Benefits of Establishing a Nursing Rounds System

Evidence-Based Quality Nursing Practice

As a result of a variety of conditions, hospitalized patients may experience extended times in their hospital bed, unable to ambulate, and forced to rely on call buttons to communicate their needs or anxieties to nurses on duty. Not infrequently, patients who attempt to get out of bed may fall. And patients who cannot get out of bed, or adequately shift their positions in bed, may experience pressure sores as a result of their immobility.

Patients experience a number of emotions in response to these types of situations, any one of which can compel them to use their call button to summon help, or even express their frustration at their helplessness, discomfort, or heightened sense of vulnerability. The use of call bells by patients may occur more frequently than nursing staff consider appropriate, consequently, the probability that responsiveness to nurse call bells will diminish over time is likely to increase. In concert with these concerns, patient satisfaction with regard to their care during their hospital stay may be low, a factor that can impact their recovery and well-being.

Effective use of call bells by patients and timely response to call bell use by nursing staff is a substantive matter and cannot be relegated to a catch-all nuisance category. The quality of nursing care received by patients restricted to their beds or suffering from profound immobility is substantially impacted by the functional substitution of call bells for face-to-face communication that can occur when an ambulatory patient seeks out needed help. Ineffective use of call bells, which entails an unavoidable mutuality between patients and nurses, undermines efforts at communication and damages the trust relationship so crucial to good nurse-patient interactions. Moreover, nursing staff may also experience the benefits of nursing rounds through a heightened sense of professionalism, feeling more in control of the demands of their shift, and by the satisfaction expressed by patients directly to the nurses.

The practice problem described above is shown in the PICOT framework below:

P = Population / patient = Non-ambulatory (bedridden) chronic care patients?

I = Intervention / indicator = Hourly nurse rounds?

C = Comparator / control = Nurse rounds at greater intervals than hourly?

O = Outcome = Reduction in number of falls, pressure ulcers, and call light use ?(plus increased patient satisfaction)

T = Time = During the time that patients are unable to get out of bed on their own

The use of call bells is a reactive system that relies on patients to initiate communication that is not tied to typical care facility routines, such as meal times, bathing routines, therapy schedules, or medication regimens. Alternately, a system that employs nursing rounds establishes a consistent and proactive means for nurse-patient communication.

Salch, B.S., Nusair, H. Zubadi, A. Shloul, S. & Salch, U. (2011, June). 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. doi: 10.1111/j.1440-172X.2011.01938.x.

A number of studies have examined the relation between call bells, nursing rounds and patient satisfaction (Mitchell, et al., 2014; Salch, et al., 2011)). The study by Salch, et al. (2011) is remarkable as it illustrated the remarkable improvement when a rehabilitation center initially implemented nursing rounds on a strict schedule every hour or every two hours. The findings after the implementation of nursing round system (NRS) showed significant reductions in call bell use (P < 0.001), the incidence rate for falls (P < 0.01), with pressure ulcers dropping by 50%. In addition, following implementation of NRS, patient satisfaction increased by for five of the seven men patients in the stroke rehabilitation unit (P

Mitchell, M.D., Lavenberg, J.G., Trotta, R.L. & Umscheid, C.A. (2014, September). Hourly rounding to improve nursing responsiveness: a systematic review.

Journal of Nursing Administration, 44(9), 462-72. doi: 10.1097/NNA.