Intentional Rounding

Project Lead: Professor Ruth Harris, Professor of Health Care for Older Adults, King’s College London

What it is:

Originating in the US, ‘intentional rounding’ is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round. The aim of our research was to find out what it is about intentional rounding that works, for whom and in what circumstances. It set out to understand how intentional rounding works when used with different types of patients, by different nurses, in diverse ward and hospital settings, and if and how these differences influence outcomes.

What we did:

The study methods included: an evidence review to create a theory of why intentional rounding may work; a national survey of how intentional rounding had been implemented; a case study evaluation investigating the perspectives of senior managers, nursing and other health-care professionals, patients and carers; observations of intentional rounding being undertaken; and an analysis of costs.

What we found:

Our survey found that 97% of NHS trusts had implemented intentional rounding, although with considerable variation. Fidelity to the intentional rounding protocol was observed to be low. All nursing staff thought intentional rounding should be tailored to individual patient need and not delivered in a standardised way. Few nurses felt intentional rounding improved either the quality or frequency of their interactions with patients; they perceived the main benefit of intentional rounding was the documented evidence of care delivery despite concerns that documentation was not always reliable. Patients and carers valued the relational aspects of communication with staff, however, this was rarely linked to intentional rounding. It is suggested that these results should feed into a wider conversation and review of intentional rounding.

Final report:

Harris R, Sims S, Leamy M, Levenson R, Davies N, Brearley S, et al. Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation. Health Serv Deliv Res 2019;7(35). Available here

Ruth is a nurse and health service researcher. Her research focuses on understanding how complex nursing and interprofessional interventions contribute to healthcare delivery, patient outcome, and patient experience of care, particularly for older people and those with long term conditions.

Ruth graduated as a registered nurse with a BSc (Hons) at King’s College London before completing a MSc and PhD, also at King’s. Her clinical background is in acute medical nursing and care of older people.

Published papers:
Sims S, Leamy M, Levenson R, Brearley S, Ross F, Harris R (2020) The delivery of compassionate nursing care in a tick-box culture: Qualitative perspectives from a realist evaluation of intentional rounding. International Journal of Nursing Studies 107, July Accessed at: https://doi.org/10.1016/j.ijnurstu.2020.103580

Sims S, Leamy M, Davies N, Schnitzler K, Levenson R, Mayer F, Grant R, Brearley S, Gourlay S, Ross F, Harris R (2018) Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why. BMJ Qual Saf BMJ Qual Saf 2018;27:743-757. http://dx.doi.org/10.1136/bmjqs-2017-006757

Harris R, Sims S, Levenson R, Gourlay S, Ross F, Davies N, Brearley S, Favato G, Grant R (2017) What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol. BMJ Open 2017;7:e014776. doi: 10.1136/bmjopen-2016-014776 Accessed at: https://bmjopen.bmj.com/content/7/1/e014776

Podcast:
Nursing Standard podcast: what is intentional rounding – and is it worth doing? Ruth Harris talking with Richard Hatchett. Available here

For more information please contact: [email protected]