Nursing rounds are a routine in hospitals around the world. The traditional nursing round used to be conducted in a coordinated hierarchical fashion with strict rules. The most senior nurse conducted a ward round in an authoritarian manner with little room for conﬂicting views. A grand round is a form of teaching round meant for education and sharing of experiences and it should continue in our environment.
Nursing clinical rounds allow nurses to interact with patients, respond to their concerns, and modify the unsatisfying conditions. More precisely, regular nursing rounds provide an opportunity to identify and fulfill patient needs via active nursing procedures. Although hospitals employ various methods of rounds for hospitalized patients, the main components of all rounds are pain management, toileting, changing position, and environmental management comfort (Meade, Bursell, & Ketelsen, 2006). It seems that improving nurse-patient communication can improve patients’ outcome including their satisfaction with nursing care.
CONCEPT NURSING/CLINICAL ROUNDS
Nursing rounds are conducted by the head nurse/ nurse teacher for the member of his /her staff or students for a clear understanding of the disease process and the effect of nursing care for each patient.
This is a procedure in the nursing profession and in later practice in which one or more visits to a hospital patient are scheduled by two or more nurses to coordinate care, troubleshoot, respond to patient needs, and share insights. Purposeful rounding is a proactive, systematic, nurse-driven, evidence-based intervention that helps us anticipate and address patient needs.
The systematic process of rounding is an intentional act conducted with clear purpose for the patient’s benefit. It has significant value for the patient. Woodard (2009) showed that availability and responsiveness of nurses correlated to patients’ understanding of the quality of nursing care.
Nurses perform their role through communication and it is believed that nurse-patient interaction is the cornerstone of nursing profession and also positive nurse-patient communication can be vital in quality of nursing care (McCabe, 2004).
In clinical rounds, nurses, doctors, therapists and other members of the care team meet regularly to discuss their patients. The team visits each patient to see how they’re going, share information and to review their plan of care. At these important meetings discussions include;
- The changes in patient’s health over the last 12 or 24 hours;
- How patient is doing at the moment;
- Review patient with new test results;
- The plan of care for that day;
- Discuss on when patient may be ready for discharge.
- Each person in the health care team will give their opinion and ideas. The admitting doctor usually makes the final decisions in clinical round in conjunction with the other team opinion.
TYPESOF NURSING ROUNDS
There are four types of nursing rounds, these are;
Nurse matrons’ rounds; which can provide senior nurses with the opportunity to achieve key aspects of their role. these include ensuring professional and clinical nursing standards, improving infection control and etc.
Nurse management rounds; which involves the nurse in charge of the shift seeing each patient and it gives the nurse manager an overview of the condition and needs of all the patients on the wards and the ability of staff to meet these needs. Also, these rounds have potential benefits for patients, relatives, for the nursing team and for other healthcare professionals.
Patient comfort rounds; are an important part of maintaining and monitoring the fundamental aspects of individual patient care. They should be carried out at 1-2 hour intervals whenever possible, commencing after lunchtime and continuing for the rest of the day. At night time, pcrs should be carried out before patients go to sleep and again in the early morning. it may be necessary to carry out more regular care to some patients. The purpose of pcrs is to maintain a regular review of the patient nursing needs, support the nursing process and evaluate nursing care.
Teaching rounds: nurses learn in a variety of ways, through courses and accredited program’s, seminars, conferences, self-directed study and so on. one of the most effective ways, however, is to participate in special clinical teaching rounds.
Theseare aimed at all learners, whether pre-registration students or qualified staff. Teaching round is to learn from direct patient contact with facilitation from an experienced nurse teacher, and also to teach and evaluate nursing care. It is useful in developing clinical practice, evidence-based care.
The How of Nursing Rounds
You can do a lot of other things well but poorly executed patient rounding has the potential to negate all other efforts. The combination of hourly rounding and the 5-Ps is designed to meet the needs of patients and their caregivers, by improving access to timely, quality and safe healthcare. Furthermore, this approach improves detection of the deteriorating patient, improves patient satisfaction, reduces the rate of falls, pressure ulcers, medication errors and call light usage. An hourly check or surveillance on every patient every day (less at night to ensure proper rest) provides the best care and experience possible.
Introduce yourself; Introduce yourself to your patient. Tell them a little bit about yourself, including how long you have been working in your profession, your title, etc
Establish rapport and use communication board; Using your patient communication boards 100% every day contributes as a significant factor in improving patient satisfaction.
Explain procedure you’re doing/Seek consent; “because we want you to receive the best care possible, we are going to round every hour while you are in the room. We will not wake you if you are sleeping unless your doctor has asked us to do so. We will check on your pain, your comfort, and ask if you need to use the bathroom”.
Assess the 5 Ps
PAIN: “How is your pain?”
POSITION: “Are you comfortable?” [Turn and position patient for comfort.]
POTTY: “Do you have bathroom needs?”
PERIPHERY: “Do you need me to move the phone, call light, trash can, water cup, or over-bed table?” [Move the phone, call light and/or trash can within reach. Arrange the over bed table and fill the water cup. Ensure all equipment is plugged in. Eliminate unnecessary clutter.]
PUMP: Check the IV pump and infusion.
IN CLOSING; Close with, “Is there anything else I can do for you while I’m here? I have the time.” Thank the patient.
BENEFIT OF NURSING ROUND
- It saves steps for the nursing staff
- It Promotes safety
- It brings nurses back to bedside
- It increases patient satisfaction
- It helps nurses to understand the patients condition better (either improving or detoriating) so as to render excellent and care nursing care.
- It helps nurses to be conversant with their patients
- It helps to create more rapport between nurses and patient
- To have a consistent nursing process
- Helps nurses in exploring better ideas and treatment on disease condition in order to render effective care
- It gives a better baseline between nurses during handing over
- It improves clinical outcomes
- It decreases patient anxiety
- It builds the patient’s trust
- It provides the best possible care
- It reduces hospital acquired conditions
- It improves nurse and patient experience and understanding
- It makes patient develop trust and to some extend said “I feel safer and more secure.” “I can reach everything I need.” “I know my nurse will come back and check on me.” “The nurses really care about me.
A nursing round must be clearly distinguished from a clinical review of individual patients which are additional to rounds.
Nursing rounds should be conducted in a coordinated manner by nursing team on a regular basis.
Nursing leaders/senior nurses should commit themselves in carrying out/leading nursing round.
Nurses should always join grand ward round
Hospital/Healthcare industries should support/facilitate nursing round.
Information systems should be tweaked to support and assist nurses to support efﬁcient nursing/ward rounds.
Strict supervision should be made on nursing round.
A well-run nursing round is good for both patients and nurses. It provides a daily reminder to healthcare professionals of why they chose a caring profession in the ﬁrst place. They must work collectively to coordinate and enhance the value of good patient care. The juniors learn by seeing numerous patients with different pathology particularly when taught by an experienced nurse who are also role models. It provides one of the best opportunities to integrate theoretical knowledge with practical skills. The motivation that a well-conducted round provides to juniors cannot be overstated.
- Royal College of Physicians and Royal College of Nursing. Ward rounds in medicine: principles for best practice. Available at:
- http://www.rcplondon.ac.uk/resources/ward-rounds-medicine-principles-best-practice. Accessed on 9 January 2013.
- Royal College of Physicians. Acute care toolkit 5: teaching on the acute medical unit. Available at: https://www.rcplondon.ac.uk/ﬁ le/1192/download?token=nvaTaolP.
- Accessed on 1 April 2016.
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Writers; Nr. Reuben Markus Zirahgi; Nr. Fatima Mustapha; Nr. Martin Eyunbe
Contributors; Nr. Abba Mai Modu; Nr. Abdullahi Suleiman Maka; Std. Nr. Tega Erokaire;
Nr. Mustapha S. kpautangi; Midwife Biakolo Christiana O.; Nr.Precious Medugu
Editors: Nr. Dathini Hamina MSc., BNSc., PGDedu., RNM. University of Maiduguri
Nr. Habu Haruna MSc., BNSc., PGDedu.,RNM., University of Maiduguri