Ryan ELJ, Jackson D, Woods C, Usher KJ. Pre-registration nursing students’ perceptions and experience of intentional rounding: A cross-sectional study. Nurse Educ Pract. 2020 Jan;42:102691. doi: 10.1016/j.nepr.2019.102691. Epub 2019 Dec 24. PMID: 31931304
Synthesis
This is the first research carried out on pre-registration nursing students’ perceptions of the practice of Intentional Rounding (IR) and its perceived benefits for nurses and patients. The results showed that nursing students recognized the benefits for both nurses and patients. Students perceived improved patient/family/nurse communication, increased timeliness in recognizing clinical deterioration, improved patient safety, and higher quality of general nursing care. Specifically, what was perceived was a reduction in the level of uncertainty and anxiety by patients/family members and greater effectiveness in recognizing and satisfying patient needs. Nursing students acknowledged the potential of IR even if they deem it necessary to have more specific education and training before starting their internship or placement. Such education would allow them to actively participate in ward activities and thereby gain professional experience.
Background and setting
Intentional Rounding (IR), or regular focused/hourly rounding, is standard practice in many acute inpatient settings. It has been used internationally, within clinical settings, as a patient safety tool to ensure regular checks on patients and family members. IR was recently reintroduced to contemporary practice as a response to the serious issue of episodes of missed or postponed care. Through the implementation of IR, nurses were asked to enter patient rooms to see and also to communicate with the patients on an hourly or two-hour basis.
Recent literature has shown that the implementation of IR increases patient safety (e.g. in terms of decreased accidental falls and the incidence of pressure ulcers), improves communication between patient/family and nurses, and increases patient satisfaction with overall care. However, some contradictory opinions cast doubts on its real effectiveness and applicability in daily clinical practice. More specifically, barriers influencing effective and regular IR remain. Such barriers include the workload required, documentation practices and their reliability, and the lack of clarity about the possibility of delegating IR checks to other staff.
Nurses’ opinions regarding IR are well known. That said, no research has been undertaken to examine the perceptions of this practice by pre-registration nursing students, to whom this task is often delegated. It is therefore vital to assess their knowledge of and attitudes towards IR and to identify whether education, training, or support is required at university or during clinical training.
This study aimed at examining the perceptions of pre-registration Bachelor of Nursing students regarding the practice of IR and its benefits for nurses and patients.
Study design, sampling and data collection tool
This was a multisite cross-sectional study carried out through an online platform survey which, through convenient sampling, involved nursing degree courses in six Australian universities. The survey link was distributed to second and third-year students in Bachelor of Nursing programs. The first part of the survey included questions regarding the participants’ socio-demographic background. This section was followed by the Nurses’ Perceptions of Patient Rounding Scale (NPPRS) – a scale composed of 42 items and divided into three subscales (benefits for the patient, benefits for the nurse, and communication). Responses were based on a 5-point Likert scale (the response of 3 was considered a neutral response). The final possible NPPRS score could fall in a range between 40 and 200 points, where the higher score corresponded to more positive answers in the questionnaire. The final part of the survey included three open questions on the meanings and possible implementation of IR in the participants’ own institutions.
Results
A total of 533 nursing students responded to the online questionnaire, with 424 surveys considered complete and valid for the study. In general, the perception of IR for nursing students in Australia is positive (M= 143.90; SD = 16.77). Most of them indicated that IR was an integral part of the internship (71%) and that they had learned its purpose and methods (74%). Specifically, the sub-scale scores indicated a positive perception concerning communication, reporting that IR improves communication between the patient/family and nurse. The responses conveyed that IR induces a sense of calmness in patients, since they know that a nurse will do rounds regularly. From a nursing care management perspective, students reported that the regular check-up allowed them to promptly detect the deterioration of clinical status, get to know the patients better, and better plan care during the day. The perception of IR was also positive concerning the patient. The responses reported that patients had a higher perception of the nursing care provided and that IR allowed students to identify patient needs, therefore reducing the level of anxiety for both patients and family members.
The authors also highlighted some negative points, such as the perceived discrepancy between theory and practice, the difficulty of performing IR due to workload, the failure to reduce the number of bells rung, and the lack of training and education in the practice of IR (50% of respondents stated that their knowledge of IR comes from clinical practice and not from university education).
Limitations
The authors identified three study limitations:
- Use of a non-probability sample can introduce selection bias, which is a common problem with survey research;
- So-called “survey fatigue” seen by a reduced number of completed questions as the study progressed;
- The use of a survey that was designed for Registered nurses in the USA, which may have created some confusion for students. Some negatively worded questions had a higher rate of ‘unsure’ responses.
What did this study add?
The study made it possible to reveal student perceptions of IR for a clinical practice implemented in many acute care settings in Australian hospitals. University education and training, like leadership and collaboration with the staff of the internship department, play a fundamental role in the adequate implementation of IR.
What perspectives?
This study indicates that encouraging nursing students to implement IR is beneficial for patients as well as for students, who are able to grow professionally and learn through their experience.
Edited by Dino Stefano Di Massimo
