Research Paper on Hourly Rounding: Enhancing Patient Care in Hospitals

Introduction

Although the practice of hourly rounding has been existing, it undergoes constant resurgence among significant hospitals in the United States, such as Harris Methodist Hospital. The method started becoming common in the mid-20th century. However, it became affected by staffing shortages, and it started occurring on a less frequent basis. Despite the fact, hourly rounding by nurses can offer protocols that delineate actions that would ensure the better outcome of patent specifically to elderly inpatient experiencing fall. DNP (doctor of nursing practice) projects provide guidelines on how to effectively implement health care practices to realize outcome (VanderKooi et al., 2018). As evidence, the proposed project is going to focus on improvements that would influence healthcare results through both direct and indirect care. According to the topic of study, the plan would be useful if conducted in an elderly care nursing setting.

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PICOT Question

To aid time strapped for nurses in the process of looking for answers regarding health care and the patient's question, the PICOT framework help in crafting the structure of relevant issues. The acronym for population/patient, interventions, comparison, outcome, time structure questions for both research study and clinical practices. It has an extended history in both the nursing and medical field (Elias et al., 2015). They have benefited from the framework provided by PICOT. Therefore it would be applicable in this project proposal to form the study topic. For elderly patients found in medical-surgical units at Harris Methodist Hospital, how does the use and implementation of hourly rounding by clinicians compared to current practices influence and reduce their risk of falling within a timeline of ninety days.

Background Evidence

Due to complexities in the healthcare system, patient harm in hospitals has been a challenge to understand. Patient safety programs should focus on preventing incidences and risk factors, exposing patients to potential harm (World Health Organization, 2019). The basis of patient safety is continuous improvement through the identification and elimination of incidences, such as patient falls that mainly is among elderly patients. This problem is a consistent experience among elderly patients in medical-surgical units at Harris Methodist Hospital in Texas, resulting in injuries. According to Leapfrog Hospital Safety Grade (2020), the hospital's score regarding patient falls is 0227, while the best hospital scores 0.000 meaning the average hospital score should be 0.436, while the worst hospital score is 1.625. The data reveals that Texas health Harris Methodist Hospital score is above average, but it has to apply more effort to prevent any patient falls.

Furthermore, falls related to injuries are rampant in the emergency department. Over 2.4 million non-fatal falls among the elderly went through treatment, and over 734 000 of these older patients got admitted in 2013 (Ozturk et al., 2017). One-third of the patient above 65 years falls once annually, and the ratio reaches half for patients above 80 years. Medicare and Medicaid spend approximately $50 billion on non-fatal patient falls and $ 754 million on fatal falls (CDC, 2019). This primary behavior causes about 2.8 million injuries treated in various hospitals (National Council on aging, 2020). In this case, implementing hourly rounds by nurses will significantly reduce falls among elderly patients since they will help patients experience a better outcome.

Model and theory Application of Model, Framework, and Theory

An application of nursing theories and conceptual models help in shaping nursing knowledge to realize the practical outcome. They define the basic meta paradigm framework related to healthcare or the nursing profession by focusing on the nursing role. In this proposed study, IOWA model, and Neuman's Theory frameworks would help care providers of an elderly patient who occasionally fall.

IOWA Model

Caregivers always understand that EBP (evidence-based practice) help in improving the quality of treatment outcome. Hence IOWA model would help these healthcare givers translate treatment findings into effective clinical practices to evidence quality care (Brown, 2014). The model has four procedural steps that would help in the reduction of falls among elderly patients within a given time frame. Firstly, to identify the nature of the problem, whether it is knowledge or problem trigger. Problem trigger would help in the identification of caregiving problem such as patient fall as in the case of the project. Secondly, categorize the concern as a priority for the healthcare unit. Thirdly is the formation of a team consisting of staff who would help in the process of development, evaluation, and implementing EBP (Gordon et al., 2008). It will evaluate the required resources and engage different stakeholders to accept the change. The last stage consists of gathering and critiquing pertinent research study relevant to the desired practice. Hence, here will lead to the formation of a good question utilizing the PICOT method. The purpose of researching is to determine if hourly rounds are a scientifically viable intervention to prevent patient falls. The last step is program evaluation.

Neuman's Theory

The model is suitable for leading nursing studies or practices, especially DNP, due to its system based framework that ensures holistic care provision (Bademli & Duman, 2017). It helps nurse practitioners with a comprehensive analysis in terms of treatments and defining how all the interventions ranging from primary to tertiary prevention are useful in problem-solving. Hence it is essential while explaining or comparing environmental forces that influence the patient care system and provide nurses with an insight that helps them cope with their families. For instance, in the process of implementing hourly rounds, nurses need to understand psychological elements, such as the interaction of patients with the environment and risk factors that would lead to falls (Ahmadi & Sadeghi, 2017). Physiological considerations of the model include assessing the structure of patients, such as the ability to get out of bed alone. Spiritual variable evaluates individual beliefs and influences while socio-economic factors, such as cultural factors influence the attitude of patients.

Besides, the project will integrate Neuman's theory by first assessing how the body of elderly patients functions. Because of the age-related issues, they may not get of bed alone without support because of fragile tissues and fractures. Secondly, the project team must understand how the patients interact with the environment, like accessing toilets and personal aspects. Cultural factors may be a barrier to hourly rounds and thus would evaluate their social values (Ahmadi & Sadeghi, 2017). Finally, the project team will identify risk factors and behaviors and ensure stakeholders understand the importance of the program so that they accept its intervention. As evidence, the theory would provide nurses with insight regarding how fall among elderly patients affect caregiving and help them plan how to implement effective interventions to improve quality care among falling elderly patient.

Value Added to Advanced Nursing Practice and Health Care Outcomes

If the health care system needs to add value through implementing hourly rounding by nurses protocol effectively, there should be much attention focused nurse stuff enlisting to ensure the performance of rounding behavior are valid and consistent in all shifts. Besides, information generation should be promptly and provided to healthcare providers to realize EBP in hourly rounding (Olrich et al., 2012). All nurses should also get adequate training on relevant protocols of hourly rounding. Hence hospital implementing this intervention should allow ample time to gain all skill required in hourly rounding and thus fall among elderly patients would minimize. Effective implementation of hourly rounding by nurses in medical-surgical units would increase the satisfaction of elderly patients and decrease falls among older patients.

Also, the hospital should understand patient needs. The first need is that elderly patients require wellbeing services to improve their health and wellbeing. For example, hospitals should develop fitness centers where they can do physical exercises to enhance their stabilities (Carvalho et al., 2016). Also, wellness centers would help hospitals to manage the severity of chronic conditions by ensuring access to social services. However, fitness instructors must be close to the patients and offer necessary to prevent falls or injuries. The extent of exercise depends on their health conditions (Carvalho et al., 2016). Sufficient understanding patient need would ensure the realization of quality improvement among elderly patient experiencing fall.

DNP Project Implementation and Evaluation Plan

Implementation of this DNP project would be through structural hourly rounding for an elderly patient in the medical-surgical unit. The achievement is going to apply the PDSA cycle framework to integrate fall prevention. The Plan, Do, Study, Act model is essential in achieving specific healthcare needs for patients and solve the elements of falls in elderly patients. Descriptive statistics would help in the evaluation of fall rates among elderly patients and understanding of nurse's readiness and preparedness to change. Nurses would record fall information on incident reports as the cases occur and processed the health information and quality management team. The result obtained before and after implementation of the change would go through comparison and thorough analysis. Also, Microsoft Excel would aid the entry of data collected in spreadsheet excel.

Conclusion

The implementation of hourly rounding by nurses is the most significant intervention program that would prevent falls in hospitals. The practices involve checking on patients every hour and take notes of the patient's behavior to ensure their safety, which is the priority of every healthcare organization. However, complexities in the healthcare system make it challenging to meet all the safety concerns. In this context, the elderly population is prone to falls, resulting in injuries, deaths, and prolonged stay in hospitals. The best intervention strategy to prevent hospital falls is implementing hourly rounds in hospitals to offer necessary support to patients. However, implementing the project requires financial and adequate human resources, as well as a holistic approach to caregiving.

References

Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal - Experimental, Translational and Clinical, 3(3), 1-8.

https://journals.sagepub.com/doi/full/10.1177/2055217317726798

Bademli, K., & Duman, Z. C. (2017). Conceptual Framework for Nurses in the Use of the Neuman Systems Model on Caregivers of People Suffering by Schizophrenia. International Archives of Nursing and Health Care, 3(3), 1-5.

https://pdfs.semanticscholar.org/e77c/f47cd87b629597823258d8f2b52def3a01a8.pdfBrown, C. G. (2014). The Iowa Model of Evidence-Based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing. Clinical Journal of Oncology Nursing, 18(2).

https://cjon.ons.org/sites/default/files/987U180063M01166_first_0.pdfCarvalho, I., al. (2016). Organizing health-care services to meet older people's needs. Washington: Worl...