Role of Hourly Nurse Rounds in Reducing Falls Pressure Ulcers Call Lights Patient Satisfaction

hourly nurse rounds help to reduce falls, pressure ulcers, call light use and contribute to rise in patient satisfaction base on evidence base practice

The healthcare center is faced with numerous challenges affecting clinical results and client satisfaction (e.g., ulcers, use of call light and falls). The above challenges have brought on the need to develop and institute an appropriate framework to improve patient care delivery by means of better and increased interaction between patients and nurses. Chiefly, the creation of this sort of system necessitates striving for required authorization and assistance from leaders and staff members in the organization. This involves meeting with top management at organization appraisal board meetings, in addition to collaborating with peers concerning existing best practices for handling the issue. Taking into account organizational issues and nursing-related evidence-based practices (EBPs), the best answer to dealing with current issues is hourly nurse rounds. Implementing this recommended strategy necessitates a team effort by all stakeholders in the organization, and the use of suitable resources to commence the process of transformation. Call-light usage in the center has come under growing scrutiny as being related to nurse scarcities, nursing round changes, and robust patient outcome analyses. Organizing routine and frequent nursing rounds can prove critical to nurses' ability to handle day-to-day, ordinary patient problems in comparison to more serious and important needs, which are regarded as the main aim for call light usage by patients. Apart from general inpatient comfort and safety, another focus of nurses is patient satisfaction. Fundamentally, patients experiencing peacefulness and contentment are likely to heal quicker, may communicate less stressfully with family, and may also acquire clarity of perspective, allowing them to distinguish between the manifold wants and requirements they have, when confined to the hospital bed. Establishing frequent, routine nursing rounds can aid with alleviation of patient anxiety regarding whether their needs are fulfilled or not, and whether nursing personnel care for their well-being. It can also facilitate establishment of a degree of predictability, which may play the role of a technique of coping, while undergoing prolonged, difficult hospitalization.

Problem Description

Typically, nursing staff play their part in patient care delivery by way of communication, which forms a key component of patient-nurse interactions. In fact, communication is deemed to be nursing's foundation or keystone, as it is central to nursing care quality. Irrespective of communication's value in the profession of nursing and nursing practice, many occasions wherein there has been negative and detrimental nurse-patient communication in the medical center, have been noted. This, in turn, results in decreased patient satisfaction, along with a negative effect on possibilities of attaining required outcomes for patients (Brosey & March, 2015).

One amongst the key causes of this issue in healthcare settings is absence of a proper procedure or system for nurse rounds. Patient care delivery encompasses carrying out routine checks individually on each patient, instead of waiting till they utilize the call light when requiring care. Nurses, in the medical center, fail to frequently check on inpatients, for forecasting and delivering necessary care and support (Brosey & March, 2015). They often have the tendency of waiting until inpatients ring for them to predict and deliver needed care. Because of the absence of an effectual nursing rounds system, there have been inpatient falls, growing usage of the call light, and ulcers.

Patients persistently protest regarding nurses' inefficiency in providing them with quality care. Most patients in the healthcare center voice dissatisfaction with outcomes and care delivery procedures. Hence, the key issue for the facility is enhanced dangers of falls, mounting call light usage, and ulcers, thereby impacting clinical results and satisfaction of patients. These issues are predominantly caused due to absence of a proper system of regular nurse rounds, for predicting and delivering necessary care proactively, instead of merely reacting after a patient has called for help (Forde, 2014, p.38).

Solution Description

The solution recommended is backed by the notion that patient checks conducted every hour will enable increased awareness amongst nurses regarding patient situation. Hourly rounding denotes visits to patients by nurses or other healthcare providers. This enables more direct patient care, while at the same time according patients the chance to convey to nurses their wants and requirements. The fundamental idea is that patients can have a better chance at communication with nursing personnel, and likewise, nurses gain the opportunity to personally regard and understand patient situation. Typically, nurses only visit inpatients once in two hours during their night rounds, although this too depends on individual patients' condition (Engebretson, 2011).

The suggested solution conforms to the theory of comfort, a mid-level theory of nursing, which supports the notion that patients look for comfort, and when this comfort is delivered to them, clinical outcomes improve. There are three forms of comfort -- relief (the most important), transcendence and convenience (AIPPG, 2011). Hourly rounding nurses can relieve patients from the discomfort they are suffering more easily when their interaction with patient is frequent.

The above theory is linked to other theories, such as the interdependence theory propounded by Roy. For instance, when discomfort is experienced by a patient, leading to feelings of anxiety, nurses can support them by creating a situation of ease: ultimately, the patient can better recover from other illnesses as well. Psychological and mental states are associated with physical healing states; the above statement implies that, patients display improved physical outcomes when provided with enhanced comfort by nurses (Brosey & March, 2015).

Hourly rounds will ensure benefits in the form of reduced usage of call light by patient, quicker, timelier response to care-related issues and patient discomforts among other outcomes. The healthcare facility can ensure better customer service and higher care standards by implementing hourly rounding at daytime and bi-hourly rounding during the night, when most patients sleep (AIPPG, 2011).

Moreover, hourly rounding has proven to aid with reduction in noise levels in the unit. This is crucial, as low noise levels are conducive to a more soothing atmosphere. This is again in relation to patients' emotional/mental state and comfort, and the link between physical healing and these comforts. In a generally less stressful atmosphere, both staff and patient satisfaction will increase, and greater proactivity in dealing with patient requirements and desires will ensue, leading to a lesser number of major problems within the unit (Engebretson, 2011; Brosey & March, 2015). Thus, middle-level as well as high-level theories of nursing, in addition to best practices in healthcare, endorse hourly rounding; the system has, previously, proven to have several positive outcomes.

Implementation Plan

Nurse rounding on an hourly basis is considered as one of the most effective ways to improve patient outcomes and satisfaction. It may be explained as an organized, proactive nurse-focused EBP for forecasting and accommodating inpatients' diverse requirements. Ample evidence exists to prove that efficient hourly nurse rounding is capable of increasing patient safety, improving nursing personnel's ability to deliver patient care efficiently, and fostering team communication. Hence, this strategy would prove adequate in helping lower falls, avert ulcers, and decrease usage of call lights, thereby leading to improved patient satisfaction via evidence-based techniques. Applying this approach to the healthcare organization with an aim of bettering clinical outcomes and patient satisfaction necessitates formulation of an inclusive implementation strategy and involvement of all major stakeholders in the organization (Deitrick, Baker, Paxton, Flores and Swavely, (2012).

There is room for many improvements in the hourly rounding process compared to that executed prevalently in the medical center. The process needs to be clearer with regards to its aims; nursing staff should be better instructed with regards to how the rounding process ought to be carried out and recorded; and, measures to evaluate nurses' accountability for performance of the process must be well-defined. Furthermore, there is a need to define and measure appropriate, sensitive measures of outcome for initiative assessment; these results have to be conveyed to staff members of the unit, displaying to them hourly rounding outcomes (Deitrick et al., 2012; Tzeng, 2010).

Evaluation Plan

Another key element in relation to effectively translating evidence-based models into practice is evaluation (Engebretson, 2011). Implementation of hourly rounding in the hospital could benefit from adoption of PDSA (Plan-Do-Study-Act) or another such quality improvement tool. Employing an instrument would have encouraged hospital administration to recognize outcome variables, which could be utilized for studying process implementation and its effectiveness in enhancing quality of patient care.

Identifying easily-measurable, meaningful outcomes for proving effectiveness of hourly rounding in terms of patient care is an obstacle to assessing translation of the hourly rounding model into practice (Dharamsi, Osei-Twum & Whiteman, 2011). Though quality outcomes like patient satisfaction and rates of pressure ulcer and falls are regularly monitored, it was not possible to directly ascribe variations in the measures to the newly-implemented hourly rounding. There were no exclusively tracked measures for assessing hourly rounding, since several literature-recommended outcomes proved to be overly tough to measure (e.g., call-bell tracking). Log sheet data could not be employed in noting hourly rounding's significance in patient care improvement, as it failed to directly link to variables, which could be applied in evaluating hourly rounding's effect. Hence, staff found no correlation between quality care and hourly rounding, and consequently, they did not give enough import to rounding on an hourly basis (Titler, 2011; Dharamsi et al., 2011).

Patient satisfaction, which is the outcome measure most frequently-cited in literature (Titler, 2011), reveals no added satisfaction assessments carried out in the health center, apart from the commercially dispensed survey mailed to patients following discharge. This survey's findings on patient satisfaction did not visibly differ on study units following execution of rounding, probably since it already was reasonably high and since the hourly rounding process was not conducted efficiently. There is, at present, limited information available in translation literature regarding a slow and gradual evaluation method for deducing the reasons behind the failure of an implemented change (Dharamsi et al., 2011). The manner in which qualitative techniques can be employed for assessing hourly rounding's (or any other patient care procedure's) effectiveness at level will be demonstrated in this study. Likewise outcomes reveal frontline nurses' significant role as valuable information sources for researches into process improvement.

The subsequent step is translating study conclusions into a worthwhile restructuring of the process of hourly rounding. The following suggestions are offered to the reformation team: (1) a more thorough appraisal of adopters, especially early adopters capable of supporting the process on behalf of unit staff; (2) involving unit staff members in all stages of process restructuring;(3) taking advantage of hospital leadership development framework for assisting with training unit-level advocators for heading implementation process; (4) setting up a sounder education and communication plan; (5) employing processes from the areas of quality improvement (PDSA) and project management for reinforcing the restructured hourly rounding process; and (6) identifying meaningful indicators of outcome, like pressure ulcers or falls, for assessing hourly rounding program efficiency (Titler, 2011; Engebretson, 2011).

Dissemination Plan

The change mentioned in the previous sections will be incorporated into the existing organizational structure, workflow, and culture as a component of its operations practices and policy. Hospital leaders will institute a system for educating staff members with regard to the solution, and providing them with essential resources to execute it. Leaders, here, will offer requisite educational resources, assessment tools and technology at the time of staff training. After training is complete, a system will be formulated by which there will be routine, frequent patient checks by nurses; that is, staff will have to put the process into practice immediately after getting trained (Deitrick et al., 2012).

The trained nurses will, notably, join forces with supervisors for carrying out the recommended solution, and will have the opportunity to voice concerns or broach issues faced while interpreting. Basically, top-level management will collaborate with supervisors to take charge of training personnel, and launching, applying and appraising the change (Lowe & Hodgson, 2012). Appraisal will depend on supervisor and nurse feedback concerning implementation and the recommended strategy's usefulness in accomplishing required goals. This feedback, in turn, will be employed in improving change process, as well as managing any surfacing concern or challenge.

The resources needed for putting change into operation include: 1) Staff, who have a critical part to play in launching, supervising and assessing change and attaining required outcomes; 2) Educational material in the form of brochures, documents, placards, and PowerPoint presentations; 3) Assessment tools such as pre-tests, post-tests, surveys and questionnaires to evaluate participants' baseline knowledge, and understanding after intervention; and 4) appropriate technology. Implementation will incur expenses pertaining to all of the above resources, i.e., staff training, delivery of required educational matter, collection and analysis of data, and implementation and assessment expenses (Tzeng, 2010).

Review of Literature

According to a 2010 study by Kristine, Laurie, Leslie, and Linda, though hourly rounding has demonstrated positive effects, its appropriate implementation impedes reaping of the program's benefits. The authors, making use of statistical information, contend that nurse satisfaction can be attained via the rounding process with devotion of more nurse time to bedside care. There are, however, issues with implementation, as studies prove that EBP change is multifaceted and tricky; also, there is no any universal implementation technique. Attlesey-Pries, Bieber, Dierkhising Olson and Tucker indicated in their 2011 study that implementation must include multiple key elements to effective implementation and process translation into practice, including a grasp of the intervention's multifaceted nature, adopter evaluation and a sound communication strategy (Tucker et al., 2011). Scholars in the field also lay emphasis on the correct assessment of the intervention's sensitive and measurable results.

The 2015 Stanford Healthcare (SHC) study addresses elements to be incorporated into effective hourly nurse rounds. Several research findings indicate the worth of hourly rounds, with a few even concentrating on its implementation. These research works have also determined the elements that must be integrated into implementation, for desirable, expected outcomes to ensue. These elements include greater clarity, by means of medical center and healthcare leaders communicating hourly rounding's objectives (Titler, 2010). Valuable instruction regarding the actions that have to be taken in hourly rounding, nurse accountability for its performance, and manner of documentation must also be incorporated, as must outcome assessment in quantifiable units (Goldsack, Bergey, Mascioli & Cunningham, 2015).

Goldsack and colleagues (2015) list hourly rounding's benefits for nurses as well as patients. Prior studies have revealed that the process, when taken from patient point-of-view, offers the advantages of decreased bell calls per shift, patient falls and pressure ulcers, together with enhanced patient satisfaction, whereas from nurses' point-of-view, nursing satisfaction increases with increase in their interaction with patients, as does collaboration among nurses. Because clear-cut conveying of program goals and adequate evaluation regarding quantifiable outcomes is essential to the program, nurse accountability is also required. Thus studies have also pointed to the requirement of a powerful leader capable of effectively implementing all process components in a healthcare/hospital context (Nursingcenter.com, 2015).

A research by Tucker and coworkers (2011) demonstrates the significance of nursing professions' 7Ps (Person, Presence, Plan, Personal Hygiene, Priorities, Position, and Pain), which must be followed in the course of hourly rounds. These are employed in combination with approaches like safety rounds and attempts to improve nurse responsiveness to patients and families. Studies put forward that nurse presence is vital, since it develops personal interaction with patients and their kith and kin, thereby cultivating an environment of assurance concerning healthcare delivery. The remaining Ps facilitate care delivery in terms of dealing with pain, comfortable patient position, toileting assistance to patient, deciding on which patients must be given more priority and offering individualized patient care. The above objectives, together with the goal of satisfying patients and families assist with effective execution of hourly nurse rounds (Olrich & Nigolian, 2012).