A realist synthesis of intentional rounding in hospital wards: Exploring the evidence of what works, for whom, in what circumstances and why

Article


Sims, Sarah, Davies, N., Schnitzler, Katy, Levenson, Ros, Mayer, Felicity, Grant, Robert, Brearley, Sally, Gourlay, Stephen, Ross, Fiona and Harris, Ruth 2018. A realist synthesis of intentional rounding in hospital wards: Exploring the evidence of what works, for whom, in what circumstances and why. BMJ Quality and Safety. 27 (9), pp. 743-757.
AuthorsSims, Sarah, Davies, N., Schnitzler, Katy, Levenson, Ros, Mayer, Felicity, Grant, Robert, Brearley, Sally, Gourlay, Stephen, Ross, Fiona and Harris, Ruth
Abstract

Background Intentional rounding (IR) is a structured process whereby nurses conduct one to two hourly checks with every patient using a standardised protocol.

Objective A realist synthesis of the evidence on IR was undertaken to develop IR programme theories of what works, for whom, in what circumstances and why.

Methods A three-stage literature search and a stakeholder consultation event was completed. A variety of sources were searched, including AMED, CINAHL, MEDLINE, PsycINFO, HMIC, Google and Google Scholar, for published and unpublished literature. In line with realist synthesis methodology, each study’s ‘fitness for purpose’ was assessed by considering its relevance and rigour.

Results A total of 44 papers met the inclusion criteria. To make the programme theories underpinning IR explicit, we identified eight a priori propositions: (1) when implemented in a comprehensive and consistent way, IR improves healthcare quality and satisfaction, and reduces potential harms; (2) embedding IR into daily routine practice gives nurses ‘allocated time to care’; (3) documenting IR checks increases accountability and raises fundamental standards of care; (4) when workload and staffing levels permit, more frequent nurse–patient contact improves relationships and increases awareness of patient comfort and safety needs; (5) increasing time when nurses are in the direct vicinity of patients promotes vigilance, provides reassurance and reduces potential harms; (6) more frequent nurse–patient contact enables nurses to anticipate patient needs and take pre-emptive action; (7) IR documentation facilitates teamwork and communication; and (8) IR empowers patients to ask for what they need to maintain their comfort and well-being. Given the limited evidence base, further research is needed to test and further refine these propositions.

Conclusions Despite widespread use of IR, this paper highlights the paradox that there is ambiguity surrounding its purpose and limited evidence of how it works in practice.

JournalBMJ Quality and Safety
Journal citation27 (9), pp. 743-757
ISSN2044-5415
Year2018
PublisherBMJ Publishing Group
Accepted author manuscript
File Access Level
Repository staff only
Publisher's version
License
Digital Object Identifier (DOI)doi:10.1136/bmjqs-2017-006757
Publication dates
Online14 Mar 2018
Publication process dates
Deposited14 Mar 2018
Accepted21 Jan 2018
Accepted21 Jan 2018
Copyright information© 2018 The authors
LicenseCC BY 4.0
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