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Harris R, Sims S, Leamy M, et al. Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation. Southampton (UK): NIHR Journals Library; 2019 Oct. (Health Services and Delivery Research, No. 7.35.)

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Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation.

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Appendix 16Definitions for observation categories

Observation categoryDefinition
Opening phrase
 Fully observedNursing staff greets the patient and introduces themselves by namea
 Partially observedNursing staff greets the patient but does not introduce themselves by name
 Not observedNursing staff does not use any opening phrase or general greeting before starting the round
Positioning
 Fully observedNursing staff checks that the patient is comfortable and assesses/asks about pressure sores when appropriateb
 Partially observedNursing staff either checks if the patient is comfortable or assesses/asks about pressure sores (not both)
 Not observedNursing staff does not ask about comfort or assess/ask about pressure sores
Personal needs
 Fully observedNursing staff asks about patient’s personal needs and asks about/assists with toileting or checks catheterc
 Partially observedNursing staff either asks about patient’s personal needs or asks about/assists with toileting/checks catheter (not both)
 Not observedNursing staff does not ask about/assess patient’s personal needs or toileting issues
Pain
 Fully observedNursing staff asks patient about pain and asks them to assess their pain on a scale of 0–10d
 Partially observedNursing staff asks patient about pain but does not ask them to assess/rate their level of pain
 Not observedNursing staff does not ask about pain
Placement of items
 Fully observedNursing staff ensures that any items a patient needs (e.g. call bell, drink) are within easy reach (note that staff may or may not vocalise this – the researcher may just see nursing staff moving things closer to patient)
 Partially observedNursing staff asks about/mentions any items a patient needs (e.g. call bell, drink, personal valuables) but does not ensure these are in easy reach
 Not observedNursing staff does not mention personal items or ensure items a patient needs are within easy each
Environmental assessment
 Fully observedNursing staff is seen/heard to assess the care environment (e.g. any fall hazards, temperature of room, whether curtains need opening/closing) and rectify any issues
 Partially observedNursing staff assesses some of the care environment issues but either does not assess them all or does not rectify any issues
 Not observedNursing staff is not seen/heard to assess any care environment issues
Closing phrase
 Fully observedNursing staff says the phrase ‘Is there anything else I can do for you?’e or words to that effect
 Partially observedNursing staff ends the conversation with a general closing phrase (e.g. ‘goodbye’ or ‘thanks’)
 Not observedNursing staff does not use any closing phrase before completing the round
Patient informed of when the nursing staff will return
 Fully observedNursing staff gives a specific time when they will return to the patient
 Partially observedNursing staff gives a general sense that they will return to the patient (e.g. ‘I’ll be back again soon’ or ‘See you in a bit’)
 Not observedNursing staff does not mention when or if they will return to the patient
a

It should be noted that, in many cases, nurses were observed to conduct rounds on the same patients regularly and it was clear that some patients already knew the names of nursing staff. It may therefore not always have felt appropriate for nursing staff to keep introducing themselves by name at every round.

b

The researchers did not have access to patient notes and therefore were not always aware of the pressure sore status of each patient. It is possible that nursing staff may not have asked particular patients about pressure sores because they knew this was not appropriate for them. However, when researchers did not see pressure sore questions being asked, this section was coded as ‘not observed’ or ‘partially observed’ (depending on whether or not they asked about other comfort issues). This ‘positioning’ data should therefore be treated with some caution.

c

Again, nursing staff may not have asked about toileting issues if they knew the patient was self-caring and/or had no toileting issues. However, when researchers did not see toileting questions being asked, this section was coded as ‘not observed’ or ‘partially observed’; therefore, the ‘personal needs’ data should be treated with some caution to cater for these nuances.

d

Again, nursing staff may not have asked this question if they knew the patient was not in any pain. However, when researchers did not see pain questions asked, this section was coded as ‘not observed’ or ‘partially observed’; therefore, these data should also be treated with some caution.

e

There were differences between the case study sites on this question. In case study site 1, staff were expected to ask this question but did not need to record that they had done so on the IR documentation. In case study site 2, staff were expected to ask this question and were required to tick the IR documentation to show that they had done so. In case study site 3, staff were not expected to ask this question.

Copyright © Queen’s Printer and Controller of HMSO 2019. This work was produced by Harris et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Bookshelf ID: NBK547455
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