CPD
CONTINUING
PROFESSIONAL
DEVELOPMENT
Effects of rounding on patient care
NS798 Langley S (2015) Effects of rounding on patient care. Nursing Standard. 29, 42, 51-59.
Date of submission: January 29 2015; date of acceptance: March 26 2015.
Abstract
Rounding is practised widely in the NHS and nurses should understand
its practice and value to patient care. Intentional rounds in the United
States have been associated with a reduction in patient harm and
increased patient and staff satisfaction. This article identifies the aims of
rounding as a nursing intervention and details how rounding is performed.
It examines the underlying principles that promote the delivery of
safe and compassionate care. Rounding has the potential to improve
nursing practice and the patients’ experience of care. However, there are
concerns that rounding does not have a justifiable evidence base. This
article highlights inconsistences in the evidence base, challenging the
assumptions about the benefits of rounding to patient care and offering
an alternative perspective on the perceived benefits of rounding practice.
Further research is required to identify the benefits of rounding practice
to patient care and to demonstrate conclusively whether achieving the
aims and principles of rounding will improve patient care.
Author
Sue Langley Divisional head of nursing, Specialist Medical Services, Central
Manchester University Hospitals NHS Foundation Trust, Manchester, and
professional doctorate student, University of Salford, Salford, England.
Correspondence to: [email protected]
Keywords
Compassionate care, falls, patient call bell use, patient safety, patient
satisfaction, pressure ulcers, rounding, staff satisfaction
Review
All articles are subject to external double-blind peer review and checked
for plagiarism using automated software.
Revalidation
Prepare for revalidation: read this CPD article, answer the questionnaire
and write a reflective account.
Online
For related articles visit the archive and search using the keywords above.
To write a CPD article: please email [email protected]
Guidelines on writing for publication are available at:
journals.rcni.com/r/author-guidelines
NURSING STANDARD
Aims and intended learning outcomes
This article reviews current practice in nurse
rounding. It presents the evidence for the
purpose of rounding, the process of rounding
and NHS practice. It discusses the evidence
for the effects of rounding and identifies the
supporting principles that make rounding a
worthwhile intervention in nursing care. After
reading this article and completing the time out
activities you should be able to:
Explain the terminology associated with the
practice of rounding.
Understand how rounding is performed and
how it can affect patient care.
Discuss with colleagues the potential patient
benefit outcome measures of rounding and
explore possible difficulties in their
measurement.
Assess and review rounding practice in your
work and area of practice.
List the principles that underlie rounding,
and demonstrate their importance in
effective, compassionate care.
Introduction
The concept of nurses doing rounds is not
new. Rounding in hospitals is a process for
checking on patients regularly. Rounding
was highlighted in the UK in January 2012
when the prime minister called for the
introduction of hourly nursing rounds in NHS
hospitals (Department of Health (DH) 2012a,
Kendall-Raynor 2012). The importance of
rounding in the UK was further promoted by
the publication of Independent Inquiry into
Care Provided by Mid Staffordshire NHS
Foundation Trust January 2005 to March
2009 (Francis 2013) and Safe Staffing for
Nursing in Adult Inpatient Wards in Acute
Hospitals (National Institute for Health and
Care Excellence (NICE) 2014).
Nurse rounding in the United States (US)
is a structured, intentional process in which
the nurse checks the patient’s pain, personal
june 17 :: vol 29 no 42 :: 2015 51
CPD patient care
Join our First Friday
Twitter discussion
on issues raised in
this article.
Friday July 3
from 12.30-1.30
using #NurseJC
1 Outline the main
points you would
make when discussing
rounding practice with a
nursing student. Include
the aims and outcomes
of the process,
and indicate how the
practice of rounding
should be conducted.
2 Reflect on rounding
practice in your care
setting and consider
the following:
 How often is
rounding performed?
 Who performs
rounding?
 Does rounding
reduce call bell use
or prevent falls and
pressure ulcers?
needs (toilet requirements), position (comfort)
and possessions (drinks and glasses, plus
whether the call bell, or call light, is within
reach) (Meade et al 2006). Three studies
that have influenced the development of
systematic nursing rounds were cited by Meade
et al (2006): Sheedy (1989) examined a hostess
role responding to patient needs, Castledine
(2002) considered patient comfort rounds in
the UK, and Sterman et al (2003) examined
interdisciplinary rounds. The concept of
intentional rounding emerged from questioning
the effectiveness of reactive responses by staff
to patients’ call bells, and considering the
structured proactive process of rounding.
Meade et al (2006) concluded that structured
interventions through interdisciplinary rounds
by pain teams, medical teams, intensivists
and physiotherapists had a positive effect on
patient care through pressure ulcer reduction,
effective pain management and increased
patient satisfaction. The process of rounding as
a timed, planned intervention by nursing staff
to address specific elements of nursing care for
patients was seen proactively to seek to identify
and meet patients’ fundamental care needs and
psychological safety (Meade et al 2006).
Intentional rounds in the US have been
associated with increased patient and staff
satisfaction and a reduction in patient harm
(Meade et al 2006, Studer Group 2007, Halm
2009, Ford 2010). However, rounding in the UK
is conceived as routine and task-oriented nursing,
which may impede its acceptability as part of
modern professional nursing practice (Hunt
2012). There are concerns that the evidence base
may not justify the practice of rounding (Snelling
2013). Nursing may be at risk of introducing
an unproven and poorly defined concept into
widespread practice, which could lead to poor
implementation and the loss of real patient
benefits.
Complete time out activity 1
Purpose of rounding
The primary aim of rounding is to promote
a timely response to patient need that has a
positive effect on patient safety and satisfaction.
This is mirrored by staff satisfaction in their
ability to meet the desired patient outcomes.
In theory, rounding reduces call bell use since
patients’ needs are met proactively. This
produces benefits for nursing staff because the
time taken to deal with the interruptions of call
lights decreases (Meade et al 2006). Therefore
nurses can use their time more effectively,
52 june 17 :: vol 29 no 42 :: 2015
increasing staff satisfaction as well as patient
satisfaction (Studer Group 2007).
Several terms are used to describe the
regular checking of patients, which may lead
potentially to confusion about the practice
and purpose of rounding. However, the term
‘rounding’ appears to be used consistently, even
where preceded or followed by other terms.
Commonly used terms and their descriptions
are presented in Box 1 to clarify these
definitions and the practice of rounding.
Complete time out activity 2
Rounding process
The concept of rounding appears simple:
a ward round is undertaken by staff, once
an hour or once every two hours, to check
on patients’ wellbeing by asking a series of
simple questions. Rounding can be seen as
another way of organising patient care, by
addressing patient’s needs regularly in a
proactive anticipatory approach to patient care.
Rounding is a defined process of care delivery,
including checklists and protocols for nurses to
follow, as well as guidance and documentation
as to who performs rounds and how often. The
recommended frequency of rounding varies,
and it is most often performed either hourly
or two hourly (Meade et al 2006, Halm 2009,
Saleh et al 2011, Sherrod et al 2012). Studies
differ in terms of who carries out the rounding
process. It may be carried out by a nurse or
by a healthcare support worker or by both
on different occasions (Murphy et al 2008,
Mower-Wade and Pirrung 2010).
Checklists and scripted protocols
A checklist or scripted protocol is used as a
prompt by nursing staff during rounding to
ascertain if the patient needs assistance at
that time. One such protocol or checklist is
known as the 4 Ps, since it focuses on pain
management, personal needs, possessions and
position (Halm 2009). Meade et al (2006)
produces a structured intentional, proactive
approach to rounding and provides a focused
tool, the Meade protocol for rounding by
nursing staff, which covers 12 points to identify
and meet patients’ needs (Box 2).
There is debate about inclusion of a fifth
‘P’ to represent presence or patient focus
(Rondinelli et al 2012, Sherrod et al 2012). The
fifth ‘P’ intends to ensure the physical presence
of nursing staff – and patient interaction with
them – at timed intervals to promote regular
patient communication. There is an emphasis in
NURSING STANDARD
the US literature on presence or visibility in the
patient’s room, since patients are predominantly
cared for in single rooms in many healthcare
facilities. Presence and visibility of nurses is
also a concern within UK health care, given
the move towards more single rooms in NHS
hospitals (Crossfield and Pitt 2012).
The Kessler et al (2012) rounding protocol
incorporates a similar scripted response to the
Meade et al (2006) protocol on leaving the
patient’s room: ‘Is there anything else I can do
for you before I leave? I have the time. We’ll be
back in an hour to check on you.’
The Studer Group (2007) includes the 4 Ps
within a process, starting with an introduction
where the nurse greets the patient and explains
the rounding process. After checking the 4 Ps,
the nurse asks the patient if there is anything
further required, before letting the patient
know that someone will return either in an
hour or in two hours overnight.
Rondinelli et al (2012) propose the use of
a further protocol and acronym ABCDE,
for activity, bathroom, comfort, dietary and
environment. This takes a wider perspective of
care than the 4 Ps, since it addresses patients’
possible dietary and mobility needs.
Documentation
The rounding process is documented usually in
a standard format. This has been controversial,
with staff reporting dissatisfaction with
burdensome documentation (Deitrick
et al 2012, Neville et al 2012). Moreover, the use
of checklist documentation has been criticised
for its potential to become an unthinking
ritual process, which detracts from delivering
individualised care (Halm 2009, Snelling 2013).
Rounding in the NHS
Following Castledine’s (2002) work detailing
patient comfort rounds, rounding in NHS
nursing practice was promoted through the
High Impact Action work of England’s chief
nurse and the NHS Institute for Innovation
and Improvement (2009). The document
Staying Safe – Preventing Falls outlines a
process similar to US practice at an NHS
hospital (NHS Institute for Innovation and
Improvement 2009). Ipswich Hospital devised a
checklist of hourly actions to prevent falls after
examining local evidence from incident reports,
and reported a reduction in falls following
the implementation of falls rounding (NHS
Institute for Innovation and Improvement
2009). In Wales, rounding was introduced via
NURSING STANDARD
the 1000 Lives Campaign, which is continuing
as 1000 Lives Plus (www.1000livesplus.wales.
nhs.uk/home), as part of an initiative called
Transforming Care (tinyurl.com/l4wngom).
The NHS has raised the profile of rounding
within its policy since 2009, linking rounding to
the government’s commitment to quality (DH
2012b) and the work of the Nursing and Care
Quality Forum (DH 2012c). However, there
have been few rigorous research studies on the
process of rounding. Several NHS organisations
have published anecdotal information about
BOX 1
Terminology in rounding
Nurse rounds, intentional rounds and proactive patient rounds:
The term ‘intentional rounding’ was transferred from its application in nursing
practice in the US to NHS practice, following the work of Meade et al (2006).
Intentional rounding may be defined as a purposeful and proactive response
to meeting patients’ needs, rather than a random and reactive response.
Meade et al (2006) used the term ‘nurse rounds’; however, the term ‘intentional
rounding’ is more prominent in the literature that followed. Meade et al (2006)
proposed demonstrable outcome measures, and these were reproduced in
studies using the term ‘intentional rounding’ (Murphy et al 2008, Gardner et al
2009, Ford 2010). The Studer Group (2007) and Tea et al (2008) emphasised
the proactive attribute of rounding using the term ‘proactive patient rounds’.
Falls rounding and comfort rounds:
Meade et al (2006) indicated an association with rounding and reduced rates
of falls, which prompted the introduction of the term ‘falls rounding’. Miller
and Limbaugh (2008), Quigley et al (2009) and Waszynski (2012) focused
on the link between rounding and falls reduction. ‘Comfort rounds’ were
articulated by Castledine (2002) and Castledine et al (2005) and are based
on ‘task rounds’ to deliver nursing care.
I Care Rounding and Caring around the Clock:
Several authors used specific terms developed to reflect an in-house or
organisational approach to rounding. Tea et al (2008) developed the ‘I Care
Rounding’ model to improve staff responsiveness. Nottingham University
Hospital Trust used the term ‘Caring around the Clock’ in developing its
rounding practice (Hutchings 2012).
Nursing rounds interventions and structured nursing rounds interventions:
Saleh et al (2011) and Tucker et al (2012) emphasised the nurse-led aspect
of rounding using similar terminology in their articles: ‘nursing rounds
interventions’ and ‘structured nursing rounds interventions’.
Hourly rounds and two-hourly rounds:
The simple prefix of a time descriptor, such as hourly rounding, is prevalent
within the literature (Bourgault et al 2008, Culley 2008, Murphy et al 2008,
Orr et al 2008, Halm 2009, D’Alessio et al 2010, Deitrick et al 2012). The term
hourly rounding may be misleading, since rounding may also be performed
every two hours (Moran et al 2011).
Patient rounds or patient rounding:
The term ‘patient rounding’ promotes the patient focus of the process. It is
used more frequently in recent literature (Lucas et al 2010, Kessler et al 2012,
Neville et al 2012).
Rounding or rounds:
Some authors use ‘rounding’ or ‘round’ for the process, since these words are
able to stand alone to give meaning to the action undertaken (Woodward
2009, Mower-Wade and Pirrung 2010).
june 17 :: vol 29 no 42 :: 2015 53
CPD patient care
the benefits of rounding (Table 1). According
to Bartley (2011), 50 hospitals in England
have implemented rounding. However, it is
acknowledged that there are no robust published
data to suggest rounding has improved nursing
care in the NHS (Bartley 2011, Mason 2012,
Snelling 2013). The lack of consistent evidence
may be contributing to a diverse and variable
approach to rounding practice, with the
potential to lead to poor or fragmented rounding
practice. This may lead to the loss of potential
patient benefits and/or failure to improve
standards of nursing care (Table 1).
Complete time out activity 3
Evidence base for rounding
3 Identify from the
literature and make a
list of the advantages
and disadvantages
of rounding practice.
Consider how rounding
contributes to patient
care.
The outcome measures used to evaluate rounding
in the literature are drawn mainly from a narrow
range of criteria measured through quantitative
studies. Many studies replicate the work of
Meade et al (2006) who define the following
outcome measures:
Improved patient satisfaction.
Reduced use of patient call bells.
Improved patient safety through reduced
rate of falls.
Improved patient safety through reduced
rates of pressure ulcers.
Improved staff satisfaction.
It is difficult to provide evidence of the explicit
links between rounding and positive patient
and staff benefits. This is a cause for concern
given the implementation of the process of
rounding based on such claims.
BOX 2
Protocol for rounding
 Assess and manage pain so that the patient does not need to use the
call bell for pain medication.
 Check if the patient requires any other medication.
 Offer toileting assistance.
 Assess the patient’s position and position comfort, and ask if he or she
requires repositioning and is comfortable.
 Make sure the call bell is within the patient’s reach.
 Position the telephone within the patient’s reach.
 Position the television remote control and bed light switch within the
patient’s reach.
 Position the bedside table next to the bed.
 Position tissues and water within the patient’s reach.
 Position the waste paper bag next to the bed.
 Ask the patient: ‘Is there anything I can do for you before I leave? I have
time while I am in the room.’
 Tell the patient that a member of the nursing staff will be back in an hour
or two hours to round again.
(Adapted from Meade et al 2006)
54 june 17 :: vol 29 no 42 :: 2015
Improved patient satisfaction
One of the concerns with the quality of the
evidence for rounding is that different measures
are used to assess the effect on outcomes in
different studies. This lack of consistency
between studies limits the reliability of findings
related to specific outcomes. This is evident
in regard to measuring improved patient
satisfaction, where a high proportion of studies
measure patient satisfaction as an outcome
to evaluate the effectiveness of rounding
as a nursing intervention (Berg et al 2011,
Blakley et al 2011, Kessler et al 2012, Sherrod
et al 2012). There is inconsistency in which
survey tool is used to collect patient satisfaction
data within the US literature. Studies differ
in the questionnaires used, the timeframes
and follow-up periods and the dimensions of
patient satisfaction. Five different national
surveys were used, with some studies devising
their own surveys. This makes the comparison
or meta-analysis of patient satisfaction outcome
data difficult and weakens the evidence base for
rounding as an intervention.
Reduced use of patient call bells
The use of patient calls bells is measured in
two ways. Some studies used feedback from
patient satisfaction surveys that asked patients
about the promptness of nurses responding to
call bells (Sobaski et al 2008, Berg et al 2011,
Sherrod et al 2012). Other studies measured
the time taken to answer call bells and
provided a data analysis (Meade et al 2006,
Studer Group 2007, Woodward 2009, Ford
2010, Berg et al 2011, Saleh et al 2011). All
studies show a statistically significant decrease
in the number of times call bells were used
following implementation of the rounding
intervention.
Meade et al (2006), Ford (2010) and
Saleh et al (2011) provide further analysis
on the rationale for call bell use, the premise
being that care needs met by the practice of
rounding would mean that patients would not
subsequently need to use their call bells for
those specific interventions.
Improved patient safety through reduced
rates of falls
Several studies measure a reduction in patient
falls as an outcome of rounding (Meade et al
2006, Studer Group 2007, Murphy et al 2008,
Woodward 2009, Ford 2010, Saleh et al
2011, Tucker et al 2012, Krepper et al 2014).
Halm (2009) proposed that a reduction in falls
would be achieved by proactively addressing the
NURSING STANDARD
TABLE 1
Approaches to rounding and reported outcomes
Hospital
Published NHS information
Reported outcomes
Aintree University
Hospital
 Two-hourly rounding on 30 wards.
 Acute provider. Nursing and Care Quality Forum demonstrator site.
(Gillen 2012)
 Reduced frequency of call bells.
Queen Elizabeth
Hospital
Birmingham
 Hourly care rounds.
 Rolled out across all wards in 2011, using Department of Health
(DH) Rapid Spread methodology.
(Crossfield and Pitt 2012, Mason 2012)
 Reduction in falls.
 Improved patient feedback.
Croydon University  Hourly rounding implemented summer 2010.
Hospital
(Duffin 2010)
 None reported.
Homerton
 Four-hourly comfort rounds.
University Hospital  Piloted on one ward for two weeks in 2010.
 Rolled out across the hospital.
(Nursing Standard 2010)
 Reduction in falls.
Leeds Teaching
Hospital
 Compliance with rounding
documentation.
 Difficulty in comparing data.
 Hourly rounding in a high dependency unit.
(Lowe and Hodgson 2012)
University Hospital  Two-hourly rounds.
Lewisham
 All adult inpatient wards in 2011.
(Burke 2011)
 Positive feedback from patients and
relatives.
Musgrove Park
Hospital
 Reduced use of call bells.
 Improved detection of pressure ulcers.
 Reduction in falls.
 Reduced complaints.
 Two-hourly intentional rounds.
 Piloted in 2010 on the acute medical unit.
 Implemented on one third of hospital wards in 2012 using
improvement methodology.
(Dix et al 2012, Mason 2012, Braide 2013)
Wansbeck General  Hourly intentional rounds.
Hospital
 Trialled on a number of wards.
(Fitzsimmons et al 2011)
 Reduced use of call bells.
 Improvements in patient experience
data.
Nottingham
Caring around the Clock
University Hospital  Three types of round:
1. Patient rounding.
2. Leadership rounding.
3. Senior leadership rounding.
 Piloted on ten wards in 2011 and rolled out to 79 wards in 2012.
(Hutchings 2012)
 Reduced use of call bells.
 Reduction in falls but concurrent falls
prevention campaign.
 Positive patient feedback.
Salford Royal
Hospital
 Reduction in falls and pressures ulcers
 Intentional rounds.
but one of several interventions noted.
 Piloted April 2011, with organisational policy November 2011.
 Acute provider. Nursing and Care Quality Forum buddy site.
(DH 2012a, 2012b, Gillen 2012, Kendall-Raynor 2012, West 2012)
University
 Intentional rounds introduced across the trust in March 2012.
Hospitals Coventry  Focus on skin assessment and preventing pressure ulcers.
and Warwickshire
(McDonagh 2013)
NHS Trust
 Reduced incidence of pressure ulcers but
several interventions noted.
Whipps Cross
 Two-hourly proactive patient rounds introduced October 2009.
University Hospital
(Duffin 2010)
 Reduction in falls but rounding was one of
several interventions.
 Patient survey showed patients more
satisfied.
Wrightington,
Wigan and Leigh
NHS Foundation
Trust
 Improved scores on National Inpatient
Survey.
 Intentional rounds introduced on all wards since May 2012.
 Initial resistance from nursing staff.
 Acute provider. Nursing and Care Quality Forum buddy site.
(Gillen 2012)
NURSING STANDARD
june 17 :: vol 29 no 42 :: 2015 55
CPD patient care
4 Ps – notably proximity of patients’ personal
items and personal needs – on either an hourly
or two-hourly basis. Halm (2009) supported
and strengthened the link made by Meade
et al (2006) between the implementation of
rounding and falls reduction. In seven out of nine
studies in which falls were evaluated, rates of falls
were reduced (Halm 2009), contributing to the
prevalent view that rounding reduces falls rates
and is an effective patient safety intervention.
However, the studies reviewed used different
methods of defining and recording rates of falls
before and after the introduction of rounding.
Therefore, there is little statistically proven
evidence in the articles cited that rounding
reduced falls rates.
Improved patient safety through reduced
rates of pressure ulcers
4 Analyse the
principles of rounding to
identify how rounding
can assist in the delivery
of compassionate care
for patients.
5 Ask patients and
team members in your
clinical area for their
views on rounding
practice. Reflect on this
and use this feedback to
improve your rounding
practice.
The evidence that rounding reduces the
incidence of hospital acquired pressure ulcers
is also open to challenge. The link between
rounding and reduced pressure ulcer prevalence
is made by Meade et al (2006), but few studies
have conclusively demonstrated a causal
connection.
Potentially, positioning could reduce the harm
caused by hospital acquired pressure ulcers and
contribute to safer patient care. The literature
is consistent in its description of positioning
as part of the rounding process, assisting the
patient to turn or change position to relieve
pressure points through weight redistribution.
Patients are checked for skin breakdown and
comfort (Woodward 2009, Ford 2010, Sherrod
et al 2012). Ford (2010) promoted plumping
pillows and straightening linen as part of the
rounding process related to position.
Of the 11 studies reviewed by Halm
(2009), a reduction in the development of
pressure ulcers was demonstrated in one only;
Meade et al (2006) cited a 14% reduction
in developing pressure ulcers as a result of
implementing rounding. However, there are
no definitive results related to pressure ulcers
within the article or mention of pressure ulcers
in the study design.
Most studies in the literature do not examine
the link between rounding and pressure
ulcer reduction, and/or evaluate pressure
ulcer reduction as an outcome of rounding,
despite describing the use of positioning as
an action of rounding (Bourgault et al 2008,
Culley 2008, Sobaski et al 2008, Gardner
et al 2009, D’Alessio et al 2010, Berg et al 2011,
Blakley et al 2011, Kessler et al 2012, Neville
et al 2012).
56 june 17 :: vol 29 no 42 :: 2015
Improved staff satisfaction
The link between rounding and improved staff
satisfaction has been reported, but few studies
have applied rigorous methodology to measure
this outcome. Meade et al (2006) presented
anecdotal data verbally reported by staff from
the experimental units in the study. The authors
claim that because of the implementation of
rounding they had additional time to care for
their patients and as a result the wards were
quieter due to the reduced number of call lights
nurses had to answer. Nurses were deemed
able to be more attentive and to respond
more quickly when patients used call lights.
The Studer Group (2007) presented similar
anecdotal evidence of higher staff satisfaction
following the implementation of rounding,
suggesting that staff are highly satisfied with
the system of rounding because it leads to fewer
interruptions and more time for activities such
as patient education and documentation of care.
Culley (2008) promoted the benefits of rounding
for staff, asserting that staff can regain control of
their workload by reducing ‘busy work’.
Rounding can have a positive effect on
staff satisfaction as a result of enhanced
teamwork and communication, but there
are no direct measurements that reflect these
assertions (Bourgault et al 2008, Gardner
et al 2009). Blakley et al (2011) reported
that the implementation of nurse rounding
contributed to both a decrease in call light use
and an environment that was easier to manage
and more rewarding for staff. However,
Deitrick et al (2012), Neville et al (2012) and
Rondinelli et al (2012) challenged the link
between rounding and increased staff satisfaction,
suggesting there are numerous complexities
and barriers to proving that such a link exists.
Theoretical basis and principles of
rounding
The principles underlying the practice of
rounding are not easily identified in the
literature. However, it is possible to understand
why the practice of rounding may improve
the patient experience by studying these
principles. A better understanding of the ‘why’
of rounding may move the process away from
checklists and tick boxes and towards the
delivery of compassionate care.
Complete time out activities 4 and 5
‘Help uncertainty’
Part of the theoretical basis of the benefit
of rounding is the effect on the patient’s
NURSING STANDARD
use of the call bell. Woodward (2009) expands
on this and identifies ‘help uncertainty’ as a
basis for establishing rounding practice.
Patient experience was poorer when they were
unaware of when help would be available for
them. Tea et al (2008) encapsulate this in their
example of immobile, orthopaedic patients for
whom unanswered call lights create a sense of
helplessness and fear. Therefore, by promoting
proactive responsiveness to patients’ needs,
rounding can increase patient satisfaction.
Nurse responsiveness to patients
The responsiveness of nurses and the presence
of the nurse (D’Alessio et al 2010, Neville
et al 2012) were studied as measures for patients
in terms of their care experience. Patients who
scored staff responsiveness or timeliness highly
were more likely to score overall satisfaction
highly (Tea et al 2008). Patients valued a more
anticipatory approach to meeting their care
needs (Tea et al 2008). More than 100 patients
were asked what made staff whom they had
rated as excellent different from other staff (Tea
et al 2008). Four main concepts emerged:
Knowing and listening to patients.
Frequently checking on patients.
Keeping important personal items within
reach.
Proactively watching and responding to call
bells.
Issues that were identified by patients as
important to them were related to fundamental
aspects of care rather than concerns about
clinical competence, for example wound
dressing techniques.
Nurse presence and visibility to patients
Blakley et al (2011) considered the perceived
improvements in compassionate care and
nurse presence and attention as benefits of
rounding. Nurse presence and visibility were
considered more important than competence
(Neville et al 2012). Gardner et al (2009)
presented a similar argument that rounding
focuses on immediate patient comfort and
not the delivery of higher level clinical care.
They indicate that rounding improves a
nurse’s ability to meet a patient’s immediate
physical needs in a timely fashion and provide
a physical comforting presence.
Communication
Gardner et al (2009) suggested a link between
rounding increasing face-to-face time with
patients and patients receiving more individual
attention. Scheduled rounding means nursing
NURSING STANDARD
staff have a reason to speak to patients
on a regular basis, which helps to develop
open communication with patients and to
form connections, enabling nurses to better
understand and meet patient needs
The nurse should understand that their
perception of the patient’s needs may not be
the same as the patient’s own perception
(Tea et al 2008).
Referring to Henderson’s (1997) theory
of identification of nursing needs, Gardner
et al (2009) suggest that rounding is linked to
the quality of nurse-patient communication
and interaction, which in turn influences
the patient’s perception of care. The 14
fundamental needs identified by Henderson
(1997) correspond well to those in the Meade
et al (2006) protocol for rounding (Box 2),
supporting the concept of rounding practice
as a method of care delivery to meet a
patient’s fundamental needs.
Behaviours and compassionate care
D’Alessio et al (2010) advanced the concept
of ‘presence’ and explored the dimensions
and behaviours of nursing presence. Patients
may not be able to discern if nurses are
providing technologically proficient care,
or care that meets practice standards, but
they can identify behaviours that indicate
care and compassion. The behaviours they
identify are:
Communication.
Respect.
Information provision.
Aid.
Comfort.
Empathy.
Being seen.
These behaviours match the processes that have
been incorporated into protocols on rounding.
However, compassionate care may become
lost in the process-driven implementation of
rounding, discussions about the effectiveness
of one or two-hourly rounding and/or tick-box
documentation.
Conclusion
This article discusses the concept of rounding,
a nursing intervention practised widely in
the NHS. As with any nursing intervention,
nurses should understand rounding and
its value to patient care. Rounding has the
potential to improve nursing practice and
the patient’s experience of care. Intentional
rounds in the US have been associated with
june 17 :: vol 29 no 42 :: 2015 57
CPD patient care
6 Now that you have
completed the article,
you might like to write
a reflective account.
Guidelines to help you
are on page 62.
a reduction in patient harm and increased
patient and staff satisfaction. However,
there are difficulties in the way practice has
been adopted from US nursing for use in
the NHS.
There are concerns that rounding does
not have a justifiable evidence base.
This article highlights inconsistences in
the evidence base, challenging the
assumptions about the benefits of rounding
to patient care and offering an alternative
perspective on the perceived benefits of
rounding practice. Established outcome
measures of the effectiveness of rounding
practice are not an effective way to evaluate
the benefits of rounding practice. Further
research is required to identify the benefits
of rounding practice to patient care and to
demonstrate conclusively whether achieving
the aims and principles of rounding will
improve patient care NS
Complete time out activity 6
References
Bartley A (2011) The King’s Fund
Hospital Pathways Programme:
Making it Happen: Intentional
Rounding. The King’s Fund
Point of Care and The Health
Foundation, London.
Berg K, Sailors C, Reimer R,
O’Brien Y, Ward-Smith P (2011)
Hourly rounding with a purpose.
Iowa Nurse Reporter. 24, 4, 12-14.
Blakley D, Kroth M, Gregson J
(2011) The impact of nurse
rounding on patient satisfaction in
a medical-surgical unit. Medsurg
Nursing. 20, 6, 327-332.
Bourgault AM, King MM, Hart P,
Campbell MJ, Swantz S, Lou M
(2008) Circle of excellence. Does
regular rounding by nursing
associates boost patient satisfaction?
Nursing Management. 39, 11, 18-24.
Culley T (2008) Reduce call light
frequency with hourly rounds. Nurse
Management. 39, 3, 50-52.
D’Alessio E, Magsalin M, Neville KL,
Patten C (2010) Enhancing nursing’s
presence. Nursing Management.
41, 12, 16-18.
Deitrick L, Baker K, Paxton H,
Flores M, Swavely D (2012)
Hourly rounding: challenges
with implementation of an
evidence-based process. Journal of
Nursing Care Quality. 27, 1, 13-19.
Department of Health (2012a)
A Commitment to Quality –
Salford Royal NHS Foundation
Trust Welcomes Prime Minister
and Secretary of State. tinyurl.
com/na43mgx (Last accessed:
May 15 2015.)
Ford BM (2010) Hourly rounding:
a strategy to improve patient
satisfaction scores. Medsurg
Nursing. 19, 3, 188-191.
Francis R (2013) Independent
Inquiry into Care Provided by Mid
Staffordshire NHS Foundation Trust
January 2005 to March 2009. The
Stationery Office, London.
Gardner G, Woollett K,
Daly N, Richardson B (2009)
Measuring the effect of patient
comfort rounds on practice
environment and patient
satisfaction: a pilot study.
International Journal of Nursing
Practice. 15, 4, 287-293.
Gillen S (2012) It is about being
highly visible to your patients at
least every hour. Nursing Standard.
26, 51, 12-13.
Department of Health (2012b) Top
Nurses Announce New Strategy to
Build Culture of Compassionate Care
Across the NHS. tinyurl.com/lseudpb
(Last Accessed: May 15 2015.)
Halm MA (2009) Hourly rounds:
what does the evidence indicate?
American Journal of Critical Care.
18, 6, 581-584.
Department of Health (2012c) PM
Announces New Focus on Quality and
Nursing Care. tinyurl.com/ofcvdey
(Last Accessed: May 15 2015.)
Henderson V (1997) Basic
Principles of Nursing Care. Second
edition. International Council of
Nurses, Geneva.
Castledine G, Grainger M,
Close A (2005) Clinical nursing
rounds part 3: patient comfort
rounds. British Journal of Nursing.
14, 17, 928-930.
Dix G, Phillips J, Braide M (2012)
Engaging staff with intentional
rounding. Nursing Times. 108, 3, 14-16.
Hunt J (2012) Intentional rounding
belies evidence-based practice.
Nursing Standard. 26, 23, 26.
Duffin C (2010) Hourly ward rounds
improve care and reduce staff stress.
Nursing Management. 17, 7, 6-7.
Hutchings M (2012) Caring around
the clock: rounding in practice.
Nursing Times. 108, 49, 12-14.
Crossfield S, Pitt C (2012)
Introducing care rounds using
rapid spread. Nursing Times.
108, 38, 20-21.
Fitzsimmons B, Bartley A, Cornwell J
(2011) Intentional rounding: its role
in supporting essential care. Nursing
Times. 107, 27, 18-21.
Kendall-Raynor P (2012) PM vows
to cut bureaucracy and introduce
hourly nursing rounds. Nursing
Standard. 26, 19, 6.
Braide M (2013) The effect of
intentional rounding on essential
care. Nursing Times. 109, 20, 16-18.
Burke K (2011) Improvements
evident thanks to new two-hourly
rounds. Nursing Standard. 26, 13, 32.
Castledine G (2002) Patient comfort
rounds: a new initiative in nursing.
British Journal of Nursing. 11, 9, 407.
58 june 17 :: vol 29 no 42 :: 2015
Kessler B, Claude-Gutekunst M,
Donchez AM, Dries RF, Snyder
MM (2012) The merry-go-round
of patient rounding: ensure your
patients get the brass ring. Medsurg
Nursing. 21, 4, 240-245.
Krepper R, Vallejo B, Smith C et al
(2014) Evaluation of a standardized
hourly rounding process (SHaRP).
Journal for Healthcare Quality.
36, 2, 62-69.
Lowe L, Hodgson G (2012)
Hourly rounding in a high
dependency unit. Nursing Standard.
27, 8, 35-40.
Lucas B, Adjoto E, Ahmed R et al
(2010) Proactive Patient Rounding:
Developing Nursing Practice to
Improve the Quality of Patient Care.
Whipps Cross University Hospital
NHS Trust, London.
Mason M (2012) More than a
check list. Nursing Standard.
26, 20, 20-21.
McDonagh V (2013) Sustaining
pressure ulcer prevention in
practice. Nursing Times. 109, 15,
12, 14, 16.
Meade CM, Bursell AL, Ketelsen L
(2006) Effects of nursing rounds:
on patients’ call light use,
satisfaction, and safety. The
American Journal of Nursing.
106, 9, 58-70.
Miller L, Limbaugh CM (2008)
Applying evidence to develop
a medical oncology fall-prevention
programme. Clinical Journal of
Oncology Nursing. 12, 1,
158-160.
NURSING STANDARD
Moran J, Harris B, Ward-Miller S,
Radosta M, Dorfman L, Espinosa L
(2011) Improving care on mental
health wards with hourly nurse
rounds. Nursing Management.
18, 1, 22-26.
Mower-Wade D, Pirrung JM (2010)
Advanced practice nurses making
a difference: implementation of a
formal rounding process. Journal of
Trauma Nursing. 17, 2, 69-71.
Murphy TH, Labonte P, Klock M,
Houser L (2008) Falls prevention
for elders in acute care: an
evidence-based nursing practice
initiative. Critical Care Nursing
Quarterly. 31, 1, 33-39.
National Institute for Health and
Care Excellence (2014) Safe Staffing
for Nursing in Adult Inpatient Wards
in Acute Hospitals. Safe staffing
guideline No. 1. NICE, London.
Neville K, Lake K, LeMunyon D,
Paul D, Whitmore K (2012) Nurses’
perceptions of patient rounding. The
Journal of Nursing Administration.
42, 2, 83-88.
NHS Institute for Innovation and
Improvement (2009) Staying
Safe - Preventing Falls. tinyurl.
com/ohsnfnc (Last accessed:
May 15 2015.)
Nursing Standard (2010) Regular
checks cut falls rates. Nursing
Standard. 25, 6, 8.
Orr N, Tranum K, Kupperschmidt B
(2008) Hourly rounding for positive
patient and staff outcomes: fairy
tale or success story? The Oklahoma
Nurse. 51, 4, 11.
Quigley PA, Hahm B, Collazo S et al
(2009) Reducing serious injury
from falls in two veterans’ hospital
medical-surgical units. Journal of
Nursing Care Quality. 24, 1, 33-41.
Rondinelli J, Ecker M, Crawford C,
Seelinger C, Omery A (2012) Hourly
rounding implementation: a multisite
description of structures, processes
and outcomes. The Journal of Nursing
Administration. 42, 6, 326-332.
Saleh BS, Nusair H, Al Zubadi N,
Al Shloul S, 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, 3, 299-303.
Sheedy S (1989) Responding to
patients: the unit hostess. The
Journal of Nursing Administration.
19, 4, 31-33.
Sherrod BC, Brown R, Vroom J,
Sullivan DT (2012) Round with
purpose. Nursing Management.
43, 1, 33-38.
Snelling PC (2013) Ethical and
professional concerns in research
utilisation: intentional rounding in
the United Kingdom. Nursing Ethics.
20, 7, 784-797.
Sobaski T, Abraham M, Fillmore R,
McFall DE, Davidhizar R (2008)
The effects of routine rounding
by nursing staff on patient
satisfaction on a cardiac telemetry
unit. The Health Care Manager.
27, 4, 332-337.
Sterman E, Gauker S, Krieger J
(2003) Continuing education:
a comprehensive approach to
improving cancer pain management
and patient satisfaction. Oncology
Nursing Forum. 30, 5, 857-864.
Studer Group (2007) Hourly
Rounding Supplement. Best
Practice: Sacred Heart Hospital,
Pensacola, Florida. Studer Group,
Gulf Breeze FL.
Tea C, Ellison M, Feghali F
(2008) Proactive patient rounding
to increase customer service and
satisfaction on an orthopaedic
unit. Orthopaedic Nursing.
27, 4, 233-240.
Tucker SJ, Bieber PL, Attlesey-Pries
JM, Olsen ME, Dierkhising RA
(2012) Outcomes and challenges
in implementing hourly rounds to
reduce falls in orthopedic units.
Worldviews on Evidence-Based
Nursing. 9, 1, 18-29.
Waszynski C (2012) More rounding
means better fall compliance.
Healthcare Risk Management.
34, 2, 21.
West D (2012) Intentional rounds
should be done every hour, says
forum lead. Nursing Times.
108, 18, 3.
Woodward JL (2009) Effects
of rounding on patient satisfaction
and patient safety on a
medical-surgical unit. Clinical
Nurse Specialist. 23, 40,
200-206.
Call for
papers
Nursing Standard is welcoming submissions from
experienced or new authors on a variety of subjects
Contact the Art & Science editor Gwen Clarke at [email protected]
NURSING STANDARD
june 17 :: vol 29 no 42 :: 2015 59