Hourly Nursing Rounds and Patient Satisfaction

Review of Literature

According to an experimental study conducted by Krouse (1991), negotiated and non-negotiated nurse-patient interactive styles were implemented to compare differences and effectiveness. Ninety-eight undergraduate students with upper respiratory symptoms were asked to participate in the experimental study. The actively negotiated interactive style consisted of collaboration and agreement on patient plan of care. The non-negotiated interactive style consisted of limited nurse-patient interactions (Krouse, 1991). Research results revealed that patient perceptions of negotiated nurse-patient interaction were significantly greater than perceptions of non-negotiated nurse-patient interaction. Overall, the results of this study illustrated that increased interaction and patient involvement in planning and management of care enhance the level of patient satisfaction with the delivery of healthcare (Krouse, 1991).

Another study conducted by Lange (1999) investigated whether hospital patients could differentiate between a licensed nurse and unlicensed assistive personnel and the correlation to the level of patient satisfaction with nursing care. The LaMonica-Oberst Patient Satisfaction Scale was revised and altered to develop a measuring tool for patient knowledge regarding recognition of licensed nurses and unlicensed assistants. Research results revealed a correlation between patient satisfaction with nursing care and identification of licensed nurses, with 72 percent of one hundred alert and oriented adults identifying their licensed nurse (Lange, 1999). Lange (1999) continues to discuss the importance of caregivers educating patients about their roles and providing this information to ensure understanding of nurse competencies, resulting in patient satisfaction with the orientation of nursing care.

According to a quasi-experimental study performed nationwide by Meade, Bursell, and Ketelsen (2006), one-hour and two-hour nursing rounds were completed to determine effectiveness on management of patient care, patient safety, patient satisfaction, and the reasoning underlying frequent call light use. Research results revealed that the two major reasons for call light use were for personal needs assistance and repositioning and mobility assistance, with a decrease in call light use for these reasons by conducting hourly nursing rounds (Meade et al., 2006). Results on patient safety revealed that with hourly nursing rounds, a significant reduction in patient falls was noted. Results concerning patient satisfaction demonstrated a significant increase with both one-hour and two-hour rounds, with hourly nursing rounds being more effective in the level of patient satisfaction among surveys (Meade et al., 2006). Reevaluation of the hourly nursing rounds revealed that 85.7 percent continued the nursing practice, 92.8 percent decided to expand the nursing practice to other hospital units, and patient satisfaction scores reflecting overall quality of healthcare continued to increase with an "excellent" rating over the year (Meade et al., 2006).

Wireless telephone systems represent another alternative solution for increasing nurse-patient interaction. According to SpectraLink (2005), wireless telephone systems allow nurse response time to patient needs to decrease and increase the amount of time with patients, thus enhancing the management of patient care and level of satisfaction (SpectraLink, 2005). Wireless telephone systems have potential for resolving the nurse-patient interaction issue, but also have potential for abuse in nurses receiving personal phone calls or legal issues regarding patient confidentiality and patient information disclosed when another patient is in the room.

Ulrich (2006) discusses evidence-based design, known as a constructional change in the architectural design of hospitals, as an alternative solution that has the potential to improve medical outcomes such as increasing nurse-patient contact, increasing patient satisfaction with care, and increasing overall effectiveness in delivering healthcare. Poor design of hospital units decreases patient safety due to staff fatigue and stress related to large amounts of time spent searching for and gathering supplies and activities (Ulrich, 2006). Ulrich (2006) states that research reveals decentralized nursing observation stations largely decrease nurse travel time and greatly increase nurse-patient interaction and care time. Although this alternative solution has potential for positive outcomes in resolving the nurse-patient interaction issue, some hospitals are at a disadvantage when discussing the expenses of spending a large lump sum for remodeling and construction purposes.

After evaluation of alternative solutions included in the selected research, the selected solution for implementation is hourly nursing rounds to increase nurse-patient interaction and level of patient satisfaction. By performing hourly nursing rounds, there is an increase in nurse-patient interaction and communication. The hourly nursing rounds will allow nurses to perform patient checks more frequently, increasing the safety of the patient. Additionally, hourly nursing rounds will allow nurses to interact with their patients more frequently to meet the physical and emotional needs of the patient, increasing the level of patient satisfaction.

Literature Analysis and Selected Solution

Although there are several advantages to hourly nursing rounds, all alternative solutions reveal some disadvantages. Performing hourly nursing rounds could reduce the amount of time nurses have and need to complete other essential nursing tasks. Nurses would have to increase walking time and distance to perform the additional nursing rounds. Lastly, nurses could perceive hourly nursing rounds as an inconvenience and interruption of their routine schedule and completely resist planned change.

Prior to implementation of the selected solution, several objectives with measurable criteria will be created to effectively evaluate and determine the success or failure of the action plan. Collaboration among the change agent and the affected nursing staff will be arranged to develop these objectives together for the overall goal that all affected registered nurses will complete hourly nursing rounds. Measurable objectives for the overall goal are as follows: all affected registered nurses will verbalize understanding of actions on a laminated pocket card prior to each scheduled date to implement the planned change. All affected registered nurses will leave printed cards on patient bedside tables to ensure hourly nursing rounds were completed while patients were resting during their shift. All affected registered nurses will sign the rounding boards outside patient rooms for monitoring and evaluating purposes.

Planning Objectives

Change agents commonly utilize change strategies to effectively influence change among other members affected by the planned change (Marquis & Huston, 2006). To effect change within the organization, rational-empirical strategies will be utilized to present to the nurse manager and supervisor, and nursing staff current evidence-based research conveying support of increasing nurse-patient interaction and the positive correlation with alternative solutions such as performing hourly nursing rounds. If resistance is the response to this change, one strategy to manage change resistance is to encourage group members to openly express their perception about the planned change to open new alternative solutions to approach the resistance and rejection (Marquis & Huston, 2006). Upon agreement to the hourly nursing rounds solution, all nursing staff will collaborate to establish the goals and objectives, discuss study monitoring and evaluation tools to accurately measure objectives, develop and discuss appropriate strategies, and set a schedule of dates for implementing the planned change (Marquis & Huston, 2006).

Implementation Strategies

Another change strategy that will be utilized to effect the planned change is normative-re-educative strategies (Marquis & Huston, 2006). The change agent identifies the innovators in the group to form interpersonal relationships with the rejecters. Through forming these interpersonal relationships with the rejecters, they will be able to influence their perception, attitudes, and feelings concerning the planned change. Not only is the change agent utilizing this strategy, but assistance of the innovators establishes a stronger influential atmosphere and environment for the rejecters, increasing the likelihood of behavior change (Marquis & Huston, 2006).

To reinforce and assist nursing staff to continually practice hourly nursing rounds, the nursing staff will be provided with laminated pocket cards of actions to perform during the hourly rounds (Meade et al., 2006). Rounding boards will be mounted on the outside of patient rooms to reinforce the nursing staff and also provide as a monitoring and evaluation tool to ensure hourly nursing rounds are performed (Meade et al., 2006). Also, to involve patients and increase the level of patient satisfaction, cards will be printed and left on patient bedside tables to assure patients who were resting that hourly nursing rounds were performed (Meade et al., 2006).

Evaluation of the action plan would be completed to determine success and/or failure with the created measurable objectives and achievement of the overall goal. Evaluation of these objectives will be performed at three months and six months to evaluate progress and effectiveness of the planned change. Success of the overall goal will be evaluated by achievement of the created objectives by monitoring the signatures on the rounding boards outside patient rooms and leaving a printed card on the patient bedside table confirming completion of hourly nursing rounds during patient rest.