Did you miss the latest #WeNurses chat discussing rounding? Let us sum it up for you…
When I first started as student nurse in the 1990s we were taught about holistic care and that the Primary Nursing system was a great way of providing holistic care. The idea was that each patient had a named nurse who was responsible for all their care - in theory it was great but in reality it wasn’t. Often patients would never meet their named nurse due to shift patterns of nurses.
Something I remember clearly though was that we all were hugely in favour of this system compared to the old rounding and task allocated care system and really couldn’t believe that nursing rounds ever really provided holistic care, but here we are now in 2012 advocating rounding! What has happened? Can rounding really provide holistic care? The recent #WeNurses chat set out to explore these issues.
This chat started by asking “Does anyone have any experience with intentional rounding (IR)?” which immediately sparked off some interesting debate:
@IanIreland tweeted “Intentional rounding was the norm when I was a student - yes I am old” and added “It lacked personalisation - but jobs like obs and fluids got done.”
@TildaMc stated “Then we were told to individualise care reather than doing “rounds”“
@cherylwilson2 said “Did the rounds 2 hourly in my day!”
@princessandtoad added “I think it should go back to it then patients wouldnt be missed and vital obs and changes wouldnt be missed”
@Caltwit said “Calvin here ITU nurse, the nature of critical care means we are constantly rounding”
@sroo91 tweeted “I recently completed placement in a ward which used intentional rounding must say it was there was great outcomes”
@princessandtoad said “But needs personlisation to patients care & not focused on the illness and make sure each patient has the time they require”
@TildaMc said “I hope when introduced to my ward we will have evidence that a lot of patients are attended to more than 2 hourly”
@studentnurdse tweeted “It was trialed on my last placement with 2 staff IR & 2 washing at same time. It should start after washes IMO” and went on to say “When IR was trialled IR and documentation became the priority rather than what it stands for, patient care”.
@WeNurses then asked “What are the benefits of IR?”
@sroo91 tweeted “IR’s will let us know our patients not just encourage us to rely on handover alone.”
#nursefriendly @sroo91 “If time is allotted for frequent rounding, yes there are many benefits. What will we not do though?”
@justgracephiri stated “In the mist of all the busy atmosphere on most wards, IR gives a chance to pay attention to any needs the pt might have”
@saraloukeogh said “The ‘non complainers’ don’t get missed!?”
@TildaMc tweeted “Often the “quiet ones” who have something going on we need to know about”
@michellemellor3 said “Benefits include, imp in clinical outcomes, red in pressure ulcers, incr in pt satisfaction, red in complaints etc”
@HarmFreeHeather stated “It looks like from the tweets that another benefit of IR is that it gives job satisfaction. Feeling like a nurse is the best”
@Bartontd then raised the important issue of patient safety: “Our great mistake was to that that TASK allocation did not individualise care - in fact it was a foundation for SAFE care”
@maidenturret tweeted “Hi principle behind IR is grounded in patient safety methodology of consistent, reliable processes = +ve outcomes :) patients”
@nursefriendly stated “The high number of #Hospital #Acquired #Infections, falls, other preventable complications merit checking on #patients”
@Bartontd said “For me the whole things rests on that fine line between holistic care and safe care - we need both / IR brings elements of safety”
@HarmFreeHeather added “IR in mental health is key to maintaining patient safety”
WeNurses then asked what do we need to make intentional rounding work?
@cherylwilson2 said “Teamwork and commitment and empathy to individuals need!”
@samabdulla added “There needs to be honesty in the communication. A nurses minute can be an awfully long time!”
@Bartontd then asked “Anyone remember “Primary Nursing” ! Every patient with their own personalised nurse!”
@TildaMc replied “Yes except I was “Primary Nurse” for 12 patients. Paper exercise.”
@Caltwit said “Oh yes I do it was the ‘in thing’ when I started training”
@samabdulla tweeted “I know places that still use named nurse system. Means ^ awareness and helps make sure pts needs are met”
@LeggeAngie said “Yes - I trained with primary nursing. I would use IR as a way of keeping an eye on them all!”
WeNurses then asked is Intentional rounding seen as another ‘fad’?
@stevens_jan responded by saying ”! Care rounds shouldn’t be viewed as fad or add on. offers chance to rethink how to organise care to interact with pts more often”
@TildaMc added “If IR allows RGN’s more contact time it has to be a good thing”
@LeggeAngie tweeted “IR, for me, is also about engaging the patient in their care. That has to be a good thing”
@stevens_jan then tweeted “At heart of Care rounds is regular interaction rather than just ad hoc intervention. They can facilitate more reliable care”
WeNurses then asked for some examples of the good stuff around intentional rounding:
@TheGypsyNurse tweeted “I believe that pt’s call less when they know when nurse will round. It’s about trust”
@Bartontd stated “I had a hip replacement last wk - I was IR’d by the team - & they were lovely, prof and nice nurses. Got analgesia on time!”
@kathjlo said “It works well generally in my area but there comes a time in the day when you know you’ve not ticked boxes but care still given”
@stevens_jan tweeted “I have seen how care rounds can help reduce falls, pressure ulcers, nos. of call bells ,complaints & improve pt confidence”
WeNurses then asked for participants’ final thoughts:
@maxwele2 said “Remember than it enhances rather than replaces personalised care”
@TildaMc tweeted “Make sure it doesn’t degenerate into a paper exercise and remains meaningful patient”
@LeggeAngie agreed “Absolutely. IR can enable us to give more personalised care as we have those moments at the bedside.”
@HarmFreeHeather said “Be an ambassador of all the benefits of IR, roll model it in action and look to make improvements from what you find”
I have to admit that when I first heard about intentional rounding I was sceptical. My views stem from my days as a student nurse when it was drummed into us that rounding was a bad thing. It was a YouTube video that someone had tweeted about that helped to change my mind: New Adventures In Hourly Rounding.
The video shows a comparison between a nurse and patient where hourly rounding is used and not used. The video is amusing but carries an important message: when rounding is used, both the patient and the nurse feel care is being given well; where rounding is not used, the patient suffers and the nurse is stressed.
I have often felt like the stressed nurse in the video but these days with the use of hourly rounding I feel more like the other nurse. I feel that with intentional rounding we can take the best of the old and the new and provide holistic care - but it takes us to do it.
@mellor3 summed up my thoughts when she tweeted “IR can be ‘holistic’, depends on the motivation & determination of #nurse to make it work”.