Introduction
This paper analyzes a study that was conducted by Deitrick et al. (2012) to evaluate the challenges associated with the implementation of evidence-based practice: hourly rounding.
Background of the Study
Even though, there is a growing body of literature highlighting the significance of evidence-based practices, a number of these practices are poorly administered in nursing practice. An example of poorly administered practice is hourly rounding. According to Meade, Butsell, and Ketelsen (2006), hourly rounding denotes a proactive nurse-driven evidence-based intervention to anticipate, as well as address needs in hospitalized patients. Scholarly evidence has shown that hourly rounding can foster team communication, improve patient safety, and boost staff ability to provide efficient patient care. The value and contribution of hourly rounding have been measured and evaluated by tracking patient falls, call bells, as well as staff and patient satisfaction. The researchers of this study acknowledge that the implementation of hourly rounding in any given institution has a host of challenges.
In fact, there is no effective and proven method to guide the implementation of this evidence-based practice. Nursing experts in this research identify the essential concepts that are needed if there is to be an effective translation of evidence-based practice. These components are comprehension of the complexity of the intervention, a well-designed communication and implementation plan, as well as a comprehensive assessment of adopters. It is thus paramount to identify not only measurable, but also sensitive outcomes that determine the success of the initiative at hand, and in this case, it is hourly rounding. Although there is a rich body of literatures highlighting the benefits of implementing hourly rounding, little effort has been made to identify the barriers to implementation of this practice at the unit level.
In line with this, the study at hand was conducted with the aim/objective of elucidating the difficulties associated with the implementation of hourly rounding. Illumination of such challenges will help hospitals in implementing successful hourly rounding regimes. Besides, since nurses are the chief protagonists of this phenomenon, findings of this study will help the nurses’ fraternity in addressing the channelings that are associated with hourly rounding.
Methods of the Study
The study conducted by Deitrick et al. (2012) took the form of an ethnographic study. Two inpatient units where hourly rounding was poorly executed, were chosen. The choice of this research design was helpful because it assisted the researchers to listen to what people on the study units said, see what the staffs were doing, and understand their perceptions. This research design necessitated descriptive, focused observations regarding how the staff in question was performing hourly rounding. Initially, interviews were conducted with 13 stakeholders including those tasked with the role of designing the hourly rounding program, nurse administrators and unit managers. Those interviews were recorded with permission.
Next, the research team evaluated existing documents and presentations on hourly rounding process engineered by the nursing administration. This step helped the research team to understand the state of affairs at the units in question. Thereafter, the research team conducted ethnographic observations and interviews of the units under study. Two team members were given the role if observing and interviewing staff on each study unit for up to 3 hours, as well as conducting impromptu interview with available unit staff. This study collectively used 40 hours of observations during the one month study. Interview questions included implementation, purpose, process, documentation, accountability and successful measurement of hourly rounding. Photographs were also used during data collection. Interview notes, as well as, field observation notes were transcribed and imported into Nvivo 7 (QSR International 2001) database for coding and analysis. This analytical method helped in showing insights whether hourly rounding was being practiced effectively on the study units, as well as the thoughts held by staff members with respect to problems with the initial rollout of the practice at hand.
Results of the Study
There were six themes that were extracted from ethnographic observations and interviews.
Dissemination
Interviews from unit and nurse administrators, as well as unit documentation, showed that these leaders believed that unit staffs had the necessary information/education hourly rounding (purpose and process). The problem was that the how-to-do factor was lacking.
Purpose of hourly rounding
Nurse leaders were could articulate the significance of hourly rounding as improving patient outcome and patient and staff satisfaction. However, they were incapable of identifying quality indicators that illuminate the success of hourly rounding. Staffs from both units had an idea about the significance of hourly rounding.
Hourly Rounding Process and workflow
Accountability
Staff members were expected to sign hourly logs indicating the tasks they had completed. It was evident that staff members did not sign these logs as expected, and these logs were not accurate. Therefore, accountability was deficient. It was evident that hourly rounding was not mandatory, but an option.
Staff Attitudes
Patient Safety
Patient safety is one of the goals of hourly rounding. However, both staff and unit leaders could not identify specific patient safety outcome as a result of hourly rounding.
Ethical Consideration
The study conducted by Deitrick et al. (2012) was approved by the health networks institutional review board. This study was approved as quality improvement study. Since the main participants for this study were nurses, the contribution of patients was not clear, and, therefore, the study does not express/ imply ethical and privacy issues associated with patients.
Conclusion
Results from the study conducted by Deitrick et al. (2012) indicates that translation of complex evidence-based interventions in the clinical practice has various challenges that can deter its expected results. Therefore, there is a need for careful planning starting firm the units’ leaders. Besides, it is essential to have a documentation plan that reveals the results of the process; it should show if the process is working or not. This study has evaluated the problems that are associated with the implementation of evidence-based practices in hospitals. Nurses, as well as, nurse leaders in different hospitals can learn from the findings of this study and plan their future evidence-based practices effectively.
References
Deitrick, L. M., Baker, K., Paxton, H., Flores, M., and Swavely, D. (2012). Hourly Rounding Challenges with Implementation of an Evidence-Based Process. J Nurs Care Qual, 27(1), 13–19. http://www.nursingcenter.com/lnc/pdfjournal?AID=1265838&an=00001786- 201201000-00003&Journal_ID=&Issue_ID=
Meade, C. M., Bursell, A. L., Ketelsen, L. (2006). Effects of nursing rounds: on patients’ call light use, satisfaction, and safety. Am J Nurs, 106(9), 58-70.
