Posted Monday 22 December 2014
A regular visit from a nurse can feel like a lifeline to a person lying in a hospital bed, but researchers from Kingston University and St George's, University of London are examining whether hourly ward rounds really do help deliver safe, compassionate, patient-centred care.
Led by Professor Ruth Harris from the Faculty of Health Social Care and Education, run jointly by Kingston and St George's, the study will examine whether regular, systematic visits by nurses to all patients on a ward are, in fact, beneficial.
The Francis Inquiry report into the failings at Mid Staffordshire NHS Trust had recommended hourly or two hourly ward rounds should be introduced to systemise contact between nurses and patients, Professor Harris explained. "This practice, known as intentional rounding, has been adopted by many NHS trusts across England, although the way it is implemented varies widely. Despite its popularity, there is little reliable evidence to show the system improves the quality of care patients receive," she said.
Intuitively it might seem like a good idea to have some sort of contact with patients every hour, but there was not strong evidence to show that was actually the case, Professor Harris said. "Some people may need more contact with nursing staff, others may have needs between those hourly or two-hourly checks and some may not need to be visited quite as frequently. The biggest danger with intentional rounding is that it becomes a tick box exercise and is not delivered in a way which will benefit patients," she added.
The concept of hourly rounds was not new, Professor Harris said. Comfort rounds or care rounds, where one or two nurses were responsible for carrying out periodic checks on all patients on a ward, had beengoing on for many years. However, intentional rounding was a more structured version of this process, using a standardised set of checks and questions. They included checks on how a person was positioned in bed, whether they needed help to access the toilet, what level of pain they were experiencing and whether they had the items they needed within easy reach, she explained.
Professor Harris and her team received a grant of almost £450,000 from the National Institute of Health Research. They will survey all NHS trusts in England to find out how many have adopted a system of ward rounds and how these are being implemented. The research team will then select both an acute and an elderly care ward in three different hospitals to conduct further, in-depth research with staff, patients and those close to them. They will observe how ward rounds are undertaken - whether by one member of staff or several and whether those staff are qualified nurses or healthcare assistants. They will examine how the rounds fit with other staff commitments, such as caring for individual patients and attending team meetings and training. They will also talk to staff and patients to get their views on whether the rounds improve their experiences. The team hopes to discover what works well, and in what circumstances, and aims to produce a set of good practice guidelines that can be shared with all healthcare trusts.
Over recent years care on hospital wards has become increasingly individualised. Nurses are allocated specific patients to look after, rather than performing particular tasks for a number of patients. An increasing emphasis on dignity and privacy has led to a shift away from large, nightingale-style wards. Newly designed wards have smaller bays and more single rooms, meaning there are fewer opportunities for patients to glance up and attract a nurse's attention, Professor Harris explained. "With all of this in mind, having regular checks on all patients may seem sensible, but this may not necessarily help improve care or increase compassion," she said. "We expect to find there are some places or circumstances where these regular checks on patients are important. They can lead to improved relationships between staff and those they care for, helping to build trust and reassure those who feel vulnerable," Professor Harris said. "However, we also may find that, in some cases, these checks are resource-intensive and do little to improve patient care, confidence or safety."
Acute trusts could be very stressful places to work and it was important to understand how new systems affected staff and how different ways of working fitted with what people were already doing, Professor Harris explained. This research will begin to address some of these issues and will help trusts to make more informed decisions about how best to organise resources and ensure the effort of all staff is used in the most effective way.
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