from Study Assesses Impact of Hourly Nursing Rounds on Patient Safety and Satisfaction
Negarandeh, R., Bahabadi, A. H., & Mamaghani, J. A. (2014). Impact of regular nursing rounds on patient satisfaction with nursing care. Asian Nursing Research, 8(4), 282-85. Retrieved from http://www.asian-nursingresearch.com/article/S1976-1317(14)00069-3/pdf
Nelson, A. (2006). Safe patient handling and movement: A guide for nurses and other health care providers. New York, NY: Springer Pub. Co.
Paul, B. (2013). Significance of hourly rounds in reducing fall of elderly patients. Phoenix, AZ: Grand Canyon University.
Saleh, B. S., Nusair, H., Zubadi, N. A., Shloul, S. A., & Saleh, U. (2011). The Nursing rounds system: Effect of patient’s call light use, bed sores, fall and satisfaction level. International Journal of Nursing Practice, 17, 299-303. doi:10.1111/j.1440-172X.2011.01938.x
Ulanimo, V. M. (2011). Patient satisfaction and patient safety: Outcomes of purposeful rounding. VA National Center for Patient Safety, 11(4), 1&4. Retrieved from http://www.patientsafety.va.gov/docs/TIPS/TIPS_JulAug11.pdf