Hourly ward rounds may not be the best way for nurses to deliver care: findings from a new nursing study

Professor Ruth Harris works in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London. (458 words)

The widespread practice of intentional rounding (IR) in England may not the best way for nurses to deliver care and IR makes a minor contribution, if at all, to the way nursing staff engage with patients. This is the main finding of our study that was commissioned and funded by the National Institute for Health Research (NIHR).

Intentional rounding is a protocol of standard regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013 as part of the government’s response to care failures in the NHS, most notably at Mid-Staffordshire NHS Trust.

In 2014 the NIHR asked us to investigate the impact of intentional rounding in hospital wards on the organisation, delivery and experience of care. Our report, Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world. A theory-informed, large-scale mixed method national study of IR and the findings have international and local relevance.

We found that:

  • The practice of IR is near universal in NHS hospitals, with 97% of NHS acute Trusts in England implementing it in some way
  • IR does not seem to be the best way to support the delivery of fundamental nursing care to patients in the English healthcare context, placing emphasis on transactional ‘tick box’ care delivery, rather than individualised care.
  • We identified eight theoretical explanations of how IR was thought to work but only two of these were supported by findings from our national survey and case studies. Our review of this evidence was published in BMJ Quality & Safety.
  • Most NHS trusts in England have adapted the IR protocol to include additional clinical components of care demonstrating that the American ‘4Ps’ protocol (Position, Pain, Personal needs, Placement of items) is not sufficient in the English care delivery context.
  • Patients valued relational elements of their interactions with nursing staff, which occurred when nurses delivered other care activities – not IR.
  • IR provides nursing staff with a safety net against allegations of poor practice, as it provides evidence of care delivery.
  • Following the Francis Inquiry Report into failures in the NHS, IR was implemented without consultation, careful planning or piloting in the interests of political expediency.
  • Caution is needed when considering the implementation of interventions from healthcare systems in other countries.

Our study shows that ‘Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery. Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.’

Please read our full report which is available on the NIHR website: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr07350

Professor Ruth Harris works in Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London.