Hourly Rounding: A strategy to improve patient satisfaction scores - Research Paper Example

?Literature Review The purpose of this paper is to ascertain whether hourly rounding by nursing professionals is an effective means for enhancing patient satisfaction scores in a health care environment. With patient satisfaction being an important factor to health care institutions, they employ innovate approaches. In the light of their frequent interaction with patients, the role played by nurses is an important avenue to explore for determining whether changes in the methods by which they go about playing their roles can be a source of increased patient satisfaction, with the mutual benefit of reduced effort in increasing patient satisfaction levels (Ford, 2010). From the perspective of a health care institution patient satisfaction is of critical importance. In addition to providing repute for the health care institution, the very existence of the health care institution depends on patient satisfaction. A past record of high levels of patient satisfaction is responsible for patients seeking health care services from the same health care institution. Dissatisfaction among patients would lead them to seeking their health care requirements from other health care institutions, where they believe they would derive better satisfaction of services provided. Word of mouth spreading of satisfaction would only lead to other patents seeking health care services from the institution. These aspects need to be looked upon from the growing demand of excellence in services received by health care service users. This only reinforces the need for health care service institutions to bring about changes in their approaches to provide services that meet the parameters of excellence form the consumers’ perspective. However, to achieve such an objective, it is necessary to discover the best means for achieving it (Grove, 2008). Hourly rounding originated in England, where such rounding by nurses is termed as patient comfort rounds. Hourly rounding by nurses follows a predetermined protocol, which is based on the four Ps of pain, personal needs, positioning and placement of patient care. During hourly rounding nurses in addition to providing care based on the 4Ps also look into issues of changing of dressings or giving medications and patient education. Hourly rounding is the basis of compassionate care and strengthening of the nurse patient relationship, wherein the key factor is the increase in anticipation of patient needs and providing the required attention for it (Charmel, Frameton, & Plantree, 2009). Hourly rounding by nurses has been recommended as a means to the objective of enhanced patient satisfaction. However, though the current literature on the effects of hourly rounding on patient satisfaction remains incomplete. Therefore any effort in adding to the body of knowledge on the benefits of nurses hourly rounding on patients will only assist in providing better evidence for its use in increasing patient satisfaction levels (Tea, Ellison & Feghall, 2008). The Studor Study Group, 2007, recommends the use of nurses hourly rounding as an approach to raise the level of patient satisfaction based on the experiences of increased patient satisfaction levels since introducing nurses hourly rounding at the Sacred Heart Hospital, Pensacola, FLA, since 2006. Theorist Jean Watson, 2005, lays the down the basis for nurses hourly rounding becoming useful in increasing patient satisfaction levels through the concept that care and love are strong, yet mysterious forces in nature. In this concept love and care for others has a strong interrelationship with spiritual inspiration for caring of the self. Caring at the individual level expands into the social level. Extrapolating this concept into the environment of the health care institutions involves incorporation of the care and love sciences into the clinical practices of the health care professionals, such that an environment for healing and rehabilitation results (Watson, 2005). McLaughlin and Bulla, 2010, suggest that hourly rounding not only offers benefits for patients in terms of enhanced satisfaction, but also offers benefits to nurses, Benefits identified by nursing professionals themselves include better ability of nursing professionals to anticipate patient needs arising from the four Ps of pain, personal needs, positioning and placement. By anticipating these needs and acting on them there were less call bells, and so there was better call bell response. Hourly rounding made it easier for nurses to prioritize and organize their work for better efficiency with lesser effort. Hourly rounding gave nurses a sense of empowerment. Hourly rounding thus not only has a positive influence on patient satisfaction, but also on the job satisfaction of better appreciation for the efforts put in by them, lesser strain on them, and a sense of satisfaction in what they are doing (McLaughlin & Bulla, 2010). The introduction of call bell or call lights is a change from the erstwhile practice of nursing keeping a constant eye on patients in their care in the wards. Changes in the infrastructure of hospitals have made it difficult for nurse to make use of the advantage of visual contact of patients to monitor their patients. Call bells or call lights became a necessity with the loss of the visual advantage to make it possible for be aware of patient care needs, and thus derive peace of mind. However, this necessity did not come without drawbacks for the nurses. Frequent use of the call bell or call lights by patients can be frustrating for the nurses, as it causes interruptions to their work schedules and time management, thus adding to stress in the care of their patients. Reduction in the frequent use of call lights and call bells reduce interruptions experienced by nurses to attend to their other tasks besides care to the patients that they provide. Any approached that reduce frequency of call bell or call light use thus increases the efficiency of nurses, and gives them more satisfaction in their patient care roles (Stowoski, 2008). Only a limited number of studies have been undertaken on the use of call lights by patients. This aspect is important in view of it pertaining to the elements of more effective patient care-management, patient safety, and patient satisfaction. Meade, Bursell, and Ketelsen, 2006 undertook a study to determine why patients used the call light and the frequency of use, and the impact of hourly and bi-hourly rounding of nurses call light use by patients, patient satisfaction, and patient safety as seen from the rate of falls. The study was designed on a quasi-experimental non-equivalent groups design and involved 27 nursing units from 14 hospitals spread all over the United States. In 15 of these nursing units hourly or bi-hourly rounding of nurses was introduced, while the remaining 12 units remained without nurses rounding as controls. The study was conducted over a period of six weeks. One hour rounding was undertaken by nurses between the period of 6am and 10pm, while bi-hourly rounding was undertaken between 10pm and 6.00 am. A hospital could also opt for bi-hourly rounding over the full 24 hour period. In the first two week period baseline conditions were established after which hourly or bi-hourly rounding protocols based on a pre-specified protocol having 12 directives were introduced. These protocol were determined through the 4ps of patient needs, and were made up of items of assessment of patient pain levels, providing toilet assistance, placing of items like telephone, TV remote control, garbage can, and water conveniently for patients, and reassurance of return in on or two hours depending on the protocol (Meade, Bursell & Ketelsen, 2006). The study found that that there was a significant reduction in the use of call light once hourly or bi-hourly rounding by nurses was introduced across all time periods and for different major reason categories. This can be seen from the case of serious medical concerns, which was 4,527 calls during the establishing of baseline conditions, which dropped to 3,398 in the first two weeks of hourly rounding, and dropped even further to 2,986 during the last two weeks. Besides decrease in use of call light, enhanced patient safety was observed through the drop in the number of patient falls. Another important finding of the study was that there was a significant increase in patient satisfaction. Based on these findings the study concluded that nursing rounds undertaken on an hourly or bi-hourly basis produces the effect of reduction in frequency of patients’ use of the call light, enhanced patient satisfaction for nursing care, and reduced patent falls. This has led to the recommendation for such an operational change in hospitals for better efficiency in patient-care management and improved patient satisfaction (Meade, Bursell & Ketelsen, 2006). The other interesting observation of the study pertained to the attitude of nurses to the introduction of nurses rounding. Nurses normally are not keen on changes in their clinical practices or care routines, since they perceive that they do not have the time for it. Therefore, there was initial resistance to the introduction of hourly rounding, and it needed strong nurse managers to enforce compliance and collaboration for hourly rounding. However, the experience of hourly rounding prompted the realization in nurses that it gave them more time actually for performing other tasks leading to their satisfaction with hourly rounding (Meade, Bursell & Ketelsen, 2006). The observation that there is the need for strong action by nursing managers and leaders to ensure compliance with hourly rounding initially is supported by the observation that behaviors steeped in value do not occur merely because of education and good orientation, but need vigilance and systems put in place to accomplish it (Kerfoot, 2009). The Madigan Army Medical Center is a level two trauma center that provides care for soldiers of the American Army and their beneficiaries, which is on the constant look out for enhancing the efficiency of patient care. In 2007, in an effort to enhance patient satisfaction through more efficiency in nursing care approaches a literature review and a study of the Meade, Bursell & Ketelsen, 2006, article was done. Based on the study and internal discussions it was found that nursing rounds could prove a solution to the problem of patient falls being experienced. A decision was taken to introduce nursing rounds and leaders for the change process identified for providing encouragement to their co-workers to facilitate the smooth implementation (Weisgram & Raymond, 2008). The Nursing Rounds Program consisted of the implementation of a 12-step process consistent with typical approaches to patient care in nursing education. Nursing education does advocate that an organized patient care approach by nursing can reduce the potential for harmful falls and enhance patient satisfaction. Integral elements to the 12-step process in the nursing rounds were essentially based on the 4Ps of patient care needs, and included evaluations of pain, toileting needs, positioning, and access to telephones, tissues, and trash can. Nursing rounds were to be undertaken on an hourly basis between the times of 8.00 am and 10.pm, and every two hours from 10 pm to 8 am. A verbal agreement between nurse and patient was put in place that assured the patient that a nurse would return every one hour or two hours based on the time (Weisgram & Raymond, 2008). The outcomes that were monitored consisted of patient falls, use of call light, adherence to the 12-step approach to patient care, and satisfaction of the patient. It was observed in the first 30days that there was 84% adherence to the 12-step process nurse rounding program, from which the following benefits were derived. Patient call light use reduced from 120 calls to 20calls in a 24 hour period. However, when adherence to the nurse rounding program dipped to 50& there was an immediate reaction of the call light increasing from 20 to 69 calls, demonstrating the requirement for strict adherence to the nurse rounding program for benefits of reduced call light by patients to be retained. In addition fewer falls were observed within the first 30 days of the introduction of the nursing rounds program, and also enhanced levels of patient satisfaction ((Weisgram & Raymond, 2008). Woodard, 2009 reports on the study under taken for evaluating nurses hourly rounding as an intervention to reduce the uncertainty among patient on the availability of nurses to respond to their pressing care needs, thereby enhancing satisfactions among patients, and patient safety. The innovative change in nursing care practices consisted of bi-hourly nursing rounds by the charge nurse that consisted of attending to the 4Ps of patient care needs, namely pain, personal needs, positioning and placement of patient care. The Mishel’s Uncertainty of Illness model was to define the help uncertainty for the project for assessing patient uncertainty levels. It was found that there was reduction in patient uncertainty levels and use of the call-light. Enhanced levels of patient satisfaction and reduction in patient falls as a measure of patient safety were observed. The study concluded that the perception of that a registered nurse is available for their pressing care needs reduces patience uncertainty, and through that reduction in use of call lights and patient falls, and enhanced patient satisfaction. Patient trust in nursing care increases as a result of regular rounding of nurses (Woodard, 2009). A Caring Model involving eight patient-satisfaction attributes that included nursing rounds as one of the interventions was used to study its impact on patient satisfaction. The caring model consisted of patient education, printing of behaviors on the name badge, monthly reminders at staff meetings, nursing rounds, documentation of patient care, job description and performance appraisal. The study was based on a comparison between a six month pre-intervention and post-intervention assessment. The findings of the study were that patient satisfaction attributes pertaining to Nursing Anticipating Needs and Response to Requests were significantly increased. The findings of this study not only show that nursing care is am important aspect of patient satisfaction, and that nursing rounds are an integral approach to nurse-patient relationship and patient satisfaction. The study also shows that the approach of nursing rounds is most effective when there is constant reminding of nursing on nurse rounding protocols and monitoring of the nurse rounding approach for increased patient satisfaction. Through such an approach it is possible to convert the priorities of patient satisfaction attributes to strengths in a hospital setting (Dingman et al, 1999). In spite of the evidence that has emerged of hourly rounding by nurse reducing call light use by patients, enhancing patient satisfaction levels, reducing falls, and enhancing nursing staff job satisfaction and productivity, hourly rounding is yet to find consistent use in health care institutions (Cairns et al, 2010). Table – 1 below gives below nurses’ perceptions on evaluation conducted with 37 nurses at three medical surgical at a medical teaching institution. Table – 1 Nurses Response to Hourly Rounding Question % of agree or strongly agree # of agree or strongly agree Hourly rounding is performed on consistently on my unit 51% 19 Hourly rounds are performed during my shift 81% 30 There are benefits and value to hourly rounding for patients 94% 35 There are benefits and value to hourly rounding for staff 86% 32 Hourly rounding decreases workload and saves time 72% 27 I am satisfied with the current process for performing hourly rounding 48% 18 (Cairns et al, 2010). The current challenge for health care institutions and nursing managers is to bring the necessary changes in patient care approaches by nursing, so that hourly rounding by nurses is an integral part of patient care and implemented. One way to increase this approach in nursing is to make nursing find value in this approach through their involvement in the approach. It would be useful to involve the nursing staff at the very start in the planning and the implementation of the nursing rounding program, and using their input in the development of the program. Once the program is initiated posting of the patient outcome data relevant on issues like patient falls and pressure ulcers, and also on patient satisfaction is essential. This will enable nurses to see for themselves the tangible benefits that have been derived through a nursing rounding program, and their contribution in it. In addition, nurses once committed to the nursing rounding program will find that they do benefit from lesser constraints of time for their other tasks. It is this appreciation of their contribution to better patient outcomes and less stress on them that will keep them motivated to the nurse rounding approach (Cairns et al, 2010). (Word Count – 2706) Literary References Cairns, L. L., Wolf, K. K., Rack, L. L. & Dudiak, A. L. (2010). ‘Hourly rounding benefits patients and staff. American Nurse Today, 5(12) Retrieved October 28, 2011, from Web Site: http://www.americannursetoday.com/article.aspx?id=7318&fid=6856. Charmel, P. A., Frameton, S. B. & Plantree, P. C. (2009). Putting Patients First: Best Practices in Patient-Centered Care. Second Edition. New Jersey: John Wiley & Sons Inc. Dingman, S. K., Williams, M., Fosbinder, D. & Warnick M. (1999). ‘Implementing a caring model to improve patient satisfaction.’ Journal of nursing administration, 29(12), 30-37. Grove, J. C. (2008). Staff Interventions to Improve Patient Satisfaction. Ann Arbor, MI: ProQuest LLC. Kerfoot, M. K. (2009). ‘What You Permit, You Permit.’ Nursing Economics, 27(4), Retrieved October 28, 2011, from Web Site: http://www.medscape.com/viewarticle/709769. McLaughlin, K. M. M. & Bulla, A. S. (2010). Real Stories of Nursing Research: The Quest for Magnet Recognition. Sudbury, MA: Jones and Bartlett Publishers. Meade, M. C. Bursell, L. A& Ketelsen, L. (2006). ‘Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety.’ American Journal of Nursing, 106(9), 58-70. Stowoski, A. L. (2008). Ring for the Nurse! Improving Call Light Management. Medscape CME Nurses. Retrieved October 28, 2011, from Web Site: http://www.medscape.org/viewarticle/570242. Studer Group. (2007). Best Practice: Sacred Heart Hospital, Pensacola, Florida. Hourly Rounding Supplement. Retrieved October 28, 2011, from Web Site: http://www.mc.vanderbilt.edu/root/pdfs/nursing/hourly_rounding_supplement-studer_group.pdf. Tea, C. Ellison, M. & Feghall, F. (2008). ‘Proactive patient rounding to increase customer service and satisfaction in an orthopaedic unit.’ Orthopaedic Nursing, 27(4), 233-240, quiz 241-242. Watson, J. (2005). Caring Science as Sacred Science. Philadelphia, PA: F.A. Davis Company. Weisgram, B. & Raymond, S. (2008). ‘Using evidence-based nursing rounds to improve patient outcomes.’ MedSurg Nursing, 17(6), 429-430. Woodard, L. J. (2009). ‘Effects of Rounding on Patient Satisfaction and Patient Safety on a Medical-Surgical Unit.’ Clinical Nurse Specialist, 23(4), 200-206. Read More