Student nurse James Merrell discusses engaging staff with intentional rounding and the moral and ethical implications it carries
Intentional rounding (IR) is the process of systematically reviewing all patients to make sure their fundamental nursing needs are met. Rounds are undertaken hourly or two hourly depending on patients’ needs, by either a registered nurse or a health care assistant.
I was involved in rolling out training in IR within a local NHS Trust with the aim of empowering staff to make positive changes to enhance patients’ experience. I found that nurses enjoyed the structure that rounding gives them and that patients benefit from knowing that they will see someone at least every two hours who is able to help and support them.
We started the training by arranging to meet with all ward staff on an individual basis or a group meeting if they prefered. This gave them opportunity to discuss their thoughts, feelings, concerns and aspirations around IR. By doing this, we enabled the team to own the problem and the solution, and to challenge current practice in a positive way. They were then able to implement this new way of working without instruction or oversight.
Staff felt that IR was being implemented to make up for inability of staff on wards due to lack of numbers. However, IR is not a substitute for adequate staffing, it is both time-consuming and labour-intensive and can never work effectively if there are not enough staff to carry it out. This was stressed and is an important consideration for every trust.
As I learnt more about IR myself, I realised the importance of all patients regardless of age, sex, level of vulnerability or illness receiving it. It needs to be a speedy, simple process, that incorporates the essentials of nursing.
The Patients’ Association (2013) state they are pleased by the number of trusts who have formally adopted a system of IR (or equivelent). However, they issued a statement earlier this year saying they are becoming increasingly concerned that commitment to IR varies across the UK. They also mention that due to some trusts implemeting their own version of IR, the fundamental principles are being forgotten, such as not all patients being treated as equal and some staff unsure who is suitable to recieve IR. This could result in some patients receiving less support and attention from nursing staff, and could become difficult to maintain if budget cuts increase pressure on staffing levels.
I think all patients should receive intentional rounding as all patients are vulnerable to some extent while under health and social care services. In my opinion, those who appear independent and able to voice their needs sometimes receive less care and support.
Nurses conduct themselves in an ethical and responsible manner, treating each and every patient with the respect and dignity they deserve and IR helps them to do this. However, it is still a work in progress.
What are your thoughts regarding the moral and ethical considerations in IR? Do you feel that it would be right to allow some patients to receive standard nursing care or do you feel that all patients should be treated as equal?
James Merrell is a third year nursing student at Bournemouth University