Table 4

Summary of eight context-mechanism-outcome (CMO) configurations

Mechanism titleContextMechanism (resources)Mechanism (reasoning/responses)Outcomes (from literature)
CMO 1: Consistency and comprehensivenessStaged or simultaneous implementation approach
Degree of fidelity to intervention
Degree of adaptation and enhancement
Staff education, training and understanding of intentional rounding
Staff characteristics
Risk/type of patient
Workload issues/lack of time
Presence of other organisational changes/competing initiatives
Intentional rounding helps keep patient care consistent through the use of a structured, systematic approach, ensuring all patient needs are met and potentially less obvious aspects of care are considered and managed at every round.
Intentional rounding also helps ensure that family members are provided with consistent care and information in line with their needs (eg, the need for information, to be respected and to be comforted).
It can also prompt agency staff to deliver care to a required standard.
This provides reassurance and confidence in the quality of care to patients, their family members and staff.
This helps staff increase their vigilance and awareness of physical and psychological safety risks.
…and leads to higher patient and carer satisfaction with care and lower patient complaints.
…and reduced patient uncertainty/anxiety.
…and reduces call bell use.
…and improves pain management.
…and leads to a reduction in falls, pressure ulcers, bed-wetting and dehydration.
CMO 2: Allocated timeEmbedding into existing daily routines
Successful teamworking
Intentional rounding gives nurses allocated ‘time to care’ (ie, time to check that patients are comfortable and their needs are being met, thereby treating patients with dignity and replaces ‘presumed care’).This helps nurses to organise their work and to feel able to prioritise this aspect of nursing care.…and leads to nurses becoming empowered.
…and to increased staff, patient and carer satisfaction with care and lower patient complaints.
CMO 3: AccountabilityDesign and suitability of intentional rounding documentation
Leadership and management support
Staff engagement and motivation
Reason for implementation
Who conducts the rounds?
Staff are required to complete and sign the intentional rounding record to say they have carried out hourly checks.This makes staff feel personally accountable for the standard of care.
This enables ward managers to monitor and audit the standard of care provided by nursing staff.
…and this leads to higher standards of care.
…and provides a protection for both patients and staff as staff can evidence what they have done.
CMO 4: Nurse–patient relationships and communicationWard setting/layout
Staff characteristics
Workload issues/lack of time
Intentional rounding provides increased and improved communication between staff, patients and family members, and ensures that patients’ perceived basic fundamental needs are met.
It also provides more opportunities for positive nurse–patient relationships to develop based on trust, respect and caring.
This enables staff to get to know patients better and become more aware of their needs, and through this knowledge nurses can gather a keen sense of unusual behaviours and appearances and detect subtle/significant changes that can impact on comfort and safety.…and this leads to a reduction in pressure ulcers, falls, bed-wetting and dehydration.
…and improves pain management.
CMO 5: VisibilityWard setting/layoutIntentional rounding increases the visibility/presence of nurses within a unit by increasing the time that nurses spend in the direct vicinity of their patients (ie, it gets nurses to the patient’s bedside).This relieves the uncertainty and anxiety often associated with vulnerable patients’ hospital experience (ie, the inability to predict when care will be delivered and when someone will be available to assist them with care).
This is comforting to family members because it denotes frequent and continuous assessment of the patient and their needs.
…and leads to improved patient and carer satisfaction with care and lower patient complaints.
…and increases staff walking distances.
CMO 6: AnticipationType of patient
Ward setting/layout
Intentional rounding enables nurses to anticipate/pre-empt and proactively address patient needs instead of being reactive and waiting for patient call bells and alarms.This ensures that all patients receive regular care instead of unequally distributed care among patients, focused towards those who have frequent call bell use.
Taking proactive and pre-emptive action reduces the likelihood of patients getting out of bed unattended.
…and this leads to a reduction in patient uncertainty/anxiety.
…and increases patient confidence in staff.
…and increases pain management.
…and reduces call bell use, falls and pressure ulcers.
…and contributes to a calmer ward environment with fewer interruptions to staff.
CMO 7: Staff teamwork and communicationStrong staff relationships
Staff education, training and understanding of intentional rounding
Intentional rounding provides healthcare professionals with documented evidence.This can be used to prioritise care in future rounds.…and this leads to improved staff communication and teamwork.
CMO 8: Patient empowermentPatient and carer education and understanding of intentional rounding
Good staff–patient communication
Intentional rounding provides an opportunity for nursing staff, patients and family members to get to know each other better.This empowers patients to ask for what they need in order to maintain their comfort and well-being.…and this leads to higher patient and carer satisfaction with care.