Evidence Based Practice

This study was performed on a small 506-bed facility. An outlier such as the delirious patient who is capable of using the call light, can result in significant negative outcomes when that data is included in such a small research group. However, the researchers discussed that with persistent re-enforcement of hourly rounding will have continued improvements in the three identified variables. They concluded that there is a need for continued hourly rounding and answering the call light. A 4.

Ethical issues The researchers obtained approval from the RIB of both the hospital and the university associated with the study. Patient identifiers were not used, therefore the RIB waived obtaining informed consents. The chosen groups for the research appeared equal as they were similar in size, both had a significant number of falls, and both units had a mixture of medical and surgical patients. However, the researchers may have made a biased decision when choosing which group would be the experimental group. The researchers chose the unit in which the nurse manager had the strongest desire in participating.

Individuals who are motivated to participate in a research have more positive outcomes than those who are not due to heir tendency to be more compliant with the study. It is possible that the researchers chose this unit so that it would result in a conclusion that would support the purpose of this research. Otherwise there are no other ethical implications noted in the study. A 5. Type of research The researchers used a quantitative research design. The relationship between variables, as identified above, are measured and then the data is analyzed statistically. The variables are classified as being independent or dependent.

The independent variable, hourly rounding, is the intervention. The dependent variables By lassoing of the effect of the independent variable (hourly rounding) on the dependent variable or variables (fall rates, call light usage, and patient satisfaction). The data from the effects of the independent variable on the dependent variable are numerical responses which are analyzed statistically. Quantitative studies compare groups. The selected groups are divided into an experimental group and a control group. The intervention is applied to the experimental group and not the in the control group.

This study did not randomly choose their subjects, therefore it is a quasi- experimental study. Due to this reason, there was not a true control group but rather a comparison group instead. The comparison group in this study did not participate in the intervention of hourly rounding. The dependent variables are measured in both the experimental and comparison group in order to determine the outcomes of the intervention. Due to the non-randomized groups, we cannot assume that this study represents other patients within the same population and but that it only applies to the groups within the study.

The researchers could have chosen to use an experimental design in which the subjects were randomly selected and the groups ere controlled. The process of collecting the data remains the same except a clear conclusion of the effects of the intervention can be concluded and applied to other similar groups outside the study. The incidence of fall rates and call light usage can be measured numerically as well as incidentally. An evaluation of incidental fall reports and using a survey to evaluate the reasons why patients use their call light can also be performed. This is a type of qualitative research.

Also, a qualitative research using descriptive studies can be done for the effects of hourly rounding on patient satisfaction. It is known that patients give high satisfaction scores when they feel their caregivers have been accessible and attentive to their needs. A qualitative research on why hourly rounding gives high patient satisfaction scores would be appropriate. B 1. Identification off Nursing Problem Falls remain the most common and persistent adverse event in hospitals with more than 1 million a year (Moon, 2012). Patient fall rates are increasing due to infrequent patient rounding.

Made, Brussels, and Ketene (2006) identified the top reason for using the call light was for bathroom and bedpan assistance, followed by robbers with the IV or pump. Dozen (2011) found that the top 3 reasons for call light use were for pain medication, personal assistance and bathroom assistance. Krause and co-authors (2005) found that many falls occurred during unassisted elimination related activities. Patients become impatient when responses to call lights are delayed (Dozen & Yin, 2009). Therefore, they attempt to resolve their needs on their own. As the shortage of nurses worsened, rounding became more infrequent.

Assistance with the bathroom and bedpan, along with other personal care tasks, can be performed by other licensed personnel outside of the nurse. Implementing a nursing round system, such as hourly rounding, in which all nursing staff perform certain actions during those rounds to address those needs can help to reduce the incidences of falls. B 3. A. Annotated Bibliography for 10 pieces Kessler, B. , Claude-Guests, M. , Donahue, A. M. , Dries, R. F. , & Snyder, M. M. (2012). The merry-go-round of patient rounding: Assure your patients get the brass ring. Understanding, 21(4), Retrieved from HTTPS petrified/,Donaldson=web. Boohoos. Com. Foyer. Seemed. Dude+petrified? This article is about a study on whether the use of hourly rounding would have positive outcomes on patient and staff satisfaction scores, fall rates, and pressure ulcers. The study spanned over a period of six years. Hourly rounding was implemented 1 year after the opening of a brand new medical-surgical unit. Majority of the nurses who were new to the facility had less than 1 year of nursing experience. Prior to implementing the rounds, education about the protocol was provided through workshops and lectures led by unit leaders, instead of short “train the trainer” sessions.

Staff also signed a statement pledging their commitment and adherence to he rounding protocol and were formally held accountable as part of their annual performance evaluations. Once the unit went live, hourly rounding became part of the new employee orientation and unit specific annual competency. Positive feedback from patients and family members motivated the staff to embrace the protocol even more so. Not only did patient satisfaction improve, fall rates decreased and nurse retention improved. In addition to the sustained positive outcomes, the longevity of the study provides credible contributions to the literature of hourly rounding.

Lowe, L. , Hodgkin, G. (2012). Hourly rounding in a high dependency unit. Nursing Standard, 27 (8), 35-40. Retrieved from http://shies. Obscenest. Com/ghost/petrified/ 1-chic-iffy-away- [email protected]=16&hid=110 This article discusses a study on whether hourly rounding could be implemented in a high dependency critical care unit to lower the number of patient harm. The study was performed over a two week period in which rounding logs were placed in patient rooms. Primary nurses were responsible for carrying out and completing the logs daily. The logs consisted of a series of checks called the 4 PSASPain: patient’s pain score

Potty: patient’s toileting needs Position: assistance with repositioning Possessions: placing personal items within reach In addition to the 4 PSASnurses are to ask patients if there was anything else they can do before leaving the room. Assessment of patient’s pain and positioning are also documented in the patient chart as part of the unit’s routine care. Due to time constraints, some of the nurses documented in the chart and not on the log and vice versa. There were also duplicated charting in both the logs and the patient chart which may have altered the results.

There were no incidents of falls within the two eek study nor were there any falls in the two months before and after the study. In a critical care unit, patients are seen routinely by their nurse at a minimum of every hour. Therefore this study cannot conclude whether implementing hourly rounds had a positive effect on falls because routine rounding at a minimum of every hour is a part of nursing care within a critical care unit. MeMadeC. M. , BuBrusselsA. L. , KeKeteneL. (2006). Effects of nursing rounds: on Patients call light use, satisfaction, and safety.

American Journal of Nursing 106(9), 58-70. Retrieved from htHTTPS/ myundernourishmentswSeemedduDuupumpedDaDamnationww. ncIncubinlMlniNIHgoGob6954767 aides, patient care technicians (PCPacts and patient care assistants can decrease the use of the call light, which in turn will decrease the number of falls and increase patient satisfaction. The study found that for both the experimental and control groups, the top reason for using the call light was for bathroom or bedpan assistance, a task in which PCPactsnurse aides, and patient care assistants are capable of doing.

In 95% of the hospitals that participated, the nurses rounded on the even hours and PCPactsnurse aides, and patient care assistants rounded on the odd hours. Nurses from the units who participated in the hourly rounding verbally reported that they had more time to perform other patient care tasks due to the reduction of call lights they had to answer. OlOilierT. , KaKalmiaM. , & NiMongoliaC. (2012). Hourly rounding: A replication study. MEUnderstanding21(1), 23-36. Retrieved from htHTTPSyundernourishment swSeemed edDudeupumpedDaDonaldsonww. ncIncubilmElmniNIHgogofr22479871This article is about a study on the effects of hourly rounding on fall rates, call light use, and patient satisfaction. It is a study that replicated the rounding protocol study by MeMadeBuBrusselsand KeKetene2006). It used a smaller sample size and the participants were non-randomized. There were a large number of nurses who floated to the experimental unit and were not trained to follow the rounding protocol. Also an outlier, who was delirious and capable of pressing the call light, affected the outcomes significantly.

When researching using a small sample size, matters such as untrained floating nurses and a single delirious patient can significantly affect the outcomes of the study. Although not significant, the study did find that hourly rounding had positive effects on patient falls, call light use and patient satisfaction. Although this is a replicated study, due to the non-randomized sample, the outcomes of the study can only apply to those within the study and not the general population. SaSalesB. S. , NuNassauH. , ZuJubbahN. A. , A1AYhSoulS. , SaSalesU. (2011).

The nursing rounds system: Effect of patient’s call light use, bed sores, fall and satisfaction level. 2011. 01938. x Xhis article is testing the hypotheses that nurse rounds performed every one or two hours could reduce the use of the call light, increase patient satisfaction, and decrease fall rates. This is an international study which indicates hat the reason for using the patient call light is universal. Although the sample size is small, implementing a 1 hour and 2 hour rounding by all nursing personnel showed positive outcomes within the study group.

Nurses who participated in the rounds expressed their concern about the amount of time it takes to perform both the rounding and patient care tasks. They expressed how rounding took time away from task that were more pertinent to their patient’s care. This could implicate that eventually these nurses will choose to do one over the other which could affect their overall patient care. ShShaverL. L. , TiTitlesM. G. MaMackinacM. L. , KuKennyA. (2011). Fall prevention practices in adult medical-surgical nursing units described by nurse managers.

Western Journal about a study on nursing practice in relation to preventing falls. Interviews were conducted via phone. The interview focused on three areas consisting of 30 questions in relation to hospital policies on falls, unit practices such as fall risk assessments, and the interventions used to prevent falls. 96% of the managers stated that they had a falls prevention policy in which 84% of them thought they were evidence-based. Of those, 67% were unable to define what type of evidence was seseed

The responses from the interviews were quantified into categories and found that the most common intervention to prevent falls is bed alarms (89%), followed by rounds (70%). However, six percent of managers stated that it was standard to have bed alarms activated for all their patients. Although this is not a credible source on the effect of hourly rounds on patient falls, based on the evidence in this study, standard practice of using bed alarms may mean that rounding is the best intervention in preventing falls. Tucker, s. J. , BiBibberP.

L. , AtAthletesnpensJ. M. , Olson, M. E. , & DtDetergent’sR. A. (2012). Outcomes and challenges in implementing hourly rounds to reduce falls in 1741- 6787. 201 1 . 002227. x Xhis article was about a study on the effects of hourly rounding on fall rates and evaluating the feasibility of implementing the protocol on popostrthopedic units. They predicted that fall rates would be lower during the rounds, higher in patients who are at a greater risk of falls and lower in patients who had more documentation that rounding had occurred.

During the hourly rounds, nursing staff had to complete a list of actions, which was modeled after the rounding intervention by MeMadeBuBrusselsand KeKetene2006). These actions were offering and assisting with toileting, assessing/addressing patient positioning, placing the call light and personal items within reach, ask the patient if there was anything else they can do for them, telling the patients that someone from the nursing staff will be back in an hour, and emphasizing to the patients that someone will help rather than leaving them to ambulate on their own and unassisted.

Data was also collected a year after the study was completed. A focus group revealed that staff members were unclear of the purpose for the study. Many of them felt that this study was not appropriate for their unit. One nurse felt out of place having to ask her healthy patient if they needed assistance using the bathroom, therefore they simply did not ask. Other nurses felt that documenting that rounds had occurred every hour became a burden and was extra unnecessary work and therefore was not done. Then there were nurses who stopped documenting the rounds because they heard that other nurses were not documenting.

These actions by the nursing staff lead to an initial decrease of falls during the rounds and an increase of falls after the study was completed. This study shows that hourly rounding does reduce the number of falls but implementing the rounds and maintaining the intervention is challenging and redundant for nurses. TzDozenH. & Yin, C. (2009). Relationship between call light use and response time and inpatient falls in acute care settings. Journal of Clinical Nursing, 18(23), 3333-3341. beBetweenall light use, response time, falls, and fall related injuries.

The most common complaint that patients express is their frustration over the amount of time it takes in answering the call light. The results of this study found that the more all light usage, the longer the response time. Subsequently, the longer the response time, the lower the fall rates. Based on this study the researcher suggest that the rate of call light use will predict the number of falls and related injuries. The author also suggest that the findings in her study challenges the purpose of hourly rounding and its role in reducing falls.

However, the author then concludes that encouraging patients to use their call light is key to reducing falls and failing to place the call light within the patients’ reach will decrease the incidences of call light use and ubabstinentlyead to a higher fall rate. Placing the call bell within the patient’s reach is part of the actions conducted in the hourly rounds. TzDozenH. (2010). Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: An exploratory survey. BMBMWealth Services Research, 10 (52). otTo101. 118611472-6963-10-52 This is a research article on staffs perception and response to call light use. 808 completed surveys were retrieved from voluntary and anonymous staff members in 4 different hospitals. Staff perceptions for call light use determined their response time. Only half of the staff believed that the call lights were a matter of patient safety and 44% of the staff thought that answering call lights would prevent them from doing more pertinent task. There were six reasons identified by 90% of the participants.

These reasons were pain medication/ management, assistance with toileting, IV/pump problems, personal assistance, accidental pressing of the call bell, and repositioning. These findings suggest that patient rounding would have addressed those needs. Although this article did not specifically address the effects of hourly rounding on patient falls, it does implicate he top 5 reasons for using the call bell, which in many other studies have found to have a positive outcome on the rate of patient falls when addressed during the rounds. WeHexagramB. Raymond, S. (2008). Using evidence-based nursing rounds to improve patient outcomes. MEUndersigning17(6), 429-430. Retrieved from http:// ehshiesebObscenestcoComhghostdpetrifieddpetrifiedsiSide341 adODL- f8fief8dada8off1 feaffectedlyecommissionaires=9=110 This article is about a study that was performed on a telemetry unit in an army medical center. Army medical centers are not required to have Joint Commission reviews. In order for the facility to maintain high standards of patient care, national patient safety goals are reviewed.

The number of falls on the stepstepsonsemetry unit prompted the review of the goal of preventing patient falls. They decided to replicate the study by MeadMadersBrusselsd KeteKetene06). They implemented hourly and every 2 hour rounds in which certain actions had to be completed during the rounds. These actions included, but are not limited to, offering assistance with toileting, placing the call light and personal items within reach, assessing patient comfort and positioning, nd aNDing if there was anything else they can do before leaving the room.

The study short and more data is needed. 83b.Bibcase for the efficacy Patients who sustain an injury from a fall stay in the hospital 6-12 days longer and the mean cost for hospitals to treat those patients are over $13,000 (MionMoon12). In addition, Medicare and Medicaid no longer pays for the services to treat inpatient falls. Hourly rounding is a cost efficient intervention that does not require any additional tools or technology. It is simply modifying the way nurses and nursing staff utilize their time in terms of patient care.

Nurses were concerned about having time to perform both the hourly rounds and other required patient care tasks (SaleSalessaNassaubaJubbah SAYoSould SaleSales11). In the study by MeadMadersBrusselsd KeteKetene06), nurses rounded on the even hours and all other nursing staff rounded on the odd hours. The nurses in that study stated that they had more time to perform other patient care tasks. This was due to a decrease in call light demands in which many nurses perceived as mere noise and interruptions to nursing tasks (MeadMadeal. , 2006).

Majority of the studies used a quantitative research approach in hichwhichy compared the effects of hourly rounding before and during the intervention. All the studies on hourly rounding resulted in a decrease of patient falls, while the study by Tucker, BiebBibbertlAthleteses, Olson, and DierDressing12) found that the rate of falls increased back to pre-intervention fall rates after the study was completed and hourly rounding had ceased. B3c.BBCentification of tools used Many of the experiments used similar tools. In order to make an analysis, data was collected before and during hourly rounds.

To measure the incidences of call lights, any of the units within the experiments used call light logs. These logs were either manual logs or electrical via the electric call bell system. The manual logs were the responsibility of the nurse or the secretary. In addition to documenting the incidence of call light use, they also documented the reason, time of call, and response time. All the studies used incident reports to compare fall rates before and after hourly rounding. The adherence to hourly rounding was measured by using rounding logs that were placed in or around patient rooms.

All of the experimental groups used heseHesss in which the nurse or nursing staff was responsible for completing the log for that hour by indicating it with a check mark or staff initials. During the hourly rounds, nurses and nursing staff had to perform certain actions. Some of the logs were specific and staff had to indicate whether these actions were performed in that hour. If they were not performed, they had to indicate why. Surveys such as the Press GaneGameyvey were used to measure patient satisfaction scores and overall patient care. B3d.Badw tools affect results In order to make comparisons, you must have a baseline to compare with.

All of he researchers have done this by obtaining before and after data. However, the results may not have been accurate because the data documented during implementation of the rounds may not have been true. For instance, a nurse or nursing staff may have entered a patient’s room, completed the rounding log but may not have addressed all of the required actions. The accuracy and validity of the studies depends on the staffs fidelity to the study. Another tool used by some of the researchers with high probabilities of inaccuracy was the electric call bell system. diffDifferentiateween actual calls from accidental calls.

Patient surveys are subjective and therefore should always be deemed true. B 4. Evidence summary and key criteria To summarize, these articles analyzed the effects of hourly rounding on overall patient care. Hourly rounding was implemented on various types of floors including medical, surgical, telemetry, and the ICU.ICCe most important key criteria is that hourly rounding had positive effects on all the experimental floors. During implementation of the hourly rounds, significant or not, all experimental floors showed a decrease in patient falls, except the ICU ICCch had no falls and patients are outidotinglyn at a minimum of every hour.

The length of each study varied from months to six years. The study by Tucker, BiebBibbertlAthleteses, Olson, and DierDressing12) found that the number of falls returned back to previous fall rates after the study concluded. The six year study by Kessler, Claude-GuteGuestsncDonahueies, and Snyder (2012) had award winning outcomes. At the time of publication in 2012, hourly rounding remained a part of standard nursing care for that floor and influenced the use of hourly rounding amongst other floors in that hospital. In 2009, TzenDozennd that patients who use their call light were less likely to fall.

In another study by TzenDozen2010 found that patients use their call light for pain, IV pumps and alarms, assistance with toileting, personal assistance and positioning. TzenDozenstioned whether hourly rounding had positive effects on falls and believed that encouraging the use of the call light instead will decrease the number of falls. TzenDozented that when nurses fail to place the call bell within reach, the number of call light use will decrease and subsequently the number of falls will increase. The findings in TzenDozensdies were correct however, she failed to realize that hourly rounding and the call bell go hand in hand.

Patients use their call bell for assistance with needs that are essentially addressed during hourly rounding. Included in the hourly rounding is placing personal items such as the call bell within patient reach. Using the call light will decrease the number of falls because it prompts nursing staff to provide the patient with assistance. On the other hand, the purpose of hourly rounding is to offer that assistance to the patient before having to be prompted. Both methods are a way of providing the patient with assistance to help reduce the number of falls. B 5.

Recommendation of a nursing strategy Hourly rounding should become a standard nursing care in which all nursing staff are held accountable. As one of Joint Commission’s national patient safety goals, patient falls continue to be one of the leading adverse events in hospitals. Through these studies, it has proven that hourly rounding has positive effects on the number of patient falls. As seen in the study by Kessler, Claude-GuteGuestsncDonahueies, nd SNDder (2012), they had significant changes in the number of falls and continued to have positive, award winning outcomes during the six years.

The nursing staff signed statements that indicated their commitment and adherence to the hourly rounds. They were formerly held accountable and their performance was evaluated annually. When nurses are held accountable for their actions, adherence is higher and they are more likely to be compliant. B 6. Explanation of the importance ofa offoretical model for nursing research In order to prove these theories, they must be applied through research. Theories have specific, expected outcomes. Therefore, it helps to guide the researcher in collecting their data and keeps them from resulting in conclusions that are not related to their hypothesis.

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