Have you ever heard the saying ‘what is old is new again’? Some 30 years ago nurses did frequent back rounds. Despite its title it wasn’t just limited to back care – it included making sure patients were comfortable and had everything they needed.
Sweeping across the US, UK and Australia is a nursing concept branded Intentional Rounding. Its being promoted by governments and organisations alike in an effort to release nurses back to the bedside as part of transforming care at the bedside. The promoted benefits are happier patients, less falls, less incidences of incontinence episodes and pressure areas, less call bell usage and increased satisfaction of nurses.
Implementing intentional rounding does not bring with it additional nursing labour resources. It’s what government and health executive management call cost neutral. Intentional Rounding is about changing nursing practise from reactive (responding to calls for assistance/clinical incidents which are unplanned) to proactive (checking in and providing assistance which is planned).
Falls, episodes of incontinence and pressure areas are costly not only for the patient but also for health organisations. Nursing labour resources associated with each can be significant in terms of time and cost of care. The assumption is that if there is decreased falls, pressure areas and episodes of incontinence due to intentional rounding this will provide additional time more than sufficient for nurses to attend (and document) hourly rounding.
An add-on value to intentional rounding has been shown to be happy patients. Happy patients make less demands and are less likely to complain even if things don’t go 100% well. Patients and their families/carers are more likely to be forgiving of minor mistakes and miscommunication.
The literature out there in the health care domain does not necessarily fully support all the promotional aspects of intentional rounding. There have been several studies done primarily since 2006 which was very positive about the benefits of intentional rounding. In recent years however the literature has identified issues with the original US research studies methodologies and also highlighting the differences in nursing roles across USA and UK where the bulk of the research has originated.
Anecdotally surely all agree that if a patient is checked each hour and all their care needs are met at the time that it is highly beneficial and worth any cost. There can be no disagreement with this as the studies do show real benefits in reduced falls and pressure area rates etc.
Dissension within the literature is related to the implementation of intentional rounding. As stated in several studies in recent years it needs to be flexible enough for nurses to have a voice in what Intentional Rounding looks like within their individual workplace based on their patient unique needs. This will facilitate nurses engagement and most assuredly provide sustainability of Intentional Rounding.
Interestingly what has not been discussed in the literature is potentially the legal fraternity using hourly rounding ie lack of full compliance or documentation as grounds for allegations of negligence against the individual nurse. This would certainly make for an interesting qualitative study involving nurses and lawyers.