Influencing contexts of intentional rounding (IR)
| Context | Description |
| Individual capabilities and characteristics of key actors | |
| Staff education, training and understanding of IR (n=28)6 8 25–27 31–33 36 39 41–45 47–52 54 64–69 | Staff education, understanding and training in IR were commonly viewed as an important factor in its success.6 8 25 27 31 32 36 39 41 43–45 47 50 52 54 65 Methods of educating staff about IR varied, including lectures/presentations, ward meetings, online learning modules, competency tests and feedback to staff on practice.25 26 32 36 42 43 49 51 64–69 Even where substantial education/training opportunities were available, not all managers participated or enabled their team to participate,31 and some staff remained unprepared for IR.47 Participating in IR educational opportunities was more difficult for nurses working night shifts33 and for agency/‘floating’ nurses.54 |
| Staff engagement and motivation (n=23)6 8 25 26 29 31–33 35–38 40–43 47 48 50–52 65 70 | IR was more successful when staff were engaged with, committed to and positive towards IR from the outset and throughout.6 8 26 29 36–38 40 41 43 48 51 52 70 Methods of fostering engagement varied, including involving staff in the design and implementation of IR initiatives, sharing best practice and developing a strong sense of team.8 25 31 36 38 42 43 48 51 IR was implemented less successfully when staff were resistant towards it, perceived it as a top-down process/paper exercise or did not believe it improved patient experience: in these situations IR was performed irregularly/with little intention by staff and poor activity not routinely challenged.26 33 35 38 47 50 |
| Staff characteristics (n=2)38 40 | Understanding of the principles and practices of IR varied according to individual staff characteristics, including age and level of training/experience.38 40 |
| Leadership/management support for IR (n=18)6 24 31 33 34 38 42 43 45 47 48 51 52 54 64 65 68 70 | Support from nursing leadership/management was key to successful IR, with leaders being required to provide a number of functions, including encouraging staff ‘buy in’, providing ongoing reminders and tips for success, and monitoring performance.6 24 38 42 43 45 47 48 51 52 64 68 70 Some papers highlighted the importance of unit champions/rounding experts/‘buddy support’,6 38 47 54 65 although others did not acknowledge their value.33 Senior ‘walkabouts’ were seen as useful,38 but some reported variable long-term commitment of leaders towards IR.31 |
| Type of patients (n=15)6 28 31 33 35 37 38 40–42 44–46 48 50 | Nurses did not think all patients required hourly rounding, and some patients did not want to be seen every hour.6 31 33 35 37 38 41 42 45 46 Complex and demanding patients took up more of nurses’ time during IR and were prioritised over those deemed to be ‘well’.6 28 44 48 50 IR was highlighted as most beneficial for older and vulnerable patients who required help with activities of daily living.37 |
| Patient and carer education and understanding of IR (n=1)67 | Variations in the amount of education and information around IR that patients and carers receive do not appear to have a significant impact on their perceptions of care.67 |
| Ward characteristics | |
| Ward setting/layout (n=5)25 34 37 38 42 | IR may be less suitable/more difficult to implement in some settings, including Accident and Emergency (A&E) and mental health.25 37 38 42 Open ward layouts facilitate IR, while closed or cluttered layouts inhibit it.34 |
| Workload issues/lack of time (n=13)6 28 30 31 34 35 37 40 44 47 50 53 69 | IR was inhibited when nurses faced competing tasks and priorities in their workload caused by busy wards, staff shortages, poor skill mix, high patient to nurse ratios, interruptions, emergencies or high numbers of complex patients.6 28 30 31 34 35 37 40 44 47 50 53 69 |
| Who conducts the rounds? (n=6)7 34 37 38 40 42 | There was variation across studies around who delivered IR (ie, staff of all levels vs senior staff only).7 34 38 40 42 Confusion around who should be delivering IR was a barrier to its implementation.40 IR worked best when all types of nursing, care and support staff were involved but where senior staff retained an active and visible daily role.38 |
| Organisation and system characteristics | |
| Design and suitability of IR documentation (n=14)28 29 32 35 37–39 41–43 45 50 51 53 | Staff who did not acknowledge the benefits of IR documentation or believed this to be a burdensome, ‘tick-box exercise’ perceived the IR process negatively.28 35 38 45 50 53 Frustration occurred when IR paperwork duplicated information recorded on other charts/logs.28 39 42 53 To document IR effectively, personalised tools were required to suit the setting and needs of the ward.29 32 38 41–43 51 |
| Presence of other organisational changes/competing initiatives (n=6)31 43 45 46 48 53 | Introducing multiple, simultaneous initiatives or changes alongside IR had a negative impact on its implementation.31 43 45 46 48 53 |
| Embedding into existing daily routines (n=5)6 8 31 38 47 | Successful implementation of IR required cultural change within organisations.6 31 38 47 Some highlighted the importance of embedding IR within existing daily routines,31 but others felt ward activity should be reorientated to fit around IR.6 |
| Staged or simultaneous implementation approach (n=5)6 26 34 38 52 | Variations in the implementation approach for IR were noted: some reported a staged introduction of IR,6 26 38 while others introduced it simultaneously across different wards and departments.38 The advantages of rolling out IR across the whole organisation outweighed the advantages of a more gradual approach.38 |
| Reason for implementation (n=2)31 53 | The reason behind the implementation of IR can influence staff perceptions of it. For example, the fact that IR was a government initiative helped some leaders to promote the concept in their clinical areas, but others reported resenting the intervention for the same reason.31 |