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'Intentional rounding does not work for all patients and nurses'

Not all patients and nurses benefit from the system on hospital wards known as intentional rounding in which nurses carry out one hourly rounds to improve care, according to research

Not all patients and nurses benefit from the system on hospital wards known as intentional rounding in which nurses carry out one hourly rounds to improve care, according to research.


Jackee Phillips (Junior Sister), on the MAU ward at Musgrove Park Hospital in Taunton,
Somerset carrying out ‘intentional rounding’. Picture: Apex

The 2013 Francis Inquiry into failings in care at the Mid Staffordshire NHS Foundation Trust recommended ‘regular interaction and engagement between nurses and patients’.

Regularity

It suggested this interaction should be systematised through regular ward rounds. There was strong government support for the idea and many NHS trusts in England adopted intentional rounding, which sees nurses asking patients regularly about their pain, position, personal needs and possessions.

King’s College London Florence Nightingale Faculty of Nursing and Midwifery professor of healthcare for older adults Ruth Harris and her colleagues have been studying intentional rounding.

Speaking at the RCN International Nursing Research Conference in Oxford, professor Harris said evidence showed that intentional rounding increased the frequency of communication between nurses and patients.

‘There is less evidence it improved communication,’ she said.

Professor Harris, whose study included a review of the available evidence, a national survey of acute trusts and in-depth case studies, pointed out frequency was not the same as quality of interaction.

One patient told her: ‘We don’t have conversations, we just answer questions.’

Uncomfortable

Professor Harris also said that some nurses felt ‘silly or uncomfortable’ asking patients the frequent questions and some patients refused to participate.

However, she said that the frequent, structured approach to delivering fundamental care was reassuring for some patients, generally those who needed more help, or were quieter.

The factors found that could influence intentional rounding were:

  • Nurse-patient relationships/communication.
  • Accountability.
  • Consistency and comprehensiveness.
  • Time.
  • Visibility/presence.
  • Staff communication.
  • Patient empowerment.
  • Anticipation.

Professor Harris said: ‘In the UK, we don’t know that much about how intentional rounding is being implemented.’

But she added that research from the United States had found benefits including a reduction in call bell use, falls and pressure sores and increased patient satisfaction, but there was little UK research.

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