EVIDENCE BASED PROJECT PROPOSAL 2

Running head: LITERATURE REVIEW AND CRITICAL APPRAISAL 1

LITERATURE REVIEW AND CRITICAL APPRAISAL 2

Literature Review and Critical Appraisal

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This paper aims to review five different articles related to the PICOT question: “on a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I), compare to no scheduled rounding (c), affect patient safety(o), within 6 months of implementation (T)?” Some of the databases that examination or review was based on included the CINAHL, Cochran Library, and PubMed. The search strategy was also based on the inclusion criteria, i.e., using articles published from 2015-2020. During this search, patient safety was used as a dependent variable, while the hourly nurse rounds were used as an independent variable. The ten keywords used in researching the PICOT question were older, adults, fall, patient, hospital, effectiveness, hourly, rounding, injury, decrease, prevention, and safety. I used the Johns Hopkins Nursing EBP Rating Scale (JHNEBP) as a guide to critically analyze my peer-reviewed journals. It means my articles were based on the most evident measure level. The strength of evidence runs from the most significant article; for instance, I mostly used randomized controlled trials and experimental tests. Also, I avoided developing my literature review using weaker articles because they came from expert opinion websites.  

Literature Review

In order to locate a specific subject for your literature review, you need to invest in countless hours of studying. It is not an easy task because when you select your articles, they must be grounded on the reliability and strength of their same EBP. Therefore, one must understand the quality and quantity of evidence available and rank it according to the pyramid visual perspective chart. For instance, when making practice recommendations, researchers use filtered resources grouped in levels I-III because they explore the articles' quality. But when a researcher is searching the primary literature of the article’s evidence, researchers use levels I-VII because resources are filtered.

Brosey & March (2015) conducted my first resource study, “Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes," that showcased how the study’s level of evidence influences nursing practices. The authors used three sample groups of hourly rounding scheduled from 1 hour, 2-hour rounding groups and no proper rounding. A systematic mixed method was used along with an integrative review to analyze how the three rounding groups would change clinical outcomes and patient satisfaction. Results revealed that the structured hourly rounding during the four-week study indicates a significant drop in fall rate from 24 falls to 12. The hierarchy of evidence for the examination based on the evidence presented was appraised as level III. The article's strength was associated with how it has impacted the nursing practice by providing a more detailed comprehension of reducing fall rates within a healthcare facility. However, the source had its weakness because researchers used a short period of 3 months to evaluate the project's success and sustainability after implementation, which would have produced unevidenced-based outcomes.

My second article was about the "Purposeful and timely nursing rounds: a best practice implementation project" by Daniels (2016), who conducted six-week quasi-experimental research. The study's primary goal is to demonstrate how purposeful and timely nursing rounds would improve patient safety and satisfaction upon implementation. The author initially set fall rates and patient satisfaction. Other objectives that were considered are to show how evidence-based procedures related to rounding protocols and times would affect nurses' compliance and knowledge and how those standards can be increased. Results showed that from zero, the compliance rate rose to 64%. Even though the study setting did not attain its set goals, there was a substantive rate increase in the three elements of patient satisfaction. It implies patient falls decreased by 50%, nurse’s response rate, especially toileting, increased by 40%, and the pain management scores and nurse communication increased by 10% and 5%, respectively. Therefore, the article displays a significant strength that nurses can use best fall management protocols to promote practice change and team collaboration. The article had a weakness in its result because the applied intervention did not compare the actual results with the control group, which could have biased nursing behaviors. The evidence presented in this research would be the hierarchy level I.

The third study was conducted by Goldsack et al. (2015) about “Hourly rounding and patient falls: what factors boost success?” to demonstrate how two units with pre-and postimplementation assessment procedures determined the impact of proactive hourly rounding on patient falls. This prospective pilot study showed how patient-centered care would improve nursing practice using the Lean Six Sigma process. Findings revealed that, when nurses worked as a team and were provided with quality support from facility administration and unit chief nurse, a significant fall rate reduction was recorded because the six-sigma process and patient-centered care changed the paradigm of the hourly rounding program. Therefore, the initial phases of the improvement project were positively impacted by hourly rounding, which served as the main strength of this article. However, the article falls short of nursing staff who felt unmotivated and did not persevere to the program's end. The hierarchy of evidence evaluated would be presented as level II.

Wilson (2017) conducted the fourth peer-reviewed article concerning “Nursing Staff Responsiveness to Patients and Hourly Rounding.” Wilson evaluated two points of fall rates using an HCAHPS survey and the scatter plot report to compare the impacts of pre-and post-nursing hourly rounding interventions rolled out in education sessions. Data collection was done using a descriptive comparative study of the two measures with an appropriate sampling, including medical-surgical unit nurses taking care of patients aged 18 and above. This study's objective was to see how nurses in a 24 hours surveillance of patient care would improve their responsiveness to patients requesting for call light and determine if their satisfaction and positive patient outcomes would be recorded. Results indicated a decrease in the number of falls for patient’s responded with call lights. The article primarily supports the claim that hourly rounding minimizes fall rates, and patient satisfaction was dependent on Press Ganey and HCAHPS surveys. One primary strength of this article was that it helped providers relate reimbursement with the level of patient satisfaction. Though it has a weakness in that it only involved nursing staff in the hourly rounding improvement program. The level of evidence supported by the findings is the level I hierarchy.

The final article was conducted by Young & Siegel (2016), about “The right person at the right time: Ensuring person-centered care.” The article focused on older adults, and this quasi-experimental study aimed to answer the question, who at the right time can provide high-value, person-centered and high-quality care to meet the demands of the nursing practice in a comprehensive outlook of what is required? The central focus is on how healthcare facilities' systems are initially designed to create a rapport between the caregiver and the elder. The article’s findings revealed that patient safety, satisfaction, and fall related issues are dependent on how the hourly rounding program is implemented within the hospital units. The article’s significant strength was that person-centered care produces unbiased results because it was between the nurse and the patient. However, it had a weakness of using a small sample size. The level of evidence supported by findings was the level I hierarchy.

Summary of Review

The PICOT question was supported by findings from all the above-discussed articles that implementing hourly rounding programs within a healthcare facility results in reduced fall rates, patient satisfaction and safety. It has been proved that the number of falls in each unit significantly reduces when there are one or two hours scheduled to look after the patient’s progress. Despite these articles supporting a similar claim, some provided more improvement in reducing fall incidences and increasing patient satisfaction. Therefore, a different inference drawn from these sources is that the adverse effects of fall incidences would be reduced and quality of care improved when healthcare facilities introduced hourly rounding in their daily activities. Also, the cultural changes from diverse populations should be considered while linking evidence with hourly rounding. As a result, a facility will report a high response rate from both the patient and the staff if they invest in educating the staff and improving the resident’s environment. It automatically translates to quality care delivery, fall incidences reduced significantly, and other associated complications when staff starts paying attention to improving primary care needs through increased surveillance and attention (Wilson, 2017). Meeting patients' needs while preventing them from getting unattended requires a reactive strategy rather than a proactive method. Therefore, it is essential to appraise the hourly rounding program based on its effectiveness in reducing fall incidences.

References

Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159.

Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Evidence Synthesis, 14(1), 248-267.

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success? Nursing2019, 45(2), 25-30.

Wilson, L. W. (2017). Nursing Staff Responsiveness to Patients and Hourly Rounding.

Young, H. M., & Siegel, E. O. (2016). The right person at the right time: Ensuring person-centered care. Generations, 40(1), 47-55.