Hourly Rounding Research Review

Purpose: The purpose of this chapter is to identify as many advantages and disadvantages of hourly rounding as possible to gain a truly retrospective perspective of the concept. To do this, three widely different sources will be utilized and examined for their opinions and findings on hourly rounding.

Introduction: Hourly rounding is an issue that has been debated a great deal within the fields of nursing, with each side claiming some advantages and disadvantages to hourly rounding. Many claim that it is crucial for ensuring patient safety and satisfaction, while others tout the expense and overall risk associated with ignoring nurse staffing ratios and stretching nurses so thin to needlessly check in on patients. This chapter will address these issues and determine whether hourly rounding is a worthy concept or not.

Theoretical Perspective: The concept of hourly rounding is not a new one, but it has been undergoing a great deal of scrutiny in the recent past. Much of this is probably due to the number of complications within the healthcare system, including some budgetary concerns, prompting numerous questions about the necessity of hourly rounding. A few replacements have been put forth as ideas, such as a simple method for patients to contact the nurse or caretaker indirectly, such as through the push of a button. However, this concept presents several problems. Most prominently, one of the literature articles states that falling, which would likely eliminate the possibility of a patient contacting the nurse via button or other indirect means, accounted for about 70 percent of hospital accidents (Olrich, Kalman, & Nigolian, 2012). Of course, falling is only one of many possible problems that could arise that would eliminate a patient's ability to contact the nurse through their power. This concept is one of the most convincing arguments for hourly rounding: it allows for the frequent checking in on the health of a patient, regardless of whether the patient asked for it or not. Hourly rounding also allows for a great deal of personal service and bonding with patients. A patient who is checked in on hourly by the nurse, even if they do not need it, will be more likely to have a satisfactory experience at the hospital, since they will feel like they have received much more personal service than otherwise.

Substantive Perspective: Literature on this subject seems to indicate that the concept of hourly rounding is effective and makes up for the extra cost and effort involved with an increase in patient safety, health, and satisfaction. However, there are a few issues concerning hourly rounding that the literature addresses. The most prominent of these issues and, indeed, what one entire article focuses on, is the problem of hourly rounding within a busy care unit. Essentially, the article states that requiring nurses to make hourly rounds on patients within a large hospital or care unit stretches their resources too thin and risks leaving needier patients unattended in favor of these hourly rounds (Lowe & Hodgson, 2012). The study also states that in many hospitals, especially larger care units, there is already a great deal of monitoring equipment in place that allow patients to be observed remotely for any sign of pain, discomfort, or needs of any kind and addressed promptly, largely removing the need for hourly rounding in these hospitals (Lowe & Hodgson, 2012). One other interesting niggle within the research found that many nurses found the concept of hourly rounding to be patronizing since it would imply that they are not doing enough to keep patients happy (Lowe & Hodgson, 2012). Of course, there is little to be done about this particular aspect of hourly rounding and it remains an issue for poor nursing staff retention. Most other research examined cast hourly rounding in an extremely positive light, far outweighing the few concerns and problems that were examined earlier. For example, one article found that hourly rounding universally promoted satisfaction in both patients and nurses (contradicting the earlier study) and showing increases in satisfaction ratings for patients across the board after implementation (Kessler, Claude-Gutekunst, Donchez, Dries, & Snyder, 2012).

Summary: There has already been a great deal of research completed concerning the effectiveness of hourly rounding, as the literature review has demonstrated. This research is perhaps best summed up in the article by Kessler et al, which finds that hourly rounding "...positively impacts the three variables studied: patient fall rates, call-light usage, and patient satisfaction" (p. 25). These studies, which demonstrate a general reduction of injuries such as falling and an increase in patient satisfaction, are well-researched and echoed by some other studies, providing for a comprehensive breadth of research that maintains the effectiveness of hourly rounding.

However, despite this body of research, there are still a few gaps in the research. Most notably, there has not been much research that examines the specific areas that hourly rounding improves, save for the very broad category of "falls" in one study. This gap in specific research necessitates studies that examine some of the underlying improvements that hourly rounding brings, such as a decrease in accidents, as the earlier study found. My research will help to address some of these gaps. Most notably, my research will utilize a very general indicator of what qualifies as an accident by simply measuring patient emergencies by the number of call lights used by patients. Another area of hourly rounding that has not been properly addressed is the psychological impact of it, especially in regards to how hourly rounding makes the patients feel on a subconscious level. To solve this problem, my research will examine several psychological concepts, such as Maslow's Hierarchy of Needs, to examine the effects of hourly rounding more closely and determine just why hourly rounding causes such a stark increase in patient satisfaction, if at all. Finally, my research will attempt to extrapolate the results with those of other studies, creating a much more retrospective scope of study than many of those completed in the past.

References

Kessler, B., Claude-Gutekunst, M., Donchez, A. M., Dries, R. F., & Snyder, M. M. (2012). The merry-go-round of patient rounding: Assure your patients get the brass ring. Medsurg Nursing, 21(4). 241-244.

Lowe, L., & Hodgson, G. (2012). Hourly rounding in a high dependency unit. Nursing Standard, 27(8), 35-40.

Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly rounding: A replication study. MedSurg Nursing, 21(1). 23-28.