Adult Nursing Systematic Review Sample Research Paper

The purpose of this paper is to examine ways in which nurses can improve the experience of Intentional Rounds Practice within Hospital wards in the UK. Implementing Evidence in Practice

 

 

Introduction:

Failures often take place in inpatient care which contributes to the need to improve care. According to Harris et al. (2017), the 2013 Francis Inquiry revealed that there were failures in inpatient care within the Stafford Hospital in the UK while also providing recommendations on how to improve care. Snelling (2013) noted that one of the recommendations from the inquiry was to enhance regular interaction and engagement among nurses and patients and their family carers. These interactions should be based on systematic regular ward rounds. As a result, this recommendation is currently known as intentional Rounding (IR) which refers to a structured process whereby nurse engages in one or two-hourly checks with each patient while adopting a standardised protocol and documentation.  According to the Nursing and Midwifery Council (NMC), there is a need to provide care that focuses on compassion and respect for the dignity and worth of every patient (NMC, 2015). Also, the NHS constitution outlined the need for compassionate care. This means that nurses should focus on responding with humanity and kindness to the pain, distress, and anxiety of patients (Department of Health, 2010).  Nurses have to look for things they can do, however small, to give comfort and relieve suffering.  Therefore, the purpose of this paper is to examine ways in which nurses can improve the experience of Intentional Rounds Practice within Hospital wards in the UK.  The essay is structured into sections such as research question, methodology, search strategy, quality appraisal, summary and synthesis of the papers, issues of implementation, discussion, and conclusion.

Research question

 

PICO framework: P-Patients in Hospital; I- Intentional Rounds; C-No Comparison; and O-Prevention of Falls.

1. How can Nurses improve the experience of Intentional Rounds Practice in Hospital Wards in the UK?

The rationale for asking this question is to provide evidence on possible strategies that can be adopted within wards so that nurses improve the experience of international rounds practice. While recommendations were made on how intentional rounding practice should be adopted, there is a lack of evidence on how nurses should be assisted to improve the quality of acre during intentional rounding. According to Hobbs et al. (2016), challenges within hospital wards such as workloads or lack of time can affect adherence to Intentional Rounding. Other factors such as ward layout whereby closed or cluttered layouts may affect the ability of nurses to engage in intentional rounds. Sims et al (2010) argued that lack of education and information on IR, poor leadership and management support, low motivation, and staff engagement can contribute to limited engagement in intentional rounds. Therefore, this essay needs to provide an understanding of how nurses can improve the experience of intentional Rounds Practice in Hospital wards in the United Kingdom.

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Methodology

This paper conducted a systematic search of literature within health databases such as Medline via PUBMED and CINAHL via EBSCOhost.  The rationale for using these databases is that they contain credible articles on health studies. Stevens (2013) argued that researchers should use credible sources of evidence that inform their evidence-based practice.  The keywords used include 'intentional rounding’, ‘hospital wards’, ‘preventing falls’, and ‘United Kingdom’. These keywords were combined with Boolean operators AND/OR. 

Another Boolean operator: Intentional round OR hourly round OR Patient round OR nursing Round OR purposeful round AND Nursing has been adopted. Some of the limiters adopted include full-text and English-language only.  Besides, the Boolean operators led to the search phrase: Intentional Rounding AND Hospital Wards AND United Kingdom.

Inclusion and exclusion criteria

The first inclusion criteria were to use articles from the United Kingdom. Dempsey and Valenti (2016) noted that search limiters ensure that researchers can limit the search to relevant articles that inform their study. Thus, it would not be appropriate to collect evidence from South America that influences practice within the UK. Second, the articles were restricted to those published in the last 10 years (2011-2021). Farokhzadian, Khajouei, and Ahmadian (2015) noted that nurses should use contemporary and relevant evidence to make decisions. In essence, it would not be appropriate to use evidence developed 20 years ago to influence current practice. The third inclusion criterion was to use those published in the English language. This was made since the researcher can only read and understand studies published in the English language. However, Stern and Kleijnen (2020) noted that language can lead to publication bias towards studies published in English thus affecting the quality of evidence obtained. Systematic reviews, quantitative studies, as well as qualitative studies were included. Wu et al. (2013) argued that systematic reviews are acceptable sources of evidence in nursing practice since they avail evidence from a wide range of sources. qualitative and quantitative studies also form part of primary articles that influence the need for nurses to use empirical evidence to influence their decisions (Ellis, 2019).

 In terms of exclusion criteria, there is a need to avoid the use of articles outside 10 years since they do not contain up-to-date evidence that can be reliable in making decisions. Also, articles not published in the English language were excluded since they cannot be understood by the researcher.

Search strategy

Table 1: search strategy

Database	Search terms	Results
CINAHL	Intentional Rounding or hourly rounding or purposeful rounding AND   experience or patient or patient relation AND UK	3 articles 2 included Kirk and Kane (2016)  Mennim and Moen (2018)
MEDLINE via PubMed	Intentional Rounding AND Hospital Wards AND United Kingdom	7 articles 4 articles included Sims et al. (2018); Morgan et al. (2017); Appleby (2019); and Harris et al. (2019)

A PRISMA chart has been included in the appendix showing the search strategy and results (appendix 1).

 

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Quality of appraisal

The CASP appraisal checklist for qualitative and systematic reviews has been provided in the appendix. Nadelson and Nadelson (2014) noted that CASP is an appropriate appraisal tool adopted within evidence-based practice to enable nurses to evaluate the quality of evidence. The wide range of checklists ensures that different papers can be appraised based on available criteria.   Since there is no CASP for quantitative studies, the checklists for qualitative studies have been used to evaluate quantitative studies.

Through CASP for Qualitative studies, there is a need to ensure that the method is appropriate. Questions should be asked to seek to interpret or illuminate the actions or subjective experiences of research participants. In the case of Kirk and Kane (2016), the qualitative research method is appropriate for addressing the research goal of exploring the experiences of staff nurses in the use of international rounding within emergency departments.  Thus, semi-structured interviews, as well as purposive sampling techniques, are appropriate for the exploration of the experiences of nurses. In terms of bias, researcher bias might affect the quality of findings since the researchers have not outlined how their attitudes towards intentional Rounding influenced their interpretation of findings. Besides, there is no criterion used to choose the five nurses interviewed while leaving out other nurses. This means that biased responses based on choices for participants may arise.

Mennim and Moen (2018), a quantitative research method was adopted through staff surveys. The CASP checklist outlines the need for researchers to explain how the participants were selected. However, there is an explanation that the nursing staff survey was appropriate since they engaged in the implementation of an intentional round programme.  Since this was a survey of nurses to understand their views, there is bias in the findings because of the low response rate. Also, bias arises because there was a lack of staff engagement in the in-house staff survey. This means that the responses provided in the survey limited the ability of nurses to provide proper explanations on how the IR programme would be improved. To overcome the bias, qualitative research should be used to examine in-depth views of nurses.

Sims et al. (2018) used a systematic review method of conducting a library search of the literature. A wide variety of sources such as AMED, CINAHL, MEDLINE, PsychInfo, Google, and Google Scholar were used to obtain published literature. A total of 44 papers met inclusion criteria. Through CASP for systematic reviews, the bibliographic databases included are of high quality which means that relevant studies with health information were included. However, there is the use of English language studies which may lead to bias in these studies. There is no use of non-English language studies which may mean that important findings have been omitted.  Nevertheless, the review managed to address the review’s question.  The review also addresses a focused question.

Morgan et al. (2017) used a customized intentional Rounding program which was implemented and evaluated.  through CASP for case-control, there is a selection bias. In particular, there is no understanding of why the researchers focused on the specific customized intentional Rounding program. it is not clear whether this is the ideal program used across the UK and what influenced its adoption. Therefore, bias in its adoption and evaluation may arise because of the preferences of its implementers. Also, there is no comparison of this program with others which means that its effectiveness has not been evaluated in terms of other available IR programmes.

Appleby (2019) used questionnaires on a sample of 270 nurses and healthcare assistants from 24 wards in a major hospital in England. However, there is no justification for why this particular ward was used. Therefore, bias in the interpretation of results arises because there are no criteria for selecting the hospital ward while eliminating others. furthermore, descriptive and inferential tests are not appropriate methods to evaluate the intentions of nurses to implement a care-round checklist. Interviews or focus groups can be effective in collecting their view.  Harris et al. (2019) used a multi-method study design. Theory development, survey, and interviews were used. This means that the researcher avoided bias associated with one method while using triangulation to enhance the quality of the findings.  Through CASP for qualitative studies, the interviews are effective in understanding the views and experiences of healthcare staff, patients, and their carers in the use of IR. The surveys are also appropriate since it reveals the levels in which Trusts have implemented IR.

Summary and synthesis of papers

First, Kirk and Kane (2016) used a qualitative research method to examine the use of intentional Rounding in the emergency departments. The focus was on exploring the experiences of nurses within a large teaching hospital in England. They used semi-structured interviews of 5 staff nurses working within the emergency department while also adopting a purposive sampling technique to recruit the participants. Data analysis employed the Framework method of Qualitative analysis. Findings revealed that nurses can improve the experience of international rounds when engaging in open communication with other nurses and patients. Also, there is a need for a more timely response to the needs of patients thereby impacting positively on levels of safety and satisfaction. Some of the challenges that must be mitigated include lack of staff engagement, environmental factors, and pressures within the emergency department.   In another study by Mennim and Moen (2018), a staff survey and completion of comfort rounds were used to collect data within Liverpool Women’s NHS Foundation Trust. Findings revealed that within oncology wards, there is a need for nurses to build relationships with patients. Nurses also needed to adopt a faster pace of working. Also, there is a need to enhance the morale of nurses so that they improve the experiences of patients during intentional rounds.  In these two studies, key emerging themes include open communication with nurses and patients, developing relationships with patients, increasing the morale of nurses, and timely response to the needs of patients.

Sims et al. (2018) used the systematic review method to develop IR programme theories of what works, for whom, in what circumstances, and why. Findings revealed that nurses can improve the experience of international rounding within wards by implementing the programme in a compressive and consistent way, embedding IR into their daily routine practices, documenting IR checks are part of measures to increase accountability and raise fundamental standards of care. also, there is a need for frequent nurse-patient contact to improve relationships and increase awareness about the comfort of patients as well as their needs. Moreover, nurses need to increase the time when they are in the direct vicinity of patients so that they can grantee vigilance, provide reassurance, and reduce any potential harm. Through the use of IR documentation, nurses guarantee effective teamwork and communication within wards that enhance the experience of patients.

Appleby (2019) used a quantitative research design by focusing on a total of 270 nurses as part of measures to evaluate the intentions of nurses to implement a care round checklist as a guideline-intervention repeated on an hourly basis within hospital wards in England. Findings revealed that attitude and perceived control predicted the intentions of nurses. also, attitude and practice had predicted the intentions of healthcare assistants. Therefore, a key theme emerging is that nurses need to adopt positive attitudes towards the use of the care-round checklist.  In essence, the theory of planned behaviour and its constructs are useful in influencing nurses to improve the experience of intentional rounds within wards.

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Morgan et al. (2017) implemented a customised intentional rounding and evaluated its effectiveness to reduce falls on a neuroscience ward. The evaluation of intentional rounding depended on engagement and communication activities, teamwork and symptoms improvement training, support and coaching, as well as the use of PDCA cycles. Results showed that the implementation of the intentional rounding program led to a 50% reduction in patient falls within an active ward a minimal increase across the rest of the trust. A key emerging theme is that nurses can improve the experience of intentional rounds through teamwork training and staff-led systems redesign. Also, there is a need to use these measures in conjunction with a pre-planned implementation strategy to deliver change and improvement.

Harris et al. (2019) used a multi-method study design through a realist evaluation methodology to examine the effectiveness of an implemented IR in England. First, there was theory development to achieve a framework for testing emerging findings. Second, a national survey of the NH SD acute trusts in England was undertaken. Third, in-depth case studies of six wards in three NHS acute trusts focused on interviewing healthcare staff, patients, and their carers. Within the case study sites that used semi-structured individual interviews, the key themes identified include the need for accountability through the documentation of IR. Also, there is a need to deliver IR in a conversational way, tailored to meet the needs of patients. This is based on concerns that IR is prescriptive and task-oriented. The use of IR should also facilitate communication between nursing staff. Furthermore, there is a need to ensure that nurses increase the quality of communication with patients.

Issues of implementation

The Promoting Action on Research Implementation in Health Services (PARIHS) framework is a commonly used framework based on the assumption that effective implementation depends on evidence context, facilitation of the process, as well as internal and external persons acting as facilitators to the process of implementation (Bergström et al, 2020).

In the context of IR, issues related to nature and type of evidence. there is a need to focus on developing evidence on how nurses can interact within the IR to enhance its effectiveness. The adoption of IR has not focused on the experiences of patients and nurses so that improvements can be made on these programmes.

In terms of context, there is a need for effective organisational culture within wards whereby team leadership enhances collaboration and communication. Also, constant evacuation should be carried out to understand the feedback of nurses on how IR can be improved. Issues relating to leadership emerge such as lack of training, education, and motivation in the use of IR.

Facilitation also experiences issues. For instance, internal facilitators such as nurses do not have the motivation to engage in IR because of the shortage of nurses, also, external facilitators such as the government should increase the number of nurses employed within wards to guarantee adherence to IR.

Discussion

The paper aimed to examine ways in which nurses can improve the experience of Intentional Rounds Practice within Hospital wards in the UK. findings revealed that emerging themes include:  staff education and training, motivating nurses, leadership and management support, staff engagement, nurse-patient relationships, and nurse understanding of IR.  Nurses can improve the experience of IR when there is a focus on education and training. Education and training should be availed to nurses while also collecting feedback of these nurses in how they use the IR. In terms of motivation, nurses should be involved in the design and implementation of IR, and developing a strong sense of teamwork. This means that staff engagement would eliminate any resistance to the use of IR within wards. Furthermore, leadership and management support for IR should be availed. For instance, leaders should encourage nurses to be involved in the programme and provide consistent reminders for success and monitoring of performance.

The evidence obtained from the review of literature can be communicated to nurses, patients, and their families in the form of lectures, presentations, meetings within wards, online learning modules, and charts on how IR should be used to enhance the experiences of patients.

The main limitation is that this review used 6 studies, one of which was a systematic review. Therefore, the review lacks robust evidence on how IR should work to improve the quality of care. the best evidence for practice should be developed on how IR improves the quality of care so that nurses can understand aspects they need to guarantee when using IR within hospital wards.

Conclusion  

The essay aimed to examine how nurses can improve their experience during IR. Results show that nurses need to engage in open communication with other nurses and patients. in addition, nurses have to provide a timely response to the needs of patients to enhance safety and satisfaction. nurses need to adopt positive attitudes towards the use of the care-round checklist. Further, nurses can improve the experience of intentional rounds through teamwork training and staff-led systems redesign. Documentation of the IR process would also guarantee accountability among nurses and the effectiveness of teamwork. 

Certain implications for practice exist. First, there is a need to establish relationships and communication between nurses and patients. compassionate care can only be provided when nurses recognise the needs of patients. The adoption of IR may not be effective unless nurses are trained and mediated on how to redesign the system to enhance the quality of care. furthermore, the leadership and management need to ensure that nurses are supported in terms of increasing staffing levels and morale so that nurses engage frequently in IR. 

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 References

Appleby, B. E. (2019). Implementing guideline‐checklists: Evaluating health care providers intentional behaviour using an extended model of the theory of planned behaviour. Journal of evaluation in clinical practice, 25(4), 664-675.

Bergström, A., Ehrenberg, A., Eldh, A. C., Graham, I. D., Gustafsson, K., Harvey, G., & Wallin, L. (2020). The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature. Implementation Science, 15(1), 1-51.

Dempsey, M., & Valenti, A. M. (2016). Student use of keywords and limiters in web-scale discovery searching. The journal of academic librarianship, 42(3), 200-206.

Department of Health (2010).  The NHS Constitution. The Statutory Office, London.

Ellis, P. (2019). Evidence-based practice in nursing. Learning Matters.

Farokhzadian, J., Khajouei, R., & Ahmadian, L. (2015). Evaluating factors associated with implementing evidence‐based practice in nursing. Journal of evaluation in clinical practice, 21(6), 1107-1113.

Harris, R., Sims, S., Leamy, M., Levenson, R., Davies, N., Brearley, S., & Ross, F. (2019). Intentional Rounding in hospital wards: What works, for whom, and in what circumstances? Health Services and Delivery Research, 7, 35.

Harris, R., Sims, S., Levenson, R., Gourlay, S., Cbe, F. R., Davies, N., & Grant, R. (2017). What aspects of intentional rounding work in hospital wards, for whom, and in what circumstances? A realist evaluation protocol. BMJ Open, 7(1), e014776.

Hobbs, F. R., Bankhead, C., Mukhtar, T., Stevens, S., Perera-Salazar, R., Holt, T., & Salisbury, C. (2016). Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. The Lancet, 387(10035), 2323-2330.

Kirk, K., & Kane, R. (2016). A qualitative exploration of intentional nursing round models in the emergency department setting: investigating the barriers to their use and success. Journal of clinical nursing, 25(9-10), 1262-1272.

Mennim, D., & Moen, C. (2018). Evaluation of matron ward rounds to enhance patient experience and improve staff morale. Nursing Management, 25(5).

Morgan, L., Flynn, L., Robertson, E., New, S., Forde‐Johnston, C., & McCulloch, P. (2017). Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls. Journal of Clinical Nursing, 26(1-2), 115-124.

Nadelson, S., & Nadelson, L. S. (2014). Evidence‐based practice article reviews using CASP tools: a method for teaching EBP. Worldviews on Evidence‐Based Nursing, 11(5), 344-346.

NMC (2015). The Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates.  Available from: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

Sims, S., Leamy, M., Davies, N., Schnitzler, K., Levenson, R., Mayer, F., & Harris, R. (2018). Realist synthesis of intentional Rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances, and why. BMJ quality & safety, 27(9), 743-757.

Sims, S., Leamy, M., Levenson, R., Brearley, S., Ross, F., & Harris, R. (2020). The delivery of compassionate nursing care in a tick-box culture: qualitative perspectives from a realist evaluation of intentional rounding. International journal of nursing studies, 107, 103580.

Snelling, P. C. (2013). Ethical and professional concerns in research utilisation: intentional Rounding in the United Kingdom. Nursing Ethics, 20(7), 784-797.

Stern, C., & Kleijnen, J. (2020). Language bias in systematic reviews: you only get out what you put in. JBI Evidence Synthesis, 18(9), 1818-1819.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2).

Wu, X. Y., Tang, J. L., Mao, C., Yuan, J. Q., Qin, Y., & Chung, V. C. (2013). Systematic reviews and meta-analyses of traditional Chinese medicine must search Chinese databases to reduce language bias. Evidence-Based Complementary and Alternative Medicine, 2013.

Appendix

 Appendix 1: PRISMA Chart

 

 

Appendix 2: CASP for qualitative study: https://casp-uk.b-cdn.net/wp-content/uploads/2018/03/CASP-Qualitative-Checklist-2018_fillable_form.pdf

Appendix 3: CASP for systematic review: https://casp-uk.b-cdn.net/wp-content/uploads/2018/03/CASP-Systematic-Review-Checklist-2018_fillable-form.pdf

Appendix 4: CASP for case-control: https://casp-uk.b-cdn.net/wp-content/uploads/2018/03/CASP-Case-Control-Study-Checklist-2018_fillable_form.pdf