A generally accepted strategy designed to improve patient care, hourly nurse rounding is defined as a consistent nurse-patient interaction involving an assessment of patient needs and the provision of effective responses to those needs.1 Considerable research has been conducted addressing the outcomes of hourly rounding, with results that support the importance of this activity.2-6 Although concern is expressed in the literature regarding the rigor of studies conducted to date, there's considerable evidence to suggest that systematic and proactive nurse rounding diminishes patient anxiety, incidence of falls, and use of call lights.4,5 Findings demonstrate that hourly rounding increases the frequency of physical presence and positively influences patient perception of care and overall satisfaction.5
Problems with analyzing findings across hourly rounding studies include measurement of different variables, assessments conducted by a variety of professionals, use of differing designs, and differences in the process itself.3-6 The variables frequently addressed are call-light use and patient falls.5 Only two studies were found to measure patients' pain management as it relates to hourly rounding, although this particular concern is frequently central to the provision of good care.3,7
Our study was conducted at six hospitals in the same geographic region. Research assistants read each question on the Baptist Health Hourly Rounding Checklist (BHHRC) to patients and recorded their responses. The purpose of this quantitative cross-sectional study was to examine patients' perceptions of hourly rounding as follows: 1) occurrence, 2) explanation, 3) treatment of pain, 4) medication management, and 5) patient satisfaction.
Method and design
Data from patients at six hospitals (n = 486) were collected over a 3-month period using the investigator-designed BHHRC. Nurse representatives from each of the six institutions generated the questions based on literature related to hourly rounding and patient needs.1-4,6,8-10 The BHHRC was developed to reflect the hourly rounding experience as perceived by the patient. Seven yes-or-no questions reflected four areas of concern: occurrence (item 1) and explanation of hourly rounding (item 2), treatment of pain (items 5 to 7), and medication adverse reactions (item 4). Overall patient satisfaction was represented by a seventh item ("Are our staff members meeting your needs?").
Additionally, there was an open comments section included in the study. During initial data input, the primary investigators decided that the comments were often unrelated to the patients' hourly rounding experience; rather, they reflected their experience with the hospital stay as a whole (such as housekeeping, dietary, and physician interactions). For this reason, the comments aren't included here.
Data related to providing assistance for patients to get to the bathroom were also collected. However, due to the number of patients not requiring assistance, insufficient data were retrieved and, therefore, not included in the analysis.
Content validity was established by a group of nurses who met monthly across the six hospitals and functioned as patient satisfaction gatekeepers. The group was led by a DNP-prepared nurse; all others were BSN or MSN graduates. The final questionnaire was reviewed and recommendations made by two PhD-prepared individuals in the research office.
Following Institutional Review Board approval, research assistants from each hospital were designated to collect data by asking patients to complete the BHHRC.
Results
Descriptive statistics were used to analyze the data. Percentages were calculated for each of the six hospitals. Variability in bed size differed among the six study hospitals, resulting in different numbers of patient responses. As a result, the first 81 patient checklists (the total number of checklists received from the smallest hospital) from each institution were analyzed (n = 486).
Results are presented in Table 1. Overall, nurses across hospitals conducted hourly rounds on a consistent basis, with percentages ranging from 90.1% to 98.8%. Staff explanation of hourly rounding was done less consistently, with percentages ranging from 51.9% to 92.6% across hospitals.
Information pertaining to pain management proved that nurses consistently managed patients' pain (range, 95.6% to 100%). Nurses routinely explained the pain management schedule, with percentages ranging from 81.3% to 98.8%. Regarding on-time delivery of pain medication, results revealed that nurses administered pain medication in a timely fashion. Inconsistency was found regarding nurses' explanation of medication adverse reactions (range, 65.4% to 90%). Lastly, responses to "Are our staff members meeting your needs?" were positive, with percentages ranging from 96.3% to 100%.
Discussion
This study assessed patients' perceptions of hourly rounding related to the occurrence and explanation of hourly rounding, treatment of pain, medication management, and overall patient satisfaction. Results were consistent with findings from previous studies: Hourly rounding leads to patient satisfaction. For example, one study established that patients' satisfaction and perceptions of nursing care quality are dependent on the nurses' ability to meet patients' needs, nursing presence, and an explanation of care/rounding protocols. The results of our study showed consistently high patient satisfaction related to hourly rounding across six hospitals.
Regarding pain management, results indicated that patients consistently felt that nurses effectively managed their pain. These findings support two previous studies regarding hourly rounding and pain control.3,7 Effective pain management has been shown to improve overall patient satisfaction.3,7
This study was unique because it examined an important component of nursing care-explanation of medication adverse reactions. Only two hospitals within the system achieved rates higher than 80%. Based on an in-hospital survey at one of the institutions, lower percentages may be attributed to patients' familiarity with their medications, leading them to refuse education. Another unique aspect of this study was the assessment of patients' understanding of their pain management schedule.
Although most studies to date have assessed the relationship between hourly rounding and pain management scores, our study examined patients' understanding of their pain management schedule as it relates to hourly rounding.3,7 A patients' understanding of his or her pain management schedule may lead to improved satisfaction with overall care. Communicating a pain management schedule to patients may increase their satisfaction with care because they understand what to expect regarding pain control.
The future
Results of this study illustrated that patients across six hospitals positively perceived hourly rounding. Although most patients responded positively to the questions asked, there was room for improvement regarding nurses' consistent description of potential medication adverse reactions and explanation of hourly rounding. Findings from this study affirmed current literature that recommends hourly rounding as a strategy to improve patient care.
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