The Effect of Hourly Rounding on Hospitalized Adults Fall Rates: Application of Jean Watson Theory

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Table of Contents

Abstract
Introduction
Succinct summary of the state of the science
Jean Watson Theory
Application of Jean Watson theory to the clinical situation
Conclusion
References

Abstract

In the United States, approximately ten falls occur in every one hundred patient days and injury results from approximately 50% of these falls (Ulanimo & Narda, 2011). The purpose of this study is to examine the effect of hourly rounding on hospitalized adults fall rates as well as the application of Jean Watson theory. This study is important because fall among hospitalized adults is prevalent. In the United States, approximately ten falls occur in every one hundred patient days (Ulanimo & Narda, 2011). From the analysis of the three articles, a positive correlation exists between hourly rounding and a reduction in patients fall rate. Although the researchers compromised rigor, the three studies had inter-rater reliability and concurrent validity.

Jean Watson theory is important in addressing the issue of patient care during hourly rounding. This is because the theory operates under the principle of care and it states that nurses should focus on practice and not technology (Sitzman, 2011). Application of Jean Watson theory to the clinical situation will assist in improving care during the hourly rounding and reducing fall rates. The application is possible via development of an evaluation form, training and assessment.

Introduction

The purpose of this study is to examine the effect of hourly rounding on hospitalized adults fall rates as well as the application of Jean Watson theory. This is because many studies indicate that hourly rounding minimizes fall rates in hospitalized patients. According to Jean Watson, nurses should provide a supportive environment (Sitzman, 2011). Hourly rounding is one way of providing a supportive atmosphere. During the round, the nurse can identify a patient’s need like elimination thus reducing the rates of fall, which occur as patients struggle to gratify their needs.

This study is important because falls among hospitalized adults are prevalent. In the United States, approximately ten falls occur in every one hundred patient days and injury results from approximately 50% of these falls (Ulanimo & Narda, 2011). In 2004, the rate of fall related death was 50 per 100,000 (Ulanimo & Narda, 2011). Most of the patients fall when they are either alone or engaging in activities like vomiting or emptying the bowel (Ulanimo & Narda, 2011). When a patient sustain injury after a fall, he is likely to stay for long in the hospital thus an increase in the bill. According to a research done, hourly rounding decrease fall rates by approximately fifty percent (Ulanimo & Narda, 2011).

Succinct summary of the state of the science

An analysis of medical literature was performed to establish the state of science concerning the effect of hourly rounding on hospitalized adults fall rates. The Google search engine was used to identify current scholarly research articles published in English from 2007 to date. The key words were hourly rounding, hospitalized patients and fall rates. Additionally, the search involved a review of the current nursing journals found in the library. From this search, three articles with the key words, published in the years 2007, 2011 and 2012 were identified and analyzed.

Olrich, Kalman and Nigolian (2012) conducted a quasi-experimental study to determine the effect of hourly rounding on patient fall rates. The area of study was a 506-bed capacity teaching hospital in Northeast of the United States. Two medical surgical-units were involved in the study because they had similarities in terms of size, fall rates and postoperative as well as medical patients. One unit was experimental while the other was control. The selection of the control unit was under the influence of the matrons desire to be included in the study. Data on fall rates were collected six months prior to the intervention and six months during the study. Prior to the study, nurses working on experimental units attended a seminar about hourly rounding. During the intervention period, the fall rate of the experimental unit decreased by 23% while that of the control increased.

The above research is not reliable because it was conducted on two units thus it cannot be generalized. A Munhall (2011) state, a research is reliable if it represents the total population. The study was valid because it measured what it intended to. For instance, Olrich, Kalman and Nigolian (2012) states that the aim of the research was to determine the effects of hourly rounding on patients falls and the results correlated with it. The study was limited by convenient sampling. This is because the selection of control unit was because of the matron’s desire (Olrich, Kalman & Nigolian, 2012) and not because it had the required qualities. As a result, the researchers compromised rigor.

Meade, Bursell and Ketelsen (2007) conducted a quasi-experimental study with none equivalent groups to determine the effect of nursing rounds on patients’ safety. The study involved twenty two hospitals and forty six units. The selection of control and experimental hospital units was through a non-random sampling. Each hospital decided whether it should perform hourly or two-hour rounding. The first two weeks of the research period involved collection of base line data. The subsequent four weeks was the intervention period. The results revealed a reduction of fall rates with the hourly rounding.

The researchers compromised rigor by using a non-random sampling method. Non-random sampling method does not give every person an equal opportunity of being involved in the study thus the results are likely to be biased (Munhall, 2011). The limitation of the study was a shorter duration of the intervention. Munhall (2011) explains that a short period compromise reliability because it does not give a true picture of the situation at hand. Lastly, the research had test-validity because of the preciseness of the test instrument.

Bassem et al., (2011) conducted a prospective study in a male stoke unit in Saudi Arabia to assess the effects of nursing round systems on patients fall. All hospitalized patients were included in the study. The first two weeks involved a collection of base line data. The subsequent four weeks involved implementation of the round together with data collection. The results after the eight weeks revealed a significant decrease in the fall rate.

Bassem et al., (2011) compromised rigor by choosing a small sample population and a short duration of study. The research was not reliable because the researchers interviewed stroke patients only yet hospitalized patients suffer from many conditions. As a result, the research was not a true representation of the whole population (Munhall, 2011). Additionally, the research lacked predictive validity. Other researchers cannot use the findings to predict the same results in a different situation (Munhall, 2011). This is because hospitals have different units that range from medical to surgical.

In summary, the researchers of the three studies compromised rigor because they relied on one aspect of the study, which was the nurses’ report. In all the studies, patients assumed a passive role because no one interviewed them to ascertain that they did not fall as reported. According to Munhall (2011), researchers usually compromise rigor by inappropriate selection of the study group. The researchers depended on the nurses who could have manipulated the data. The limitation of the researches was small sample size and short duration of study. None of the studies had a theoretical framework. On the other hand, the three researches had inter-rater reliability because they all reported a positive correlation between hourly rounding and decrease in fall rates. Concurrent validity was evident in the three researches because they all measured what they purported to analyze.

APN should apply hourly rounding in the clinical areas. This is because the three researches revealed that hourly rounding reduce the rate of falls in the hospital units. In the final analysis, researchers should include patients in the study about hourly rounding and fall rates. This will improve the validity of the researches because it will alleviate the problem of nurses’ biasness.

Jean Watson Theory

Jean Watson theory is important in addressing the issue of care during hourly rounding. This is because the theory operates under the principle of care and it states that nurses should focus on practice and not technology (Sitzman, 2011). According to the theory, nursing is a science of a person and illness experience mediated by professional, scientific, personal as well as ethical transactions (Sitzman, 2011). This means that during the hourly rounding, the nurse should assess the patient’s condition and intervene accordingly. The chances of a patient getting out of the bed decrease when he is comfortable. This is because many patients fall when they move out of the bed so that they can vomit or empty the bowel (Sitzman, 2011). Proper application of Jean Watson theory during the hourly rounding will significantly reduce the fall rates of hospitalized patients.

Sitzman (2011) explains that the theory has seven assumptions about nursing care. The first assumption states that the practice of care is through interpersonal relationship. The second states that care should satisfy some of the human needs like elimination. The third states that efficient and effective care should promote the health and growth of the patient as well as the family. The fourth states that when caring for a person, one should respect his present and future state. The fifth states that a caring environment should enable a person to develop and be in a position of making a wise decision. The sixth states that caring should complement curing. Finally, the key concern of all nurses should be comprehensive patients care.

According to Jean Watson, nurses should apply the ten carative factors while caring for the patients (Sitzman, 2011). The first one is formation of humanistic-altruistic values. Nurses should be altruistic towards the patients. The second is faith and hope. Nurses should instill hope to the patients, as it is essential in curative process. The third is that a nurse should be sensitive to herself and other people. Sensitivity promotes health through interpersonal relationships. The fourth is that a nurse should establish a helping therapeutic relationship with the patient. The fifth factor is that the nurse should allow the patient to express his feelings whether negative or positive. The sixth factor is that a nurse should scientifically solve the existing problems using research-based evidences. The seventh factor is promotion of learning and teaching activities through interpersonal relationship. The eighth factor states that the nurse should protect the patient from physical, mental, social and environmental injury. The ninth factor is assisting a patient to gratify his needs. Finally, the nurse should assist a patient to have courage of confronting life as well as death.

According to Jean Watson theory, when a human being interacts with the environment, his health is at risk. For example, through environmental interaction, a person can get environmentally associated diseases like pneumonia and asthma (Sitzman, 2011). Therefore, during the nursing process, the nurse should not only treat the patient but also evaluate the environment where the patient stays.

Application of Jean Watson theory to the clinical situation

The clinical situation at hand is that fall rates are high in many hospital units. According to the reviewed literature, hourly rounding can reduce fall rates. Therefore, a nurse should learn what to do during the hourly rounding in order to reduce the fall rate. As an APN, I can apply the Jean Watson theory during the hourly round because it ensures that the patient is comfortable after the procedure.

The main objective of applying the Jean Watson theory is to incorporate the carative factors and assumptions about nursing care into the hourly rounding. This is because a round without attending to the needs of the patient will not assist in reducing falls rate because the patient may later fall as he strive to gratify his needs. For instance, many patients fall as they strive to perform activities related to elimination.

I plan to apply Jean Watson theory by developing an evaluation form that nurses should use during the hourly rounding. The evaluation form will have the seven assumptions about nursing care and the ten carative factors. The evaluation form will have a statement that remind nurses that nursing is a caring profession (Sitzman, 2011) and that they should ensure that the patient is comfortable and free from pain. I will develop activities that the nurses should perform during the hourly rounding. To begin with, during the hourly rounding, the nurse should strike a rapport with the patient before attempting any procedure. This is because a rapport assist in development of a therapeutic relationship which make a patient feel appreciated and thus open up to the nurse (Sitzman, 2011). Secondly, the nurse should involve the patient in the process of need assessment. When the patient is an active participant in the process of care, he is likely to share his concerns with the nurse (Sitzman, 2011). Thirdly, the nurse should address the patient’s needs accordingly. For instance, if the patient wants to empty the bowel, the nurse should provide a bedpan. Finally, the nurse should provide psychological care to the patient and leave him comfortable.

Nurses training will follow the development of the evaluation form. I will train all nurses how to use of the evaluation form during the hourly rounding. The training will equip them with knowledge about the application of Jean Watson theory during the hourly rounding. Secondly, I will educate them on the importance of Jean Watson theory and patient involvement during the hourly rounding. According to Jean Watson, an interpersonal relationship between the nurse and the patient is a sign of comprehensive care and it has a healing effect (Sitzman, 2011). Finally, I will train the nurses about documentation process. The nurses should document all the care given to the patient during the hourly rounding.

The actual application of Jean Watson theory will entail the use of the evaluation form during the hourly rounding followed by documentation. I will participate in the hourly rounding to ensure that nurses are using the evaluation forms as required. After a month, I will conduct an analysis to determine the impact of application of Jean Watson theory during the hourly rounding on the fall rate and patient satisfaction. Additionally, I will hold a meeting with other nurses to determine the barriers surrounding application of Jean Watson theory during the hourly rounding. In case there is a reduction in the fall rate, we will address the barriers and continue with the process. Finally, I will write a report to the hospital in charge about the application of jean Watson theory during the hourly rounding and its impact on fall rate and patients satisfaction. I will recommend that other hospital units should apply Jean Watson theory during the hourly rounding so that fall rate can reduce.

Conclusion

Hourly rounding reduces fall rates of hospitalized patients. This is evident by a review of three literatures, which showed a positive correlation between hourly rounding and reduction of fall rates in different hospital units. Application of Jean Watson theory during the hourly rounding is imperative because it increase patient satisfaction. Therefore, nurses should strive to apply Jean Watson theory during the hourly rounding. Finally, nurses should conduct researches about application of theories in the nursing practice. This is because many nurses are not aware of evidence-based practice.

References

Bassem, S., Nussair, H., Zubadi, N., Sham, S., & Saleh, U. (2011). The Nursing Round System: Effects on Patients Call Light Use, Bed Sores, Fall and Satisfaction Level. International Journal of Nursing , 17 (3), 299-303.

Meade, M., Bursell, L., & Ketelsen, L. (2007). Effects of Nursing Rounds on Patientiens Call Light Use, Satisfaction and Safety. american Journal of Nursing , 106 (9), 58-59.

Munhall, P. (2011). Nursing Research. Philadelphia: Jones and Bartlett.

Olrich, T., Kalman, M., & Nigolian, C. (2012). Houly Rounding: A Repliation Study. Medsurg Nurs , 21 (1), 23-36.

Sitzman, L. (2011). Understanding the Work of Nurse Theorists: A Creative Beginning. Philadelphia: WB Saunders.

Ulanimo, V., & Narda, L. (2011). Patient Satisfaction and Patient Safety: Outcome of Purposefull Rounding. Topics in Patients Safety , 11 (4), 1-4.

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