Nurse Rounds, Bedside Reporting – pros and cons
Purpose of Informal Nurse/Patient Rounding by Donna Setterholm – 03/13/2014
Patient rounding is not a new concept; it has been utilized as long as I have been a nurse. However, it seems to be new to some staff nurses and managers. The purpose for rounding on patients is to support patient progress in the healing arena. That means the person doing the rounding needs to know the patient’s condition and any stumbling blocks that are in the way of progressing to wellness. Examples of stumbling blocks: attitude/disposition of the patient, knowledge of their situation/condition, level of understanding, family issues, complications, misunderstandings, noncompliance, irrational behavior/thoughts, to name a few. And medications and conditions can and often do disrupt rational thinking and memory. If a patient says he/she knows the daily plan, but cannot tell the rounder what it is – the rounder should remind them (reinforce knowledge). Jumping to the conclusion that the nurse did not spend any or enough time with the patient on the plan has no merit. Use rounding to reinforce the plan.
I frequently ask my patients if they can read the care board. Many of them say they cannot see it to read it, even with glasses on. So I reinforce the information verbally to them at the beginning of my shift. They may or may not retain the information. Many of our patients are hard of hearing. They will say they heard what you said, but when asked what was said, they really did not hear you correctly. That can be embarrassing to them when they want to deny they have a hearing problem. We have patients who may be confused at one time and alert and oriented at another time (ex. “Sun-downer Syndrome”). And we occasionally have non-professional staff giving out misinformation. Know the variables we are dealing with.
If the person who is rounding has all the facts pertaining to the patient before entering a patient’s room, they will be prepared to REINFORCE the teaching, supporting, correcting, and planning to help the patient cope with their situation and progress. Rounding was never meant to support patients’ or family members’ irrational thinking. Nor was it ever until recently, in my experience, used to punish or discredit the care givers who are directly dealing with all the many facets of patient perceptions.
Allowing a patient or family member to criticize a nurse may help blow off steam – so be it. Let it happen, but then redirect the patient’s or family member’s thoughts to coping with the realities of his/her situation. Management: Blaming or punishing nurses for a patient’s or family member’s perception does not improve long-term patient satisfaction. You just alienate the nurses, preventing nurse satisfaction. Please focus on using rounding as a professional tool, rather than a political toy. Try to make it a win/win situation?