This paper examines the case for shifting nursing rounding practices toward hourly or more predictable schedules, framed within the broader movement toward evidence-based practice in medicine. Drawing on multiple studies, the paper outlines two viable pilot study designs for evaluating such a change and discusses the importance of staff education and buy-in before implementation. Research by Melnyk, Baker, Sidani and Braden, Gardner, and Davies is reviewed to support the argument that increased and predictable staff-patient contact improves patient well-being, reduces falls, enhances compliance, and lowers staff stress. The paper concludes that evidence-based rounding reforms benefit both patients and healthcare professionals.
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Every community has a set of conventions that help govern both how people behave and what beliefs they hold. The conventions that are important to a group — which may also be called the culture of a profession or organization — mean that it can be very difficult to bring about change in the way that individuals act. This is no less true for medical professionals than for any other group; indeed, medical professionals may be even more resistant to change than others, since the consequences of their actions can mean life or death. However, sometimes it is in the best interests of patients — as well as of the medical professionals themselves — that they change the way in which they work.
The most important development in the culture of medicine over the last decade is a shift toward an ever-greater reliance on evidence-based practice. This requires medical professionals to examine how effective their practices are, based not on any intuitive sense of efficacy but on a careful review of actual outcomes. This paper examines the data on one potential shift in nursing practice: how rounds are conducted. Rosswrum and Larrabee (1999) note that the essential elements of a shift to evidence-based practice include the requirement that medical professionals remain current on the most recent research.
The authors also write that this shift to evidence-based practice requires a much closer association between clinical practitioners and researchers than has historically been the case. Academic research has always informed medical practice, but at a remove — with clinicians in general not giving significant credence to research they considered disjoint from the real-world conditions they face. The subject of this paper is an excellent example of the ways in which practice must be informed by research and, at the same time, of the very high degree of difficulty involved in getting clinicians and researchers to understand that they are in fact on the same team. As Rosswrum and Larrabee (1999) write: "practitioners continue to have difficulty with synthesizing empirical and contextual evidence and with integrating evidence-based changes into practice."
A pilot study to determine the effectiveness of a change in rounding practice must be grounded in the rules of evidence-based practice. The conditions of such a pilot study are relatively straightforward to determine, although there are several different research designs that could be implemented and would be equally valid and reliable. One possible research design would be to survey the feelings of both patients and staff regarding the current (non-hourly) rounding and then again after a shift to hourly rounding, alongside detailed documentation of patient outcomes. The fact that the same locale, with many of the same professionals and the same basic patient population, would be used throughout is a distinct strength of this research design.
Another equally valid research design for such a pilot study would be to implement a shift in rounding policy in one setting that is comparable to another in every significant way, except that the second setting retains its traditional form of rounding. In this case, patient and staff satisfaction would also be assessed, along with an evaluation of patient outcomes in both settings.
Before such a pilot program is launched, it will be essential to educate the professionals who are being asked to shift their practice. Providing evidence on the effectiveness of such a shift will reduce friction and help increase staff compliance. Many members of the staff may — and indeed are likely to — be resistant to such changes. However, given that medical professionals are dedicated to improving patient outcomes, once they are provided with documentation that new rounding procedures are likely to produce better results, they are more likely to be willing to try them.
"Studies linking rounding frequency to better outcomes"
"Predictable contact reduces falls and improves control"
Having staff contact with patients be unpredictable increases patient stress and decreases compliance, both of which in turn increase stress on staff. Changes in nursing rounding can significantly improve both patient and staff outcomes, and the weight of evidence supports the value of conducting a well-designed pilot study to confirm these benefits in specific institutional contexts.
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