APN-led nursing rounds: An emphasis on evidence-based nursing care

Summary

In today's healthcare environment, nursing staff are challenged to care for patients with increasingly complex needs in an ever-changing environment. Nurses are expected to stay up to date on a tremendous number of institutional initiatives, best practice guidelines, and policies and procedures. These practice imperatives are often disseminated through passive means of information-sharing such as staff meetings and electronic mail. In this setting, it is difficult for nurses to simultaneously focus on incorporating practice updates while continuing to value basic nursing functions such as oral care, skin care, and incontinence management. The concept of Interventional Patient Hygiene emphasises that basic nursing functions are not only tasks, but also important evidence-based interventions that contribute to improved health for the patient. Interventional Patient Hygiene facilitates the integration of science and practice. This article describes a quality improvement intervention, Advanced practice nurse-led nursing rounds, which supports Interventional Patient Hygiene and be used to help staff integrate best practices while balancing the multiple priorities inherent in nursing care.

Introduction

Interventional Patient Hygiene (IPH) is a concept introduced by Vollman et al. (2005) to bring attention to the importance of performing “basic” nursing care activities according to evidence-based standards. Although initially focused on oral care, bathing and incontinence management, the concept of IPH has expanded to include other essential nursing functions such as mobility, catheter care and hand hygiene. These activities contribute significantly to improved patient outcomes by decreasing the risk of healthcare-acquired conditions such as pneumonia, pressure ulcers and skin breakdown (Carr and Benoit, 2009, McGuckin and Torres-Cook, 2009, Vollman, 2006).

Clinical leaders are challenged to create a culture in which basic nursing care is evidence-based and appropriately prioritised within the myriad of tasks that nurses face. Evidence-based guidelines, protocols and procedures are often written to integrate science into practice but are rarely implemented to the fullest extent. One reason for less than full implementation is that a passive approach is used to introduce the best practice. Passive dissemination of information is insufficient to change practice whereas a multi-faceted, interactive approach is more likely to be successful (Grol, 2001, Gross et al., 2001).

Nursing rounds have been used in a number of settings to provide education and enhance patient care. In some settings, rounds focus primarily on staff education and critical thinking (Brault et al., 2009, Guin et al., 2002, Segal and Mason, 1998). In other settings, the primary purpose is to develop or enhance the nursing plan of care (Catangui and Slark, 2012, Coleman and Henneman, 1991). Nursing rounds have not been explicitly linked to empirical outcomes, in part because nursing rounds do not focus on one intervention, but rather the integration of multiple interventions into bedside practice. Outcomes reported include mostly process measures, such as participation and staff willingness to present information.

Advanced practice nurses (APNs) are viewed as resources that can assist staff in linking direct care to current evidence (Gerrish et al., 2011). APNs are well-poised to bring evidence to the nurse clinician, and to develop innovative strategies to assist nurse clinicians in integrating the evidence into practice. One quality improvement initiative that may impact nurse-sensitive indicators is APN-led nursing rounds.