Has intentional rounding turned ward nursing into a tick-box exercise?

Routinerounds are more to do with managing risk than patient-centred care, studysuggests

Routine ward rounds may not be the best way for nurses to deliver care, King's College London (KCL) research suggests.

The practice, known as intentional rounding, is widespread in England, with 97% of NHS acute trusts using it in some way, researchers found.

But the KCL findings suggest intentional rounding results in ‘tick-box’ nursing, not individualised care.

Practice of intentional rounding found not to promote therapeutic relationships

Study authors say that although intentional rounding 'may satisfy an organisational culture preoccupied by risk management', it does little to promote the nurse-patient relationship.

‘Few front-line or senior nursing staff felt intentional rounding improved either the quality or the frequency of their patient interactions’

Researchers suggest the principle of intentional rounding should now be reviewed.

What is intentional rounding?

Intentional rounding is a set of regular checks at set intervals. It was introduced in hospitals in England in 2013 as part of the government’s response to care failures at Mid-Staffordshire NHS Trust.

It normally involves checking the patient's positioning, their personal needs, pain level and control and placement of items they need, together known as the ‘four Ps’.

Intentional rounding requires nurses to:

• ·         Introduce themselves
• ·         Perform scheduled tasks
• ·         Investigate the four Ps
• ·         Assess the care environment
• ·         Use a prescribed way to end the round, telling the patient when they will be checked again
• ·         Document the round

Patients want more natural interactions than intentional rounding allows

Lead author, Ruth Harris, professor in the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at KCL, said: 'Checking patients regularly is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care.

'Few front-line nursing staff or senior nursingstaff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.'

Patients were found to value less formulaic interactions with nursing staff, which occurred when nursesdelivered other care activities.

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