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Evidence supporting intentional rounding only 'flimsy', claims academic


There is only “flimsy” evidence to support the benefit of introducing hourly ward wards, despite their backing by the prime minister, a nurse academic has claimed.

The government’s initial response to the Mid Staffordshire Foundation Trust Public Inquiry report, published week stated that the majority of NHS hospitals in England have introduced hour by hour nursing rounds on their wards.

It added that targeted action plans for the new national nursing strategy, Compassion in Practice, will urge the remaining hospitals to do so within a year. In addition, it said nursing rounds would be one of the “well-established practices that benefit patients”, which will be the focus of a new hospital inspection regime.

Intentional rounding by nurses has also been championed by David Cameron who called for their wider uptake in January last year when he set up the Nursing and Care Quality Forum.

But Paul Snelling, a senior lecturer in adult nursing at the University of the West of England, claimed the intervention was based on “weak and inconclusive” evidence.

After carrying out a research review, Mr Snelling said the study that provided the most influential evidence in favour of intentional rounding was “flawed” because two of its authors worked for a US private healthcare company that sold DVDs promoting intentional rounding.

He also said “caution should be exercised” over suggestions that intentional rounding cut falls due to “mixed” and that there did “not appear to be a single good quality study” to support claims that it reduced pressure sores.

Mr Snellings findings were published last month in the journal Nursing Ethics and this week he writes on the topic in Nursing Times.

But a Department of Health spokeswoman said regular nursing rounds have a “key role to play in care in the NHS”.

“They systematically check that patients are comfortable, are helped to eat and drink, are treated with dignity and respect and have confidence that they can talk to staff on a regular basis about their care and concerns,” she said.

“Hospitals that have put these rounds in place have reported healthy reductions in the number of patient complaints and significant improvements in patient satisfaction levels,” she added. 


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Readers' comments (37)

  • we already 'systematically' check to ensure our patients are comfortable, are offered something to eat or drink and are treated with respect and dignity at all times. on our ward I wonder if we need another piece of paper with an hourly tick on it.

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  • No we definitely do not. For Cameron to champion them and then have trusts introduce them, just shows that those not on the shop floor havn't got a clue about the reality of nursing today.

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  • This is very much the same conclusion that the National Nursing Research Unit reached in the recent Policy Plus:

    My view is that nursing needs fewer 'quick-fix' solutions being put forward, and more robust policies to deal with underlying issues that we know affect the quality of care - such as SAFE STAFFING LEVELs. Regularly checking patients needs are met and that they are comfortable is intrinsic to good quality nursing care. We need to make sure that what is needed to deliver that good quality care is in place, rather than add in another 'tick-box' activity, designed to monitor activity rather than enable it.

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  • I think it is a sad state of affairs that hourly rounding has to be even suggested! Flimsy evidence there may be but I do know that there are patients who are not as lucky, (should it be luck?), and have nurses who talk to and check the patients even as often as hourly. If it even highlights to nurses the importance of checking your patients then it provides a start. The mindset of nursing training has to change to include instilling these principles from the beginning. Only then will nursing accountability, understanding of caring and compassion and 'nursing diagnosis' will return. This however, will take time to become embedded. Hourly rounding is certainly another tick box exercise as without auditing the patients views, to see if they were seen on an hourly basis we will never know if it actually happens. Can we think of an alternative to improve care at the moment? I think it is worth a try but please, please audit the value of it.

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  • The hospital is not a factory where the foreman goes round hourly with his tick boxes, to show that all equiptment is functioning.
    Please Mr Cameron give us nurses some credit we are not all horrible thick headed fools.
    We have good nurse education in this country which drums into our heads to prioritise ALL the time, and maintain a check on all our patients in a safe order of supervision.
    A professional nurse is able care for the critical patient and still be able to remember when to go to his/her other patients, who are not so critical. It takes training to be able to have this ability not a blxxxy tick box.
    What can be of some assistance however, without having to interrupt the nurses' work pattern is to have the Ward Manager do this hourly round while he/she is supervising every one on his/her ward including the cleaners and also while teaching patients, nurses and carers.

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  • Anonymous | 3-Apr-2013 4:23 pm

    I think the government would prefer that hospitals are run like factories with automatons who don't argue instead of staff who rely on their own intuition and reflective practice, arising from good training and professional experience, which is far less predictable.

    It seems automatism has taken over the modern management mind and is equated with efficiency rather than having to listen to what people say when they express either or both openly or covertly their needs and wishes.

    Maybe in the government's ideal narrow world they really do believe that hospitals run in this way would save costs - which may possibly be the case in the short term, but would create total havoc and disaster in the longer term but then they have already demonstrated how very short-sighted they are, especially when peering through their rose-coloured lenses.

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  • The Prime Minister is seen by people knowledgeable on nursing matters by mentioning rounding.

    Most people have no idea what a nurse does anyway so the PM can get away by saying anything.

    The only people who disagree are the nurses, who are experts and nobody listens to them anyway.

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  • All these rounds are taking us back years!!!!!
    What we need to prevent nursing by rote reappearing are more staff. both in the Public and the private sectors

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  • hca's do that now ! with added paper work
    while nurses do their own thing.
    hca come do their work to a high standard then go home by this time many have had enough because if you have a stressed nurse the whole day is hell!!!!!!

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  • Anonymous | 4-Apr-2013 9:43 am

    HCAs with an attitude can also make the whole hellish!!

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