Hourly rounding is something that has been around for a while. One of the first things we learned in nursing school was that you should check on your patient every hour or every 2 hours (depending on nursing aid assistance). I started my research by looking at what hourly rounding entails. From there I found the majority of articles that think hourly rounding really does affect patient care and only a few opinion articles that think the opposite. Develop a focused question
Since there were so many articles on hourly rounding, picking through them to find ones that related to the direction I was going with my research was really difficult. The main question that came into my head when thinking about hourly rounding was, does it really make a difference in patient care or just patient satisfaction? Hourly rounding is used for an assortment of reasons. Anticipating patient’s needs before they have to ring the call bell, along with patient safety are key reasons for hourly rounding. The majority of the articles I found focused on patient satisfaction.
Although patient satisfaction is a huge deal, the direction I wanted to go was more with patient safety. Initial and related terms I started out my search by using phrases like “patient hourly round significance”, “why is hourly rounding important for patients”, and “how does hourly rounding affect patients”. This didn’t get me very many articles, so I tried a different approach. I broadened my search by just writing in “nursing hourly rounds” and “nursing rounds” and this got me a lot of articles on hourly rounding.
Evaluation of articles I found after reading my four articles, the critiquing using the Johns Hopkins form was pretty difficult. To me the forms are confusing because I don’t have a lot of experience using them or doing much research. All four articles that I chose to use had adequate information to help me come to a conclusion for the question I formulated. All four articles supported at least one finding from the other articles.
This helped me conclude that the research done was adequate information that could be used to evaluate the ore focus of my questions. The studies that were done or talked about in the articles were easy to pick out and straightforward. Identification of outcome Based on my research I learned that hourly rounding during the hours of 0600-2200 and 2-hour rounding from 2200-0600 is effective in providing patient safety, anticipating patients needs, decreasing the amount of call bell rings and increasing patient satisfaction. All of the articles had similar studies done to provide these conclusions.
The article that I found most helpful was Hourly Rounding: A Replication Study by Todd Olrich, Melanie Kalman and Cindy Nigolian. This article clearly stated the three studies that were done and their results. All the articles though had similar results, which is how I came to the conclusion that hourly rounding during the day and 2-hour rounding during the night is effective. “Results indicated both hourly and every 2-hour rounding decreased call-light usage and increased patient satisfaction.
Patient satisfaction increased significantly on the units from 79. 9 to 91. using a 100-point scale, patient call-light usage decreased significantly, and falls decreased only when rounding was done hourly” (Olrich, Kalman, Nigolian 2012). All but one of the articles talked about doing a base-line measurement first to see how often the call bells rang, how often patient’s fell and how satisfied they were with the care they were getting. The base-line measurement studies went on from 4-8 weeks before the actual studies began. This is a great way in my view to get an overall look at what happened before the hourly rounding was implemented and what happened after.
In one of the articles I chose, nurses had a hard time following the hourly rounding format. “Registered nurses and TPs from both study units overwhelmingly viewed hourly rounding as more work instead of a proactive process that might have benefits for them and their patients. However, some staff members did feel that hourly rounding was a good idea but difficult to accomplish because of competing priorities and tasks” (Deitrich, Baker, Paxton, Flores, Swavely 2011). This is the only article I found that the nurses had a hard time following the hourly rounding protocol.
All of my articles that I chose besides one were research articles. The only one that wasn’t was more of a review of other people’s work that had been done. Even though this article was only a review and only talked about the results that were found and not the actual studies that were done, the information was very relevant to my question and easy to understand. “In 5 of 6 studies (83%) that examined use of call lights, the use was reduced. Fall rates were reduced in 7 of 9 studies (77%) in which falls were evaluated.
In 8 of 9 studies (88%), researchers discovered improvements in overall patient satisfaction and likelihood of recommending the hospital, as well as satisfaction with anticipation and attention to personal needs, timeliness of nurses’ response, and management of pain” (Halm 2009). All four articles stated what the nurses and nurse’s aids did during hourly rounding and they were all very similar. Two articles said they attended to the “4 P’s”: pain, positioning, potty (elimination) and proximity of personal items.
The other two articles had similar actions during hourly rounding. Overall, the main actions done were: pain assessment, toileting, patient positioning and comfort, environmental check (call light, telephone, TV remote, water, tissue box within reach, bedside table close to bed, and floor free from clutter), and the last thing they all did was ask the patient if there was anything else they could do for them before they left the room and told the patient the next rounding would be in an hour.
After doing all of these things, patients overall were more satisfied with the care they got, falls were recorded less because patients weren’t trying to get up on their own, and call bells were going off less. Learning that occurred While doing this research project I learned that patient rounding is significant in increasing patient safety, satisfaction and decreases call bell use. Before this project I had an idea of why nurses checked on patients hourly, but these articles helped me better understand what really needs to me done on these checks besides toileting.
I also learned more about how to research a topic. I had a difficult time narrowing down my search but finally got the hang of it by going to the library for a little extra assistance. By being forced to use the Johns Hopkins forms, I learned more about filling them out. Although they are still a little confusing to me, this project helped me understand them more.
Conclusion My conclusion from all of this research is that hourly rounding is necessary to help keeps patients happy, healthy and safe. As a first year nursing student, a lot of the things we do in nursing are foreign to me and I’m constantly asking myself why nurses do things the way they do. This project helped me to pick one of those questions that I ask myself and really start to understand why. I really think this project helped to better my nursing career. Now that I fully understand hourly rounding, it will also help me to tend to my patients needs more.