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Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why
  1. Sarah Sims1,
  2. Mary Leamy1,
  3. Nigel Davies2,
  4. Katy Schnitzler3,
  5. Ros Levenson4,
  6. Felicity Mayer5,
  7. Robert Grant6,
  8. Sally Brearley6,
  9. Stephen Gourlay3,
  10. Fiona Ross6,
  11. Ruth Harris1
  1. 1 Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
  2. 2 School of Health, Sport and Bioscience, University of East London, London, UK
  3. 3 Kingston Business School, Kingston University, London, UK
  4. 4 Independent Researcher, London, UK
  5. 5 Nurse Development Team, South West London and St George’s Mental Health NHS Trust, London, UK
  6. 6 Centre for Health and Social Care Research, Kingston University and St George’s University of London, London, UK
  1. Correspondence to Professor Ruth Harris, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London WC2R 2LS, UK; ruth.harris{at}


Background Intentional rounding (IR) is a structured process whereby nurses conduct one to two hourly checks with every patient using a standardised protocol.

Objective A realist synthesis of the evidence on IR was undertaken to develop IR programme theories of what works, for whom, in what circumstances and why.

Methods A three-stage literature search and a stakeholder consultation event was completed. A variety of sources were searched, including AMED, CINAHL, MEDLINE, PsycINFO, HMIC, Google and Google Scholar, for published and unpublished literature. In line with realist synthesis methodology, each study’s ‘fitness for purpose’ was assessed by considering its relevance and rigour.

Results A total of 44 papers met the inclusion criteria. To make the programme theories underpinning IR explicit, we identified eight a priori propositions: (1) when implemented in a comprehensive and consistent way, IR improves healthcare quality and satisfaction, and reduces potential harms; (2) embedding IR into daily routine practice gives nurses ‘allocated time to care’; (3) documenting IR checks increases accountability and raises fundamental standards of care; (4) when workload and staffing levels permit, more frequent nurse–patient contact improves relationships and increases awareness of patient comfort and safety needs; (5) increasing time when nurses are in the direct vicinity of patients promotes vigilance, provides reassurance and reduces potential harms; (6) more frequent nurse–patient contact enables nurses to anticipate patient needs and take pre-emptive action; (7) IR documentation facilitates teamwork and communication; and (8) IR empowers patients to ask for what they need to maintain their comfort and well-being. Given the limited evidence base, further research is needed to test and further refine these propositions.

Conclusions Despite widespread use of IR, this paper highlights the paradox that there is ambiguity surrounding its purpose and limited evidence of how it works in practice.

  • healthcare quality improvement
  • health services research
  • nurses
  • patient safety

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  • Contributors RH conceived the study. RH, SS, ND and KS undertook data extraction and synthesis. All authors revised the manuscript critically for intellectual content, and agreed and approved the final version to be published.

  • Funding This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number: 13/07/87).

  • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Institute for Health Research Health Services and Delivery Research Programme or the Department of Health.

  • Competing interests None declared.

  • Ethics approval NHS Health Research Authority South East Coast - Surrey Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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