Documentos de Académico
Documentos de Profesional
Documentos de Cultura
ment that is easier to manage and hospitalized patients and ultimately regularly round on patients?
more rewarding for staff and for improve patient satisfaction scores. • To what extent do nurses find
patients. In addition, hospitals are the rounding process helpful in
challenged to create cultures of their practice?
safety where risks such as patient Purpose • To what extent do patients
falls are monitored and measured Rounding describes the process of report a more positive hospital
continuously (Thomas et al., 2005). proactively meeting patient needs by experience if nurses round regu-
Weisgram and Raymond (2008) pro- a nurse making a routine visit to larly?
posed interventions to provide a fea- patient rooms to check on specific • To what extent do patients
sible solution to an increase in items and perform basic self-care report more effective pain man-
patient falls. Hourly nurse rounding tasks on a regular, consistent basis agement if nurses round regular-
was found effective as a protective (Tea et al., 2008). Nurse rounding is ly? How is medication adminis-
strategy to prevent both accidental an opportunity to involve patients tration affected by nurse round-
and anticipated falls. in their care, and show care and con- ing?
Factors contributing to a patient’s cern for patient well-being and heal- • To what extent do patients
overall satisfaction with inpatient ing. Hospitalized patients often report their nurse demonstrated
hospital care include measures, such require assistance with basic self-care care and concern during their
as commode assistance, call light tasks, such as using the commode, hospitalization if their nurse
placement, and telephone place- ambulating, and eating meals. Pa- rounded regularly?
ment (Kerfoot, 2008; Meade et al., tients’ level of satisfaction with the
2006). Attending to small details hospital experience depends largely
demonstrates care and compassion on their perception of how effective- Conceptual Framework
toward the patient’s perception of ly the nursing staff met their basic and Methodology
the care received (Kerfoot, 2008). needs (Meade et al., 2006). The sub- The case study method was select-
These small details can be covered in ject unit for this study experienced a ed for the research design, method-
the process of nurse rounding but dramatic change in its registered ology, and framework. Case study
are sometimes overshadowed by a nurse turnover rate over the last 5 is commonly used in medical
growing emphasis on equipment, years. Registered nurse turnover aver- and health science research and is
procedures, and quality manage- aged 16% in 2003; by 2008, it aver- grounded in the post-positivist per-
ment (Tea et al., 2008). As Meade aged 19%, as reported in West Valley spective with an emphasis on rigor-
and co-authors (2006) stated, “There Medical Center human resources ous multiple data collection meth-
is limited research on patient call data (T. Peoples, personal communi- ods (Creswell, 2007). Case study was
light use as it relates to effective cation, November 13, 2008). The chosen because the researcher
patient-care management, patient purpose of this study was to deter- explored a bounded system (med-
safety, and patient satisfaction” (p. mine if patient and nurse satisfac- ical-surgical inpatients and nursing
58). Their study sought to determine tion is influenced by intentional staff on a medical-surgical unit), in-
the effectiveness of regular, consis- nurse rounding every 2 hours on a depth data were collected through
tent nurse rounding on patient satis- medical-surgical unit in a small com- multiple sources of information
faction and call light usage on a munity hospital setting. (observations, interviews, question-
medical-surgical unit. naires, survey reports), and a final
Continued research is needed in case-based descriptive report was
the field of patient satisfaction to Research Questions generated.
determine the impact of nurse The following questions reflect This project also was considered
rounding and attention to small the study’s direction and focus on an action research project. Stringer
detail on the delivery of quality nurs- both patient and nurse satisfaction: (2007) defines action research as a
ing care and the patient experience. systematic approach to investigation
1. What is the impact of intention-
In an effort to understand more fully that enables people to find effective
al, regular, and consistent nurse
the relationship among nurse round- solutions to common, everyday pro-
rounding on a patient’s satisfac-
ing, call light use, and patient satis- blems. Stringer’s action research
tion with his/her hospital expe-
faction, nursing leaders of West framework, Look, Think, Act, was
rience?
Valley Medical Center (Caldwell, ID) used to organize and focus research
2. What is the impact of rounding
initiated a rounding program as a activities. Stringer also described
on the delivery of patient care
significant part of a larger patient action research as localized and spe-
from the nursing staff’s perspec-
satisfaction initiative. West Valley cific to a community setting. In this
tive?
Medical Center is a 150-bed, acute case, the community setting was the
In addition, researchers were
care community hospital. The study, medical-surgical unit of West Valley
interested in determining answers to
which was conducted on the hospi- Medical Center and the common
the following related questions:
tal’s 37-bed medical-surgical unit, everyday problem on the unit was
• To what extent do nurses experi-
was initiated in September 2008 to the need to increase patient satisfac-
ence less call light usage if they
determine how to meet needs of tion and loyalty.
TABLE 1.
Data Collection (Tools and Descriptions)
INSTRUMENTS (Surveys)
Staff Survey on the 4 Ps Rounding Process
• Have you been able to incorporate 4 P rounding every 2 hours in to your practice?
• What system problems have you identified with the 4 P rounding system?
• What call light changes have you observed since 4 P rounding started?
• Do you have any specific comments you’d like to share about the 4 P process? How can it be improved?
INTERVIEW (Nursing Director)
Medical-Surgical Nursing Director Interview
Research was conducted under Data Collection terms of employee satisfaction, nurs-
the direction of James Gregson, EdD, ing staff was asked to complete ques-
Patient satisfaction data were col-
University of Idaho professor of tionnaires that address the feasibility
lected and summarized on a weekly
basis by the Gallup Organization. The of 2-hour rounding and whether or
Adult, Career, and Technology
HCAHPS survey was also an impor- not they have observed a reduction
Education. The project fulfilled in call light usage. The department
tant outcome measure. HCAHPS
requirements for the graduate course director also was interviewed and a
scores were updated and published
“Introduction to Research in on a quarterly basis and available patient focus group was conducted.
Workforce Education” (ADOL 570). through the HCAHPS online survey
Dr. Gregson received institutional results Web site (hcahpsonline.org).
Participant Selection/
review board approval for the project In addition to the survey data,
patients were interviewed during
Sampling
through the University of Idaho. In
their hospitalization through the Study participants included mem-
addition, the hospital administra- rounding process (see Table 1). bers of the medical-surgical nursing
tion of West Valley Medical Center Informal questions were asked and staff and persons who had been hos-
reviewed and approved the study. rounding logs were maintained. In pital inpatients within the last 6
lenge to maintain the process as dex.ssf?/base/living/12360753931568 Tea, C., Ellison, M., & Feghali, F. (2008).
patient census fluctuated and staff 10.xml&coll=1 Proactive patient rounding to increase
Kerfoot, K. (2008). Patient satisfaction and customer service and satisfaction on an
turnover occurred. In June 2009, the orthopaedic unit. Orthopedic Nursing,
high-reliability organizations: What’s the
4 P rounding program became part connection? MEDSURG Nursing, 17(5), 27(4), 233-240.
of a larger initiative designed to 357-358. Thomas, E.J., Sexton, J.B., Neilands, T.B,
improve patient engagement and Hospital Consumer Assessments of Frankel, A., & Helmreich, R.L. (2005).
The effect of executive walk rounds on
increase HCAHPS scores. The initia- Healthcare Providers and Systems
nurse safety climate attitudes: A random-
tive focused on three key areas: (HCAHPA). (2011). CAHPS® hospital ized trial of clinical units. Retrieved from
nurse communication, pain man- survey. Retrieved from http:www.hcahps http://www.biomedcentral.com/1472-
online.org 6963/5/28
agement, and cleanliness of room
Leighty, J. (2006). You called? Hourly rounding Weisgram, B., & Raymond, S. (2008). Using
and bathroom. The 4 P rounding cuts call lights. Retrieved from http:// evidence-based nursing rounds to
program became part of the nurse www.studergroup.com/dotCMS/know improve patient outcomes. MEDSURG
communication action strategies ledgeAssetDetail?inode=323256 Nursing, 17(6), 429-430.
and a continued focus for the med- Meade, C.M., Bursell, A., & Ketelsen, L. Wood, D. (2008). Rounding cuts call-light use.
ical-surgical unit of West Valley (2006). Effects of nursing rounds on Retrieved from http://www.nursezone.
patients’ call light use, satisfaction and com/nursing-news-events/more-news/
Medical Center. Rounding-Cuts-Call-Light-Use_28644.
safety. American Journal of Nursing, 106
(9), 58-70. aspx
Shaw, G. (2008). What’s your brand?
REFERENCES ADDITIONAL READINGS
Healthleaders, X1(11), 14.
Creswell, J.W. (2007). Qualitative inquiry & Blizzard, R. (2003). Engagement unlocks
Stringer, E.T. (2007). Action research (3rd ed.). patient satisfaction potential. Retrieved
research design: Choosing among five
approaches. Thousand Oaks, CA: Sage Thousand Oaks, CA: Sage Publications. from http://www.gallup.com/poll/8650/
Publications. Studer, Q. (2007). Serious about service. E n g a g e m e n t - U n l o ck s - Pa t i e n t
Doyle, S. (2009, March 3). Hourly nurse round- Retrieved from http://www.studergroup. Satisfaction-otential.aspx
ing is a growing trend around the coun- com/content/tools_and_knowledge/ The Picker Institute. (1999, November).
try. The Huntsville Times. Retrieved from articles/associated_files/QuintNov07 Improving service in health care (Bulletin
http://www.al.com/living/huntsvilletimes/in HealthEecutive.pdf Issue 11). Boston, MA: Author.