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Nursing Rounds: Enhancing Patient Care and Communication

Nursing Rounds: Enhancing Patient Care and Communication -Nursing rounds are a crucial aspect of healthcare that involves regular visits by nursing staff to patients. These rounds aim to assess patients’ conditions, provide necessary care, and promote effective communication between healthcare professionals. In this article, we will delve into the significance of nursing rounds, explore different types, and highlight best practices for conducting them efficiently.

Table of Contents

What are Nursing Rounds?

Nursing rounds refer to scheduled visits made by nurses to patients in hospitals or other healthcare settings. These rounds serve various purposes, including assessing patient progress, administering medications, addressing patient concerns, and collaborating with the interdisciplinary team.

The Importance of Nursing Rounds

Patient assessment and care.

During nursing rounds, healthcare professionals conduct thorough patient assessments. This includes evaluating vital signs, wound healing progress, pain levels, and overall well-being. Regular assessments help identify any changes in the patient’s condition promptly, enabling timely interventions.

Medication Administration

One essential aspect of nursing rounds is medication administration. Nurses ensure that patients receive the right medications at the correct dosages and timings, reducing the risk of medication errors and adverse reactions.

Identifying Changes in Patient Condition

Nursing rounds facilitate the early detection of any changes in a patient’s health status. This can be critical in preventing complications or deterioration and ensuring appropriate actions are taken promptly.

Enhancing Communication and Collaboration

Effective communication is vital in any healthcare setting. Nursing rounds provide an opportunity for nurses, physicians, and other team members to discuss the patient’s progress, care plans, and any modifications needed to improve outcomes.

Different Types of Nursing Rounds

Bedside rounds.

Bedside rounds involve nurses and healthcare professionals gathering at the patient’s bedside to discuss the care plan directly with the patient and their families. This approach promotes patient engagement and empowers them to actively participate in their care decisions.

Walking Rounds

Walking rounds involve nurses and healthcare professionals moving from one patient’s room to another, discussing each patient’s condition as they walk. This type of round can be efficient and foster teamwork.

Multidisciplinary Rounds

Multidisciplinary rounds involve various healthcare professionals, including physicians, nurses, therapists, social workers, and more. These rounds encourage collaboration, ensuring all aspects of the patient’s care are considered.

Best Practices for Conducting Nursing Rounds

Preparing for rounds.

Before conducting rounds, nurses should review patient charts, recent test results, and care plans. This preparation ensures that the team is well-informed and ready to address any concerns or changes in the patient’s condition.

Prioritizing Patients

In busy healthcare settings, prioritizing patients based on their acuity and needs is crucial. This approach ensures that patients with critical conditions receive immediate attention.

Using Documentation and Technology

Efficient documentation and the use of technology can streamline nursing rounds. Electronic health records (EHRs) allow for real-time updates, reducing the risk of errors and facilitating seamless communication among healthcare providers.

Engaging Patients and Families

During nursing rounds, involving patients and their families in discussions about care plans fosters transparency and patient satisfaction. Engaged patients are more likely to comply with treatment recommendations and actively participate in their recovery.

Overcoming Challenges in Nursing Rounds

Time constraints.

In busy healthcare environments, time constraints can make it challenging to conduct comprehensive nursing rounds. Nurses must prioritize tasks efficiently while ensuring patient care is not compromised.

Staffing Issues

Shortages of nursing staff can impact the frequency and quality of nursing rounds. Healthcare facilities must address staffing concerns to provide adequate patient care.

Communication Barriers

Effective communication can be hindered by hierarchical structures and communication barriers among healthcare professionals. Open and respectful communication must be promoted to improve patient outcomes.

Measuring the Effectiveness of Nursing Rounds

Patient outcomes.

One way to measure the effectiveness of nursing rounds is to analyze patient outcomes. Improved patient outcomes, reduced complications, and shorter hospital stays are indicators of successful rounds.

Nurse Satisfaction and Engagement

The satisfaction and engagement of nursing staff can also reflect the success of nursing rounds. Engaged nurses are more likely to provide high-quality care and contribute to a positive work environment.

Reduction in Errors and Adverse Events

Effective nursing rounds can lead to a decrease in medical errors and adverse events. Regular monitoring and timely interventions can prevent potential complications.

Nursing Rounds in Specialized Settings

Critical care units.

In critical care units, nursing rounds take on added significance. Constant monitoring and immediate interventions are vital for critically ill patients .

Pediatric Wards

Nursing rounds in pediatric wards require special consideration for the emotional and developmental needs of young patients.

Geriatric Care

In geriatric care, nursing rounds play a crucial role in addressing age-related health challenges and ensuring patient comfort.

Benefits to Nursing Rounds

There are many benefits to nursing rounds. They can help to:

• Improve patient safety by ensuring that all patients are regularly monitored and assessed.
• Identify and address patient concerns early on.
• Improve communication between nurses, doctors, and other healthcare providers.
• Promote patient satisfaction by giving patients the opportunity to ask questions and get their needs met.

Nursing Rounds Advantages and Disadvantages

There are many advantages and disadvantages to nursing rounds. These include:

The Future of Nursing Rounds

The future of nursing rounds is likely to involve greater integration of technology, such as remote patient monitoring and telemedicine. These advancements can enhance efficiency and patient outcomes.

Nursing rounds are indispensable in providing high-quality patient care and promoting effective communication among healthcare professionals. Regular assessments, medication administration, and collaboration are among the key benefits of nursing rounds. Despite challenges, implementing best practices can optimize their effectiveness, leading to improved patient outcomes and higher nurse satisfaction.

What is the frequency of nursing rounds in hospitals?

The frequency of nursing rounds can vary depending on the healthcare facility and patient needs. In some settings, rounds may occur hourly, while in others, they could be conducted several times a day.

Do nursing rounds only involve nurses?

No, nursing rounds often include various healthcare professionals, such as physicians, therapists, social workers, and more, to ensure comprehensive patient care.

Can nursing rounds be conducted in home care settings?

Yes, nursing rounds can also be conducted in home care settings to provide ongoing care and support to patients who receive treatment at home.

How can technology enhance nursing rounds?

Technology, such as electronic health records and remote patient monitoring, can streamline information sharing and facilitate real-time updates during nursing rounds.

Please note that this article is for informational purposes only and should not substitute professional medical advice.

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How to Effectively Implement Nurse Rounding in Hospitals

• December 4, 2018

Vitalacy Team

Well-executed purposeful nurse rounding – nurse-led patient checks performed consistently, using a standardized protocol – has been shown to significantly increase patient safety alongside patient and staff satisfaction.

Yet despite evidence demonstrating its benefits, and validated protocols – like the Studer Group’s International Rounding Protocol – that provide clear instructions on how to perform these rounds, well-executed purposeful nurse rounding remains the exception, rather than the rule in hospitals.

Research suggests that this disconnect exists because of numerous barriers to consistent and effective implementation of purposeful nurse rounding in hospital settings.

To ensure that purposeful nurse rounding is properly executed, we must first identify these barriers and then look to tackle them.

The Barriers to Effective Purposeful Nurse Rounding

Findings from a systematic review published in the Journal of Nursing Management revealed that the key barriers to nurse-compliance with purposeful rounding include:

• Lack of time – heavy existing workloads make it nearly impossible for nurses to conduct thorough hourly checks on all their patients, and also find the time to carry out their other duties.
• Lack of understanding – contradictions between nurse rounding protocols and existing policies can create confusion. For example, should nurses respect policies on undisturbed sleep and meal times, or should they interrupt patients eating and sleeping to carry out the checks? Must rounding be performed when emergencies occur elsewhere on a ward?
• Lack of belief in the system – nurses who don’t buy into the idea that purposeful nurse rounding will bring benefits for their patients and themselves are less compliant.

How to Best Tackle Nurse Rounding Barriers

The identified barriers indicate that nurses undoubtedly need more support to effectively implement purposeful rounding. This can be achieved as follows:

The lack of time barrier can be addressed in several ways. First, adding just one extra nurse to wards with large numbers of high-acuity patients can make a world of difference when it comes to reviewing all patients. Where staff and budget constraints make this unfeasible, it is worth adopting the equally acceptable bi-hourly purposeful round instead.

It is also important to allocate patients to nurses according to acuity levels. As high-acuity patients take more time to assess during each round, ensuring nurses have an equal number of high-needs patients will help to make sure time demands on each nurse are more uniform.

Understanding

Before rolling out the protocol, hospitals should trial purposeful rounding on their wards and identify areas that could lead to confusion for staff. Once identified, these can be proactively addressed.

Contradictions between existing policies on sleep and mealtimes can be resolved by adding a degree of flexibility to the protocol. Nurses could be advised to adopt an ‘observe,’ rather than ‘ask’ approach when patients are sleeping, eating or otherwise engaged.

Alternatively, hospitals adopting hourly checks could reduce the frequency of checks to bi-hourly at night time.

A clear protocol should be agreed upon for nurse rounding during medical emergencies. Is it acceptable for nurses to forgo all purposeful rounding during an emergency or should they delegate their rounds?

If nurses understand exactly how to act in these situations, they will be more likely to comply with the strategy in the long term.

As the nursing staff are integral to the success of a purposeful nurse rounding approach, thorough education before implementation is vital, and this education must be collaborative.

Nurses need to understand why this protocol is important and be given a chance to see how it could transform their workflow, time management and patient outcomes. This can be achieved by exposing them to patients and nurses from other hospitals who have experienced the benefits of purposeful nurse rounding first hand.

Finally, nurses should be given a chance to air their doubts and fears, be listened to, reassured and given practical solutions before introducing purposeful rounding.

The Uniting Piece

Once these key barriers to compliance have been addressed, attention can turn to the execution of the program. For purposeful nurse rounding to be truly successful, hospitals will need a system that can monitor the process and alert nurses to perform their checks. And this system will need to do so in a manner so seamless that compliance becomes effortless and habitual.

Automation of this monitoring process is likely to be most effective, as this is hands-down the best way to prompt nurses to take action with precise regularity. An automated monitoring system can also prove invaluable for overcoming some of the aforementioned barriers to the proper execution of purposeful rounds.

For example, nurse alerts can be programmed to be automatically issued hourly during the daytime and bi-hourly at night time – ensuring that disruption to sleeping patients is minimized.

Notifications can be further customized to match the degree of patient risk, with alerts for high-risk patients set more frequently.

Such systems will also allow nurses to digitally log their checks and receive feedback on their performance over the day, week or month.

Having a graphically documented report that shows nurses how well they have performed to date is more likely to motivate them to maintain performance or improve in areas where they feel they are falling short. This, in turn, fosters the type of compliance with purposeful rounding that many hospitals are currently struggling to achieve.

Lauretta Ihonor is a medical doctor and a health journalist. She is based in London, UK and specializes in writing about medical technology and general medicine. She has worked for CNN International, BBC and Sky News.

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Mitchell MD, Lavenberg JG, Trotta R. Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review. J Nurs Adm. 2014 Sep; 44(9): 462–472.Sims S, Leamy M, Davies NI, et al. Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why. BMJ Qual Saf. 2018 Sep; 27(9): 743–757.Toole N, Meluskey T, Hall N. A systematic review: barriers to hourly rounding. J Nurs Manag. 2016 Apr;24(3):283-90.

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Purposeful and timely nursing rounds: a best practice implementation project

Affiliation.

• 1 1. UCSF JBI Center for Synthesis and Implementation: an Affiliate Center of the Joanna Briggs Institute.
• PMID: 26878929
• DOI: 10.11124/jbisrir-2016-2537

Background: Purposeful and timely rounding is a best practice intervention to routinely meet patient care needs, ensure patient safety, decrease the occurrence of patient preventable events, and proactively address problems before they occur. The Institute for Healthcare Improvement (IHI) endorsed hourly rounding as the best way to reduce call lights and fall injuries, and increase both quality of care and patient satisfaction. Nurse knowledge regarding purposeful rounding and infrastructure supporting timeliness are essential components for consistency with this patient centred practice.

Objectives: The project aimed to improve patient satisfaction and safety through implementation of purposeful and timely nursing rounds. Goals for patient satisfaction scores and fall volume were set. Specific objectives were to determine current compliance with evidence-based criteria related to rounding times and protocols, improve best practice knowledge among staff nurses, and increase compliance with these criteria.

Methods: For the objectives of this project the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool were used. Direct observation of staff nurses on a medical surgical unit in the United States was employed to assess timeliness and utilization of a protocol when rounding. Interventions were developed in response to baseline audit results. A follow-up audit was conducted to determine compliance with the same criteria. For the project aims, pre- and post-intervention unit-level data related to nursing-sensitive elements of patient satisfaction and safety were compared.

Results: Rounding frequency at specified intervals during awake and sleeping hours nearly doubled. Use of a rounding protocol increased substantially to 64% compliance from zero. Three elements of patient satisfaction had substantive rate increases but the hospital's goals were not reached. Nurse communication and pain management scores increased modestly (5% and 11%, respectively). Responsiveness of hospital staff increased moderately (15%) with a significant sub-element increase in toileting (41%). Patient falls decreased by 50%.

Conclusions: Nurses have the ability to improve patient satisfaction and patient safety outcomes by utilizing nursing round interventions which serve to improve patient communication and staff responsiveness. Having a supportive infrastructure and an organized approach, encompassing all levels of staff, to meet patient needs during their hospital stay was a key factor for success. Hard-wiring of new practices related to workflow takes time as staff embrace change and understand how best practice interventions significantly improve patient outcomes.

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Strategies for teaching in clinical rounds: A systematic review of the literature

Amin beigzadeh.

Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Peyman Adibi

1 Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Kambiz Bahaadinbeigy

2 Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Nikoo Yamani

Background:.

Strategies for teaching in clinical rounds are dispersed. There is a need to comprehensively collate bedside strategies to enhance teaching and learning and make clinical rounds more effective.

Materials and Methods:

A systematic review of English articles using Web of Science, PubMed, Embase, Scopus, and Cochrane library was conducted. Relevant keywords for teaching rounds/medical teachers/medical students/strategies and their synonyms were used accordingly. Additional studies were identified by searching reference lists of retrieved articles. All searches were conducted within a 10-day period from May 25, 2017, to June 3, 2017. In this systematic review, studies with any design on the subject of strategies for clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 524 articles. After removing duplicates, 337 articles remained. Based on the title and abstract review, 37 articles were obtained for further review and finally 18 entered the study. Data were extracted from the included studies. Two authors independently screened and scored the studies. We used inductive content analysis, and categories of strategies were derived from the data.

Content analysis yielded identification of strategies for clinical rounds in nine categories named: system issues, advance planning, a preround huddle, patient issues, teachable moments, teacher issues, student issues, atmosphere issues , and a postround huddle . These were classified as “before rounds,” “during rounds,” and “after rounds” activities. Quality assessment scores for the research studies ranged from 5 to 14 (possible range, 1–16). Fourteen (77.8%) studies received quality scores at or above 10, and 4 (22.2%) studies received quality scores below 10.

Conclusion:

Due to the importance of clinical rounds in students’ learning, medical teachers should divide their teaching session into activities before, during, and after rounds. These strategies on rounding practices can improve teaching and learning.

INTRODUCTION

Teaching and learning of medicine is basically premised upon patients’ encounters in the clinical environment where patients and their problems lie at the heart of clinical teaching. At both undergraduate and postgraduate levels, clinical teaching encompasses routine teaching rounds, bedside rounds, daily clinical care, its analysis by discussion and decision-making, and opportunistic or highly structured teaching sessions held in inpatient and outpatient settings.[ 1 ] Clinical environment is the only setting where skills of history taking, physical examination, decision-making, clinical reasoning, and the humanistic aspects of medicine such as professionalism can be taught and learned.[ 2 ] Therefore, clinical teaching is the cornerstone of medical education where we should give heed to as much clinical exposure as possible because the identity and professional development of medical students is formed in this setting.

Although teaching in such an environment with the presence of the patient is very common, but clinical exposures or clinical rounds are conducted with little standardization.[ 3 ] In parallel, studies suggest variable teaching quality or varied rounding practices by teachers[ 4 ] and lacking creativity for teaching at the bedside.[ 5 ] Finally, effective rounds cannot be practiced due to lack of teachers’ preparedness before bedside teaching.[ 6 , 7 , 8 ] The resultant of such instances is students’ incompetency by having inadequate bedside teaching skills[ 7 , 9 , 10 ] and lack of confidence when examining patients.[ 11 ]

By the same token, evidence shows that, in recent years, there has been a shift in clinical teaching from inpatient care to outpatient care or the clinics. This not only brings down the proportion of routine teaching rounds and daily clinical care at the bedside, but also hinders medical students from following and learning the natural history of a disease.[ 1 ] The results of surveys reveal that the move from bedside teaching, a dominant model of instruction, to conference rooms and hallways is on a rise, and time allocation spent at the bedside varies from 15% to 25%.[ 12 ] This signifies that teaching in rounds or by patients’ bed is losing its popularity among medical community.

On the premise of the current literature concerning the paucity of comprehensive and widely recognized best practices for rounding practices and the shift away from the teaching rounds which make teaching in the clinical environment less intrinsic, we conducted this systematic review based on the available information to generate an extensive list of strategies to be used on rounds to enhance teaching, learning, as well as patient care. The comprehensive identified strategies are pinpointed steps that guide the medical teacher to move from one activity to another by taking into account the needs of students and patients. Our findings can be a basis for more research concerning teaching in the clinical environment to manage clinical rounds more effectively. A management plan can also be used to redesign or reorganize teaching in the clinical environment by taking the findings of this study into consideration. Thus, to improve rounding practices to be beneficial for the clinical teacher, students, and patients, we sought to provide a reliable synthesis of the available evidence with prespecified eligibility criteria to address our specific research question: What are the strategies for clinical rounds in order to increase the effectiveness of teaching and learning from clinical teachers’ and students’ perspectives based on the available literature?

MATERIALS AND METHODS

Search methods for identification of studies.

We performed a systematic literature search on the subject of strategies for clinical rounds from clinical teachers’ and medical students’ perspectives, using Web of Science, PubMed, Embase, Scopus, and Cochrane library [ Table 1 ]. No time limit was considered for article searching to collate as many relevant papers as possible. Synonyms were used for the domains “medical students/clinical teachers/strategies” and the determinant “clinical round” [ Table 1 ]. We tried to consider our searches as extensive as possible to ensure that as many possible of the necessary and relevant studies will be included in our review. In this regard, comprehensiveness and maintaining relevance were taken into consideration when developing the search strategy. The reference sections of all retrieved articles were manually scanned to identify additional potentially relevant articles as well [ Figure 1 ].

Search syntax for Web of Science, PubMed, Embase, Scopus, and Cochrane

TO=Topic; TI=Title; AB=Abstract; KW=Keyword

Flowchart depicting the literature search and study selection process

Criteria for considering studies for this review

Articles meeting the following criteria were eligible for review. They encompassed (a) English-language articles; (b) electronic full-text articles; (c) articles regarding the strategies for clinical rounds from the perspectives/opinions of clinical teachers and medical students; (d) in case of reflections from multidisciplinary teams, only those related to medical teachers and medical students were included; (e) original articles not letter to editor, short communication, review article, editorial, commentary, conference paper, discussion paper, and any sort of gray literature; and (f) articles with any research design could be included in our systematic review. It is important to mention that the result and discussion sections of all included studies were perused for data extraction. We also used conclusion section for data extraction in order not to miss any strategies put forward by the writer of the article as some papers might have indications of writer's point of view in this section. In our systematic review, we considered the term “clinical round” with all its variations such as bedside teaching, ward round teaching, and attending rounds when searching for relevant articles. Our main focus was on the encounters involving the clinical teacher and a team of multilevel learners (medical students, interns, and residents) where teaching takes place on a round. We excluded other formats of rounding practices such as family-centered bedside rounds where patient's family is present and involved in the process of clinical care and teaching.

Screening process and selection of studies

At the initial screening stage (preliminary screening), we screened relevant articles with regard to title and abstract. Irrelevant articles were excluded at this stage. Full text of relevant articles was obtained to be screened for eligibility. By the same token, we removed duplicate records of the same study (if any identified). In case of not accessing some databases due to access limitation, the name of the articles, DOIs, or any relevant information was forwarded to a person in the main medical library of Kerman University of Medical Sciences with access to such databases to find the studies.

Verification of extracted data

To extract or obtain data, a strategy search was compiled and confirmed by a health-care librarian. Then, relevant databases were searched by one of the authors (AB). The search results were checked with the health-care librarian and modifications were made as appropriate. Concerning the eligibility assessment, two authors independently examined the titles and abstracts of the retrieved articles to obviate irrelevant studies; full text of the potentially relevant studies was retrieved and examined for compliance with the eligibility criteria. In case of any disagreement between the two reviewers regarding article inclusion, a third person of the research team was negotiated to resolve any discrepancies. However, in case of existing disagreement, arbitration by another person was sought. The reviewers assessing the relevance of studies were not blinded to the names of authors or journal publication.

Data abstraction

All data were abstracted from the included studies in the review by one member of the research team (AB) to confirm eligibility for full review, and another review author (NY) checked the extracted data relevant to the study questions. This was done using a data abstraction form. The final version of the form was created after the initial data abstraction on six randomly selected included articles and the discussion among the research team to refine and confirm it (whether the abstraction form served to collect all relevant data). The following information was sought from each article: first author's name, type of study design (any type), participants, sample size, geographical location of the study, and year of publication [ Table 2 ].

Summary of Included Studies identifying the strategies for clinical rounds (sorted by year)

SPRs=Specialist registrars, SHOs=Senior house officers, FY=Foundation year

Data extraction form (quality scoring form)

To assess the quality of the included studies (both quantitative and qualitative) in our systematic review, we developed a valid and reliable scale. This quality scoring form was developed based on the literature review by aggregating our findings and designed a form specific for our systematic review. Some modifications were applied based on the feedback received from experts competent in doing systematic reviews. In this regard, some items were added and revised. We then pilot tested the form on six articles, and the obtained results were negotiated with the research team for further modification. The quality assessment form has scores ranging from 1 to 16, with 16 being the highest score. The form contains 10 indicators divided into study type, total sample size, study aims, setting, study sample, data collection, data analysis, findings, conclusions, and internal validity [ Appendix 1 ]. Quality scores were independently obtained from two reviewers (AB and KB). The interrater reliability (agreement between the two reviewers) was assessed, and the overall agreement was 83.3%. In case of any disagreement, negotiations between the two reviewers resolved the differences and a final quality score was reached.

Qualitative analysis of strategies for clinical rounds

Content analysis is a method of analyzing written, verbal, or visual communication messages.[ 13 ] Through this method, the researchers can test theoretical issues to enhance understanding of the data. In addition, it would be feasible to distil words into fewer content-related categories; thus words, phrases, and the like share the same meaning.[ 14 ] This method involves an iterative process allowing themes and patterns to arise from the data.[ 15 ] We used inductive content analysis, and categories of strategies were derived from the data. Inductive content analysis moves from the specific (phrases/codes) to the general (subcategories), so that particular instances are observed and then combined into a larger whole (categories).[ 16 ] Using this technique, one member of the research team (AB) identified all references to strategies for clinical rounds in the reviewed articles and listed them in phrase format (codes) in a list for strategies used in clinical rounds. The list was then negotiated with another member of the research team (NY). This was done in an iterative process until reaching completeness and agreement on the final contents. The final, categorized lists were reviewed by other members of the research team (PA and KB) for coherence and consistency.

Study selection

A total of 524 articles were identified for inclusion in the review (Web of science 61 hits, PubMed 131 hits, Embase 109 hits, Scopus 175 hits, Cochrane 33 hits, and reference check 15 hits). After adjusting for duplicates, 337 remained and were screened based on the title and abstract for possible inclusion. Of these, 300 studies were discarded, and 37 studies were obtained for further review. In total, on the premise of inclusion/exclusion criteria as well as full-text considerations, 18 articles contained useful information related to strategies for clinical rounds, and they were analyzed in depth. Among this batch, five studies that met the criteria for inclusion were identified by checking the references.

Study characteristics

Concerning the year of publication, 11 (61.2%) articles were published during a 7-year period from 2010 to 2016. Two (11.1%) articles were published in 2009 ( n = 1) and 2006 ( n = 1). Four (22.2%) articles were published in 2008 ( n = 2) and 2003 ( n = 2). One (5.5%) article was published in 1986.

Regarding the place of study, most researches were conducted in the USA ( n = 8), the UK ( n = 4), and Australia ( n = 2). The rest of the studies were conducted in countries including Canada ( n = 1), New Zealand ( n = 1), Pakistan ( n = 1), and Saudi Arabia ( n = 1).

In terms of data collection method, four studies used a questionnaire,[ 4 , 17 , 18 , 19 ] five studies used focus group discussion,[ 6 , 9 , 20 , 21 , 22 ] two studies used telephone interviews,[ 23 , 24 ] one study used card sorting technique,[ 25 ] one study used NGT technique,[ 26 ] and one study used report writing.[ 27 ] In addition, other studies used a combination of methods such as focus group discussion/interview[ 28 , 29 ] and questionnaire/group discussion.[ 8 , 30 ]

Qualitative analysis findings

Content analysis yielded identification of 299 codes concerning strategies for clinical rounds in nine major categories classified as “before rounds,” “during rounds,” and “after rounds” [ Table 3 ]. Quality assessment scores for the 18 research studies ranged from 5 to 14 (possible range, 1–16). The majority of the research studies (10 out of 18 studies; 55.5%) received quality scores in the range of 9 to 11.5; 7 (38.9%) studies received scores at or above 12 to 14, and only one (5.6%) study received the quality score of 5.

Strategies for clinical rounds

Our review aimed to discuss good bedside teaching strategies/practices which were derived from a systematic literature review. The significance of this systematic review lies in the fact that the identified strategies arise from both qualitative and quantitative methods of data collection as well as the opinions and experiences of clinical teachers and medical students. There is also a paucity of evidence which has comprehensively categorized the strategies for rounding practices to be applied when teaching students at the patients’ bedside. By taking the findings of this study into consideration, the effectiveness of clinical rounds will be increased, making rounds mutually beneficial for teachers, students, and patients. We identified numerous strategies for clinical rounds that could be classified into nine major categories and fifty subcategories [ Table 3 ]. We describe them in greater depth here that can be carried out before rounds, during rounds, and after rounds.

Before round strategies

System-related issues.

Before the initiation of the clinical round, it is highly important for the medical education system to take into account five essential factors in advance: (1) Teaching at the bedside must be a high priority for the system. In this regard, provide institutional incentives,[ 9 ] create rewards for bedside teaching,[ 9 , 23 ] promote awareness about students’ learning,[ 20 ] and have an integrated curriculum for bedside teaching.[ 8 ] (2) The medical education system must have ongoing faculty training in clinical skills and teaching methods for medical teachers.[ 6 , 9 , 20 , 23 ] (3) If the best is going to be achieved from teaching at the bedside, responsibilities or competing demands on teachers should be reduced or eliminated.[ 9 , 17 , 19 ] (4) Make sure that teachers have a comprehensive knowledge base or expertise to offer to learners.[ 6 , 25 ] (5) Last but not least, it is crucial to have motivated teachers to conduct rounds for medical students.[ 8 ]

Plan in advance

There are three important factors to be done by medical teachers before rounds. These are “teacher preparation,” “proper round planning,” and “proper organization.” To have an effective round and to increase teacher comfort at the bedside, preparation plays a pivotal role. When planning bedside rounds, a preparatory phase is invaluable. The activities that could be carried out in this phase are to consider advance planning and preparation.[ 8 , 18 , 20 ] Familiarize yourself with the clinical curriculum[ 20 ] and formulate goals for each session.[ 6 , 22 ] Evidence shows that clinical teachers usually do not have any briefing on the clinical curriculum to be taught.[ 31 ] In addition, investigate the actual clinical skill levels of all the learners[ 20 ] and review physical examination skills to be taught during bedside rounds.[ 24 ] Make a list of specified learning objectives[ 18 , 24 , 30 ] and set explicit teaching expectations.[ 9 , 23 ] Finally, select a definite course study resource for students[ 20 ] and make handouts for rounds or the teaching session the night before.[ 24 ] This preparation puts the teacher on track when conducting bedside encounter. In addition, think about when, where, who, what format, and length of rounding. Meet with the senior resident the day before round to discuss what kind of problems will be presented on round.[ 24 , 27 ] Decide between morning or afternoon rounds if no limitation exists. Plan for morning rounds as minds are fresh and enthusiasm is at its highest.[ 30 ] Similarly, afternoon rounds can be arranged for the completion of ward work.[ 30 ] In case of assistance from staff on round, invite nurses into rounds.[ 28 ] As participation is central in knowledge acquisition, plan for a small round with smaller groups.[ 29 ] Break the round into manageable parts[ 30 ] with a focused teaching time.[ 4 , 26 , 28 ] If you want to accomplish your goals, set a firm start date for bedside rounds to occur.[ 23 ] Make it public that everyone knows when, where, and on which days of the week bedside round occurs.[ 24 , 30 ] Do not forget to arrive on the teaching unit to assure continuity and availability[ 27 ] and initiate the session at the start of a shift without a preexisting patient load.[ 18 ]

Perform a preround huddle

At this phase, try to draw a road map for students by “selecting patients,” “preparing them,” “explaining their roles and expectations,” “elaborating on the layout of the round,” and “explaining do's and don’ts” of the round. This enables them to step into the encounter with some confidence. A very important part of the planning for the bedside encounter is patient selection. It is vital as all the teaching at the bedside round goes around the patient. Based on the embedded situation at the bedside by evaluating patients before round[ 24 ] or seeking help from the resident in charge, apply different approaches in selecting patients. As a general rule of thumb, consider consent of patient in his selection at first. If it is the first bedside rounding experience, select ideal patients for students[ 24 ] or plan bedside round for most patients[ 28 ] to make them familiar with the rounding experience. This can go with a sit down round with students before seeing the patient.[ 26 ] If the situation is exacerbated with patient condition and high patient volume, it is better to go first with sick patients requiring immediate care[ 24 , 27 ] or patients who need clinical decision-making[ 24 ] as well as pending discharges.[ 24 , 28 ] Plan the patient rounding order based on the 3 D's (decompensating, dischargeable, and complex decision-making)[ 28 ] if appropriate. As a general rule, go for patients with high educational value[ 24 ] and patients with interesting features for discussion and learning.[ 27 ] It is worth investing some time and energy in preparing learners.[ 17 ] This can be done by organizing an orientation meeting before round.[ 24 ] It is significant if learners are prepared cognitively and emotionally and also the preparation may revolve around providing guidance on the content of presentations for learners.[ 28 ] Orient the learners to your plans for the session and clearly express the expectations for each team member's role in rounds[ 24 , 28 ] and negotiate goals/objectives[ 6 , 9 , 24 , 26 , 27 ] with students. This assists learners to focus on the goal of the session and get the most out of the round. In addition, by assigning roles, the chaos that might be present during bedside teaching can be avoided, and learners’ participation will be maximized. It is critically important to provide an overview or a clear layout for the session[ 8 , 24 , 28 ] and review how encounters should be accomplished[ 24 ] if it is the first session of the round. Finally, establish ground rules set by program[ 26 ] in terms of discipline and accountability,[ 8 ] positioning of team at bedside,[ 24 ] and appropriate bedside dress code.

During round strategies

Patient-related issues.

The patient is at the heart of clinical education, and as William Osler states, medical students begin with the patient, continue with the patient, and end study with the patient.[ 32 ] The first encounter on a round is the patient's bedside. Before anything to be done, say to the patient that you are the person in charge of the round,[ 24 ] and then introduce everyone else to the patient.[ 22 ] This step is very important because it might cause confusion about who the real physician is, as large crowds attend the bedside. As learning occurs by taking history or doing physical examination on a patient, there is a need to orient the patient to the purpose of the session.[ 6 , 9 ] Evidence shows that this orientation by physician team is often lax and it causes patients to be baffled during and after the encounter.[ 33 ] Hence, provide information/explanation as needed[ 17 , 22 ] and consider what the patient could expect and prepare the patient as well.[ 24 ] As you are moving on the round, delineating knowledge or modeling a physical examination, show respect to the patient. Request permission from the patient to examine,[ 9 ] treat him/her as a human being, not the object of teaching exercise,[ 6 ] consider desired bedside actions to ensure respect,[ 24 ] and be sensitive to how the disease has affected the his/her life.[ 6 ] Bear in mind that a bedside teaching cannot be effective if patients are not involved during the round. This can be achieved by including the patient in discussions,[ 9 ] encouraging the patient to correct and contribute to details of history,[ 6 , 17 ] informing the patient about his care and decisions,[ 9 , 28 ] and asking him/her questions.[ 24 ] The last two factors that must be taken into account are enhancing communication with the patient and decreasing patient discomfort. During discussions with the medical team on rounds, use lay terms to communicate with the patient.[ 6 , 22 , 24 , 28 ] If you use too many medical jargons while communicating, this would baffle and alienate the patient. Try to have communication strategies for patients with language barriers as well.[ 28 ] After taking history or performing a physical examination and providing on spot explanations, if more lengthy discussions are going to be traded back and forth, postpone them to an appropriate time,[ 28 ] or resume them in another room[ 20 , 30 ] to care for the patient's comfort. Also, decrease the time students spend at bedside near patients.[ 20 ]

ABCs of teaching on rounds (teachable moments)

To have an effective bedside round with maximized satisfaction, look for teachable moments and use them to teach history and physical exam as well as rectifying deficiencies in students’ knowledge or clinical skills. This phase is of utmost importance as most of learning occurs at this stage. Ask one student or the primary person caring for the patient to present a synopsis of the case.[ 22 , 24 ] Alternatively, you can go for subjective, objective, assessment, and plan to have a more efficient and shorter round.[ 24 ] Look for how the student demonstrates the skills of interviewing.[ 27 ] When this is done, provide clarification on history points to students[ 24 ] and verify the main points of the history.[ 27 ] At this stage, allow room for questions to be traded among learners and you if any. It is now the best time to provide feedback following oral presentation.[ 17 , 19 , 21 , 22 , 23 , 27 , 28 , 30 ] Try to give positive and negative feedback as well.[ 25 ] After case presentation teachable moment, go for physical examination and model it to students.[ 21 , 24 ] Based on the case, try to perform a complete physical examination.[ 4 ] Show technique when teaching procedures[ 17 ] and demonstrate key physical findings.[ 26 ] Then, it is time for hands-on experiences on students’ part by providing opportunities to practice clinical examination skills.[ 22 , 29 ] Ask one or a couple of students to perform a complete physical examination and let others elicit key signs afterward.[ 4 , 27 ] Supervise examination technique done by students.[ 4 ] Like case presentation teachable moment, do the same for physical exam by clarifying physical examination points,[ 24 ] adding teaching points to what was done[ 24 ] and verifying the main points of the physical examination.[ 27 ] After demonstration and clarification, provide feedback as appropriate.[ 17 , 19 , 21 , 22 , 23 , 25 , 27 , 30 ] Before calling the session a day and moving for the postround huddle, teach and write orders for the patient.[ 25 ] This can be done using mobile computers or devices to write orders down.[ 28 ] Your last teachable moment is to come up with a management plan with students for the patient. Have a consistent and coherent plan of care in place when seeing a patient.[ 26 ] Discuss it with students[ 19 ] or push students to establish a care plan by your help.[ 28 , 27 ] And finally, as appropriate, address discharge plans for and with each patient by students.[ 25 ]

Teacher-related issues

Plan for an organized and efficient round[ 25 ] with enough time spent at the bedside[ 22 , 27 ] and focus more on teaching than getting the work done.[ 25 , 26 ] Take learners’ needs into account and make sure that teacher–learner goals are in line with each other.[ 6 ] When transferring knowledge to students, try to consolidate it[ 19 ] and provide real-life examples.[ 26 ] This can be achieved by challenging the learners to think critically,[ 6 ] emphasizing on problem-solving rather than accumulating facts,[ 27 ] integrating theory with actual patients and work,[ 9 , 25 ] and focusing on examination findings and symptom management rather than interpretation of results and diagnosis management.[ 30 ] Explicitly explain what on your mind is when dealing with the patient. Students need to know what sort of thinking you have when treating the patient. Share this thought process and think aloud.[ 26 ] Be aware of your role as a professional who is observed and imitated by medical students concerning your professional behaviors, the values, and ethics.[ 34 , 35 ] Be a good role model and demonstrate good bedside manner during patient care[ 17 , 26 ] as positive role models have a great impact on students learning.[ 20 , 21 , 22 ] Show enthusiasm and passion for your teaching[ 23 , 30 ] and be clear and concise instead of belaboring on issues at bedside.[ 26 ] Have succinct teaching points and lead encounters, demonstrating desired actions.[ 24 ] To engage everyone, plan for some activities to keep everyone involved in the teaching and learning. First of all, obviate didactic lecturing at the bedside which would diminish participation.[ 6 ] As appropriate, invite ward staff in bedside teaching to boost engagement. In your teaching, use a format that would involve all parties[ 4 ] and provide room for questioning and answering.[ 19 , 30 ] Keep a balance between student involvement and time spent at the bedside. Although keeping all learners engaged is paramount, but dragging the time causes boredom. Consequently, select some cases to present in full and abridge others,[ 25 ] plan teaching in a flexible manner to accommodate other duties and work schedules,[ 9 , 26 ] and set time limits when teaching.[ 9 , 22 , 26 ] Admit your own limitations, errors, and gaps in your knowledge on rounds.[ 9 , 17 , 21 , 27 ] Admitting your own lack of knowledge might set the tone for students to follow suit. This encourages them to admit their limitations and evokes a willingness to inquire questions. Try to make all students vigilant by requesting them to minimize interruptions[ 24 ] or avoid interruptions such as noise on rounds.[ 30 ] This can also be related to presentations by ensuring that no interruptions exist while they are being discussed.[ 28 , 25 ]

Student-related issues

This category includes “learners’ autonomy,” “thought processes,” “respecting learners,” “involving learners,” and “motivating learners” issues. When students feel that they are part of the caring team by sharing responsibility with them,[ 9 ] giving them autonomy[ 9 , 26 ] and allowing a degree of independence in decision-making[ 26 ] better learning outcome will be achieved. It is vital to inculcate a sense of responsibility in students and show them the way to lifelong self-directed learning to equip them with required skills dealing with patients. As students are presenting patients, ask them to think aloud and trigger a professional conversation to share their thought processes.[ 21 ] Respect all team members[ 6 , 25 ] and defer to them as a primary caregiver for the patient.[ 6 ] Bear in mind that embarrassing students can destroy team morale. Show to students that you have a zest to learn from them as this raises involvement. Include them in collegial discussions and clinical decisions[ 25 , 29 ] and encourage them to participate in daily ward work and patient care.[ 29 ] As learner involvement about patient care boosts the aura of usefulness and connectedness,[ 29 ] encourage students to be part of a team[ 30 ] and make them feel important in the learning process.[ 27 ]

Learning atmosphere-related issues

It is highly important for the clinical teacher to have an emphasis on the importance of a comfortable learning environment as trust between the teacher and the students facilitates communication during the encounters. In this regard, provide a comfortable environment with rooms for asking questions and discussion without restraint and humiliation.[ 6 , 26 ] Reassure students that their mistakes on rounds will be cushioned with grace.[ 23 , 25 ] Be approachable not intimidating[ 26 ] and induce a serious but a relaxed and friendly learning atmosphere.[ 8 , 25 ] If you have a desire for more participation and involvement, you should make the learning environment free of pressure by creating a safe, nonpunitive, nonthreatening environment.[ 19 , 23 ] Such considerations increase students learning. This can be augmented by providing support as well.[ 19 ] Inculcate a desire in learners to be at bedside by emphasizing its importance.[ 6 ] If you facilitate bedside rounds to enhance learning for all team members[ 23 ] and teach new things about an area of specialty[ 17 ] to students, you can make the bedside an aura of success. Finally, try to eliminate the mundane task of bedside which at times causes boredom for students by showing enthusiasm,[ 17 , 26 ] appreciation for team members for work performed,[ 26 ] and make the so-called boring diagnostic problems exciting.[ 6 ] Evidence shows that the learning environment and the learning atmosphere of medical schools should be investigated by standardized tools such as the Dundee Ready Education Environment Measure. A study conducted by Dehghani et al . in Iran showed that to augment learning, there is a need for some improvements in the environment concerning the residents’ supervision on students learning activities and the clinical teaching of attending doctors.[ 36 ]

After round strategies

Perform a postround huddle.

Get together after round before leaving the bedside. It is your job to summarize or recap what was taught and learned during the session.[ 21 ] Tell students that the session was mutually beneficial[ 6 ] and if a point needs to be clarified, offer a summary about the patient's illness or the management plan.[ 22 , 24 ] Do not forget to provide feedback after bedside teaching encounter on what was done during the session.[ 6 ] This kind of debriefing can be accompanied by self-evaluation of learners on their own performance and your comments on positive aspects of their performance before pointing out the areas that require improvement.[ 27 ] At last, provide room for students to ask their questions.[ 6 , 24 ] Allow discussion of sensitive issues if any and resolve confusion. Finally have a genuine, encouraging closure[ 22 ] and decompress after the intense encounter. This postround huddle maximizes clinical learning and leads to improvement in the teaching process for succeeding rounds.

Limitations

This study has its own limitations. First, we only included original articles not articles of other types such as perspectives, correspondence, book reviews, letter to editors, short communication, or any books as well. Second, gray literature sources, such as internal reports and conference proceedings, were not included in our review. We only encompassed published papers and averted our effort to obtain unpublished information which was impossible and beyond the control of the review authors. Furthermore, language restriction was included in the search strategy. Third, it is important to highlight that information about strategies for clinical rounds might not apply to every rounding situation as the rounding practices might be different due to the level of students, the content to be taught, and the context in which rounding practice occurs. In addition, the codes extracted from each included article and our interpretation of data are dependent on the authors’ views. Despite the existent limitations, our study has its own strengths owing to the explicit search strategy, clear inclusion/exclusion criteria, and the systematic process applied to identify and evaluate articles to be included in our review. In addition, both qualitative and quantitative methods as well as the opinions and experiences of clinical teachers and medical students were incorporated in our findings which fortify our research. Concerning our quality scoring system, it is important to mention that despite its acceptable interrater reliability, it has not been used in other studies. We assume that the weightings may require refinement and there may be additional relevant categories.

Most of students’ learning concerning history, physical examination, communication skills, decision-making, humanism, and role modeling to name a few occurs at the bedside. This invaluable venue is perfect for the acquisition of such tangible and intangible skills. Therefore, finding strategies to applaud good work and foster knowledge, skills, and attitudes is critical. In this review, we have provided some pinpointed strategies for medical teachers to take into account when teaching at the bedside. These were classified as before rounds, during rounds, and after rounds. Following these strategies once teaching students make bedside encounter run more smoothly and the resultant will be an improvement in the quality of teaching rounds. This not only improves knowledge and skill acquisition but also offers better services of care by more qualified doctors to society in general.

Financial support and sponsorship

This article is part of a PhD. thesis at Isfahan University of Medical Sciences with code number 396165. The entire project was financially supported by the vice chancellor of research at Isfahan University of Medical Sciences. In addition, the National Center for Strategic Research in Medical Education (NASR) supported it financially with code number 960215.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

We express our thanks to Dr. Yazdi for reading drafts of this manuscript and for his helpful comments.

Quality scoring system for evaluation of research studies on strategies for teaching in clinical rounds

RCT=Randomized, controlled trial

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Practical Nursing Guide to Patient Rounds

• February 11, 2020

Patient rounds are the cornerstone of hospital communication. They enhance both care and safety by giving members of the health care team the chance to meet and collaborate on patient needs.

When everyone is on the same page, outcomes improve. However, because no one spends more one-on-one time with patients than nurses, their input is among the most essential during patient rounds.

What Are Patient Rounds?

The purpose of rounds is to assess patients’ progress. Members of the multidisciplinary health care team—from doctors and nurses to therapists and nutritionists—get together to discuss changes in condition and review plans of care.

In a hospital, patients are acutely ill and need a higher level of medical supervision, so rounds are done daily. The process is quick and to the point.

Most days, rounds include only the staff members working most closely with the patient, typically doctors and nurses, while the entire team, including patients and their families, meet regularly to fill in the gaps.

How Do Patient Rounds Work?

The logistics of doing patient rounds can be tricky. The days when only a few physicians served wards full of patients have passed. Movies depicting doctors and nurses moving from room to room reviewing patient cases are largely inaccurate except in teaching hospitals.

Today, hundreds of physicians share privileges at multiple hospitals, something that enhances patient choice but makes scheduling rounds a challenge.

In most facilities, daily rounds are informal. Nurses touch base with doctors when they visit to chat about how patients are doing. They review diagnostic test results, discuss responses to treatment, and make changes in the plan of care based on progress.

In the interest of time and to ensure essential details aren’t missed, some hospitals have developed scripts or checklists for patient rounds.

Rounds may occur at the bedside to encourage patient involvement, but in today’s fast-paced hospitals, it’s increasingly rare for the patient and providers to be available at the same time.

Instead, patient rounds are often held at the nurses’ station or in a conference room both for convenience and to ensure confidentiality. Technology now allows providers to participate in rounds remotely.

The Role of Nurses in Rounds

Once, only registered nurses rounded with physicians. But the Institute of Medicine , a U.S. based non-profit, nongovernmental organization that provides evidence based recommendations for public health policy, has since recommended that nurses at all levels, including LPNs, be involved.

As front-line caregivers, LPNs are often the most familiar with how patients are responding to care. During rounds, they offer a summary of patient progress and describe changes in condition that may need to be addressed.

Doctors can then, in turn, respond to issues with new orders or requests for information. When rounds are complete, nurses follow up by

• Gathering needed information
• Transcribing new orders into the medical record
• Amending the nursing plan of care
• Informing other team members about changes
• Educating patients and their families about new orders
• Determining the best approaches to implement an evolving plan of care

The Benefits of Patient Rounds

Studies credit rounds for a wide range of improvements in patient care, including preventing errors, reducing costs, decreasing readmission, and supporting team based health care.

Preventing Errors

Physicians can access patient charts remotely, but because they contain only limited, objective data, they don’t tell a complete story. So much of the patient experience is subjective, and it evolves quickly.

Without the input of the nurses who provide 24/7 care, nuances are easy to miss. Rounds give doctors the most comprehensive, up-to-date information with which to interpret findings and make clinical decisions.

Face-to-face communication is also proven to be more accurate than written words. Communication failures are cited as a contributing factor in nearly a quarter of serious medical errors, so any process that improves accuracy and allows participants to clarify points before making life or death decisions is worth pursuing.

Reducing Costs

Patient rounds ensure efforts among all members of the health care team are coordinated. Information is disseminated in real-time, minimizing redundant services and delays that extend hospital stays unnecessarily.

Redundant medical services, such as diagnostic tests, are estimated to cost up to $500 billion annually. Studies identify the chief causes as lack of communication and poor planning between providers. Rounds reduce unnecessary expenditures by helping primary care physicians, specialists, and consultants avoid writing duplicate orders.

Decreasing Readmissions

Rehospitalizations occur for many reasons, but the failure to address each of the many issues that impact health is cited as a top contributor.

Modern health care is complex, with multiple professionals collaborating on care.

Team members strive to work together, but without opportunities to share thoughts face-to-face, information is easily lost. Patients benefit when team members communicate with each other and work toward the same goals.

Supporting Team Based Health Care

Participating in patient rounds benefits members of the health care team on more than a professional level. It encourages collaboration and makes the most of what each discipline has to offer. Care is optimized, and the patient benefits, but no one member must shoulder the burden.

For nurses, patient rounds are an opportunity to tap into what physicians and therapists are thinking. Understanding the general direction in which care is moving helps nurses keep patients and their families well informed while ensuring providers are aware of patients’ changing needs.

Skills for Success During Patient Rounds

Nurses participating in patient rounds benefit from a set of skills that help them contribute successfully. These skills include good communication, organizational skills, confidence, and compassion.

Communication Skills

Patient rounds take an average of five minutes per patient. For a busy day nurse with an average caseload, that’s up to an hour per shift. In that time, everyone participating has a chance to contribute, but each team member’s time is limited. Getting the most important points across requires being concise and accurate.

Listening skills are also a must. Nurses are asked not only to implement orders from a range of providers, but also explain them to patients and their families. Details count.

Organizational Skills

Because patient rounds can consume such a large part of a nurse’s day, preparation is critical. Nurse-to-nurse reports at the start of a shift highlight changes in patients’ conditions, but there’s no substitute for assessment.

Nurses should plan to see each patient, at least briefly, and collect pertinent data before the rest of the team arrives. Organizing tasks in a way that gleans the most information before rounds begin helps the process stay on track and be more productive.

With a broad base of knowledge, nurses are ideally positioned to serve as liaisons between patients and other members of the health care team, but they do more than follow orders.

Nurses are independent professionals whose primary role is to serve as patient advocates. They should not only share data during rounds, but they should also ask questions and make recommendations within their scope of practice.

Surveys in major hospitals reveal that entry-level nurses, including LPNs, feel uncomfortable speaking during rounds because they believe they have nothing to offer or that their suggestions will not be valued.

But the culture of health care is changing, and physicians are increasingly accepting the expertise of other disciplines. Studies show that up to 25 percent of nursing recommendations are accepted. When nurses speak confidently on behalf of their patients and the nursing department, care improves exponentially.

Patient rounds are a clinical process. Information is distilled into a snapshot of data that’s medically meaningful, but devoid of emotion. For clinicians, it’s how they stay in the know while saving time, but for patients, it can feel detached.

On post-hospitalization surveys, lack of compassion and feeling like no one is listening are consistently among patients’ top complaints. Health care is an intensely personal experience, and it’s up to nurses, as advocates, to act as patient representatives during rounds.

Final Thoughts

As medicine becomes more technically complicated, nurses are taking a leading role in patient care by actively participating in rounds. In an industry that depends so heavily on the accuracy and timeliness of information, the time it takes is less of an expense than an investment in team building and quality health care.

Did learning about performing patient rounds by a licensed practical nurse (LPN) interest you? Ready for an exciting new career in the health care field?

The Practical Nursing certificate program provides the graduate with the knowledge, skills, and attitudes needed to function as a licensed practical nurse, or LPN.

Part of the Practical Nursing training curriculum is devoted to theory and the rest to hands-on laboratory skills practice and off-site clinical externship rotations. These rotations include work at long-term care and rehabilitation facilities, hospitals, and childbearing and pediatric outpatient settings.

Upon successful completion of NCLEX-PN, the National Council Licensure Examination, which is a nationwide examination for the licensing of nurses in the United States, the licensed practical nurse (LPN) works under the direction of a registered nurse or licensed physician in a variety of health care settings.

Contact us today to find out more about how to become an LPN on Long Island.

Interdisciplinary rounds in the acute care setting: A powerful tool for student nurses

My colleague shook his head skeptically as he said, “I’m not sure the students know what nurses actually do.” The fall semester was coming to a close, which often prompts faculty members to wax philosophical about our nursing students. Despite hours of lecture and intensive work in the skills lab and on hospital rotations, we can never be sure that all students have gained an appreciable understanding of what being a nurse means—clinically, intellectually, and emotionally. Our university graduates hundreds of new nurses every year, many of them second-degree students. The program is built for speed—in 15 months our prospective nurses must be ready to sit for the NCLEX licensing exam. Apart from my colleague’s worries about emotional and intellectual preparation, I wonder if 15 months is enough time for students to understand the complicated culture of the US hospital system. The week after my colleague shook his head, a chance assignment opened a door for exploring how the use of interdisciplinary rounds can help prepare students for the work ahead.

The assignment

On the last day of the students’ hospital rotation, I assigned two second-degree freshmen to take care of a 73-year-old man who was actively dying. Mr. S. had complications from a previous hip surgery that included a postoperative infection, Vancomycin-resistant enterocci in his urine, and respiratory failure. A past medical history included hepatitis C and chronic obstructive pulmonary disease. I had reservations about assigning the patient to relatively inexperienced students and was not at all confident they were ready to handle this involved case, let alone manage an end-of-life experience. Only a few weeks ago they were working in jobs light years from nursing; one young woman came from the public relations world and the other from a job as a sales associate at a large chain department store. The night nurse, who appeared tired and overwhelmed, whispered that Mr. S. would probably die on our shift. When I learned he had no family or visitors, my decision was made. I could not bear the idea of a patient dying alone.

My goals for the students that morning were to provide comfort, monitor vital signs and intake/output, be responsible for his general care and, possibly, observe postmortem care. The patient’s code status was do not resuscitate, with no plan for hospice care. The RN case manager was wringing her hands, trying to chase down the attending to write an order for hospice care. Complicating the situation was the fact that Mr. S. had been placed on the orthopedics floor, and the nurses wanted to transfer Mr. S. to a medical unit.

Nervously, the students tied filmy blue gowns around their waists, struggled into plastic gloves, and approached our patient. His eyes were dry and staring as we entered the room. A bag of normal saline dripped into a vein keeping him hydrated, along with several piggybacked antibiotics to treat the infections overwhelming his body; a Venturi mask covered his face pushing air into lungs that no longer worked on their own. We were told he was responsive to pain only.

We talked to Mr. S. as we cleaned and bathed his face, body, and wounds. We adjusted his breathing mask, placing cotton gauze under strategic areas to prevent the plastic ties from biting into fragile skin. We put saline drops into dry eyes, massaged hands and feet with moisturizer, and applied barrier cream to a reddened sacrum. The students took vital signs. His temperature was 94.6 F degrees, and we rushed to cover him with extra blankets. We turned and positioned him carefully, relieving stress on a body that could no longer move on its own. Mr. S. had been a professional musician, so we turned the radio to a classical music station. As the notes of a piano concerto begin, we snipped and replaced wristbands that had grown tight around his swollen arms. We reattached sequential compression devices, which had been lying on the floor, to the patient’s legs.

The students barely left the patient’s side the entire morning. At some point, a resident entered the room, and stood at the foot of the bed. “Mr. S.,” he shouted, “How are you today? Are you in pain?” Mr. S. remained silent. “Well, no change I see.” He quickly left. Any reservations I had about assigning the patient to freshmen evaporated.

The students went back to caring for Mr. S., cleaning his mouth with a soft swab and mouthwash solution. By the end of our shift, he proved the nurses wrong. His vital signs improved. He was able to squeeze our hands when we said goodbye, and his eyes followed us as we left the room.

Reflection to resolution

In the postclinical conference, the freshmen were tired but quietly exhilarated. Apart from the primary nurse hanging the antibiotics and saline infusion, they had taken complete care of their patient. They spoke with some surprise, a little awe, and finally pride because they saw first-hand how their care significantly influenced their patient’s clinical outcomes that morning. They talked about how nursing goes beyond simple tasks and following medical orders. Ultimately, they were taken with the incredible power nursing has to change the course of a person’s outcomes. They experienced first-hand how nurses should respect the needs of all patients, and never more so than when those lives are nearing death.

I was pleased with the students’ work and appreciative of their sensitive reflections on a challenging day. As novice nurses they excelled in performing tasks, monitoring vital signs, and reporting changes. They were able to discuss larger issues surrounding those tasks. I thought back to the last faculty meeting, and the skeptical teachers. I told my students that I was proud that they learned not just what nurses do, but what nurses are capable of doing.

Unfortunately, our conference was running late, and we still needed to talk about what did not go right, but the students had to leave. If they had stayed, I would have talked about how the busy night nurse missed providing basic care to Mr. S. and how the preoccupied day nurse administered medications then left the room without talking or touching her patient and without talking to us. I would have pointed out that from a distance of 6 feet, the resident ascertained his patient was still dying: a caricature of poor bedside manners. He stereotypically ignored the nurses taking care of his patient – the students and me. There were other issues I needed to address with the students. We had not followed up on the missing hospice care order. We had not effectively communicated our concerns to the primary nurse. Perhaps most importantly, we missed interdisciplinary rounds.

While I had no regrets assigning Mr. S. to my novices, I realized I cannot teach any students without showing them how to manage patients in a healthcare culture that is in itself ailing and overly complicated. These are enormous issues to tackle, and I think I am partly to blame for what I saw as the failure to help Mr. S. on the many levels that needed care and attention. We should have engaged the medical team, tried to talk to the physician who left so abruptly. We should have followed up with the primary nurse, the RN case manager, and hospice care. Perhaps most importantly, because it could have answered many questions regarding Mr. S.’s care, we missed attending the unit’s interdisciplinary rounds.

The next week, I went back to the hospital, determined to change the way I manage the students’ day and our patients’ plan of care. Interdisciplinary rounds are held at 10:00 am, and I made sure we were there. A large group of people gathered by the nursing station, led by the nurse manager. Floor nurses, the social worker, the case manager, physicians, a nutritionist, and two nurse practitioners make up the team. Seventeen beds, 27 discussions, and many questions raised—some answered, some left unresolved. The topics ranged from moving a patient with newly diagnosed Clostridium difficile to an isolation room, to finding available rehab beds, to discussing how to best deal with a patient with Alzheimer’s disease who was pulling out her nasogastric tube to a psych consult for a young woman with metastatic breast disease. After rounds, the students began to see how critical interdisciplinary care is to managing a patient’s hospital stay. They began to understand the roles of the varied disciplines in the hospital with each discipline playing a vital part in the management of their patients.

What the research shows

Interdisciplinary rounds (IDR) have been widely used in the hospital setting for a number of years, and studies have shown their benefits in improving clinician efficiency, quality of care, and improved teamwork climate. Moreover, research shows the importance of interprofessional collaboration. The quality of healthcare provided by the hospital staff is affected by how clinicians communicate and interact with each other, and poor communication can influence patient outcomes, length of hospital stay, and costs. An informal review of the literature reveals few studies examining student involvement in IDRs. One Danish study showed that interprofessional training can offer students the chance to use new clinical expertise while teaching them about other professional roles; the study found more positive attitudes were fostered between the professions using this model. The use of interprofessional training has been championed by the Robert Wood Johnson Foundation, and a number of training grants and research studies have been funded.

Students who participate in IDRs are taking a step toward interprofessional collaboration, and this early training may prove critical on both a personal and clinical level after graduation. The suggested benefits of student participation in IDRs include:

• Opportunities to obtain an understanding of other disciplines
• Appreciation for alternative health care approaches
• Increased student participation in patient care
• Exploration of the values and challenges of each discipline
• Improved interprofessional relationships

Time to learn

Fifteen months may not be a long time to learn how to become a professional nurse. Nevertheless, it can be enough time to instill in new nurses an appreciation of how to effectively manage and collaborate patient care. Instructors who have access to interdisciplinary rounds can speed a student’s understanding of how best to achieve those goals.

Karyn Lee Boyar is a family nurse practitioner and a faculty instructor of nursing at New York University College of Nursing in New York City.

Selected references

O’Leary KJ, Sehgal NL, Terrell G, et al. Interdisciplinary teamwork in hospitals: A review and practical recommendations for improvement. J Hosp Med . 2012;7:48–54.

Reeves S, Perrier L, Goldman J, et al. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev . 2013;3:CD002213.

Jacobsen F, Fink A, Marcussen V, et al. Interprofessional undergraduate clinical learning: results from a three year project in a Danish Interprofessional Training Unit. J Interprof Care . 2009;23(1):30-40.

Naylor M. Promoting rigorous interdisciplinary research and building an evidence base to inform health care learning, practice, and policy. Commentary; Institute of Medicine, Washington, DC. Nov 15, 2013; http://iom.edu/interdisciplinaryresearch . Accessed September 5, 2014.

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Nursing Abbreviations and Acronyms: Guide to Medical Terminology

Ever wondered how healthcare professionals communicate complex information so efficiently? Dive into the world of medical abbreviations and acronyms—essential tools that transform lengthy terms like “ complete blood count ” into simple “CBC,” ensuring clarity and speed in patient care .

Table of Contents

Medical and nursing terminologies, precautions, official “do not use” list, list of common medical and nursing abbreviations, acronyms, and terminologies.

Healthcare professionals, including nurses and doctors, use a specialized set of vocabulary to ensure precise and efficient communication . These terms, often abbreviations or acronyms, are essential for clear documentation and effective patient care .

When working within the medical and nursing fields, it’s important to distinguish between abbreviations and acronyms, as they are key components of healthcare communication .

Abbreviations are shortened forms of words or phrases. For example, “vol” is an abbreviation for “volume.” These shortened forms are used to save time and space when writing or speaking about common terms and are prevalent in medical documentation.

Acronyms , on the other hand, are words created from the initial letters of each major part of a compound term. For instance, “CBC” stands for “complete blood count.” Acronyms streamline communication by condensing complex medical terms into more manageable and recognizable forms.

Medical abbreviations and acronyms are essential for efficient communication within healthcare settings. However, their meanings can vary significantly between different agencies, hospitals, and regions. To prevent miscommunication and ensure patient safety , follow these precautions:

• Always verify meaning . Always verify the meaning of any unfamiliar abbreviations or acronyms with the one who wrote it. Different facilities might use the same abbreviation to mean different things.
• Reference Facility-Specific Guidelines. Each healthcare facility typically has its own set of approved abbreviations. Familiarize yourself with and reference these guidelines regularly to ensure compliance with local standards.
• Use Full Terms When in Doubt . If there is any uncertainty about an abbreviation, write out the full term to avoid misinterpretation.
• Documentation Clarity . When documenting patient information, ensure that the context around the abbreviation is clear. This helps other healthcare providers understand the intended meaning without confusion .
• Standardize Communication . Encourage the use of standardized abbreviations within your team to reduce variability and enhance communication clarity.

The Joint Commission’s Official “Do Not Use” List aims to enhance patient safety by eliminating the use of dangerous abbreviations, acronyms, symbols, and dose designations that could lead to misinterpretation and medication errors . It applies to handwritten orders and free-text computer entries but not to preprogrammed health IT systems, though organizations are encouraged to eliminate such abbreviations during system upgrades. An exception exists for trailing zeros in specific contexts like lab results. The list was developed following a 2001 Sentinel Event Alert and was formalized in 2004, later integrated into Information Management standards in 2010. By adhering to this list, healthcare professionals can reduce errors and improve patient outcomes .

These terminologies can vary between different agencies and hospitals. This list serves only as a general reference for nurses. Always consult your hospital manual or institutional guidelines for the most accurate and specific information.

12 thoughts on “Nursing Abbreviations and Acronyms: Guide to Medical Terminology”

im right weeehhh.. .

This helped me out sooo much

What does WOF stand for?

“watch out for”

What does E/N stands for?

Evening/Night

What is the abbreviation for did not void in nursing

Thanks for this.soooooooo helpful.

What does tinc stand for

why are these all the med abbreviations? why is DOB not included

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5 Nursing Narrative Note Examples + How to Write

One of the most important lessons nursing students learn is the importance of documentation. Whether you are a nursing student or a seasoned nurse, knowing how to create accurate nurses' notes is vital. Narrative nurses' notes are one of the most popular forms of nursing documentation. Perhaps you are wondering how to write a nursing narrative note? In this article, I will share 5 nursing narrative note examples + how to write them and discuss the importance of accurate charting.

What is a Nursing Narrative Note?

What is the purpose of writing a nursing narrative note, what is the difference between a nursing narrative note and a nursing progress note, 3 advantages of nursing narrative notes, 3 disadvantages of nursing narrative notes, what elements should be included in a nursing narrative note, • date and time:, • the patient’s name:, • subjective data:, • objective data:, • assessment:, • interventions:, • evaluation:, what elements should not be included in a nursing narrative note, 1. symptoms without intervention:, 2. speculations:, 3. non-descriptive or non-precise terminology:, 4. premature charting:, 5. personal information about the patient’s family or loved ones:, featured online msn programs, how to write a nursing narrative note, 1. stay on point and be specific, 2. state the facts, 3. note presentation, 4. note objective data, 5. record subjective data, 6. make notes regarding your assessment, 7. record any medication you administer or treatment you perform, 8. did you have to include interdisciplinary team members, 9. don’t forget to sign each entry of your note with your name and credentials, what are some excellent examples of nursing narrative notes, example #1: head-to-toe admission assessment narrative note for patient admitted with recent cerebrovascular accident (cva), example #2: assessment of nursing home resident, example #3: nursing narrative note example for patient recently admitted and found on hospital floor, example #4: patient with complaints of left knee pain, example #5: patient complaint of nausea, prn medication administered, bonus 6 expert tips for writing an excellent nursing narrative note, 1. document nursing actions immediately., 2. keep documentation descriptive., 3. be objective., 4. add new information anytime it is necessary., 5. convey enough information to get your point across., 6. make sure your handwriting is legible., my final thoughts, frequently asked questions answered by our expert, 1. who can write a nursing narrative note, 2. when to write a nursing narrative note, 3. can i use abbreviations in a nursing narrative note, 4. what tense do you write a nursing narrative note, 5. are nursing narrative notes handwritten or printed, 6. how to sign off a nursing narrative note, 7. what happens if i forget to write a narrative note in the time it should have been written, 8. should i write about a patient crying in my nursing narrative note, 9. how to note pulses on a nursing narrative note, 10. how to describe lab results in a nursing narrative note, 11. can a nursing student write a nursing narrative note, 12. what are the common mistakes nurses make when writing narrative notes.

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“It’s a burning issue”: How one midwife is harnessing new technology to support mothers and newborns in India

As a midwife, Lovepreet Saini is always on the lookout for new ways to help mothers.

While studying for her bachelor’s degree in nursing, Ms. Saini developed a special interest in maternal and newborn health. “Even now, it’s a burning issue for governments to deal with, as a healthy baby and a healthy mother are key foundations for a developed country.”

After more than a decade spent working closely with mothers in labour wards, Ms. Saini qualified as a midwifery educator in early 2024 – a process made more arduous by her busy schedule at the hospital. Thankfully, a digital tool designed specifically for midwives helped her to reach her goal.

A new way to learn

In 2015, the  Maternity Foundation , an international NGO focused on maternal and newborn health,  launched the Safe Delivery app . The platform is a free training tool for midwives and other health-care providers in low-resource settings, offering animated videos, descriptions of practical procedures and other features to guide users on how to handle childbirth and related complications.

For Ms. Saini, whose packed schedule meant she struggled to find the time to study, the app marked a turning point. “The videos and short formats helped me a lot to pass my exam,” she shares. “It covers pre-conception to postnatal care, including modern methods of contraception.”

With the support of UNFPA, the United Nations sexual and reproductive health agency, and other key partners, the app has now reached 435,000 people across more than 70 countries. 

In Ludhiana, a bustling city in the north Indian state of Punjab where Ms. Saini works, accessing accurate information on maternal health is particularly important: A large migrant population means that many women experience barriers to care due to a lack of resources and knowledge on how to navigate the health-care system, while certain cultural beliefs can often lead to the spread of misinformation.

“They have more issues with maternal and newborn health,” explained Ms. Saini. “And they don’t have enough money to get treatment from the private hospitals.” Tools like the Safe Delivery App make it easier for midwives to learn and disseminate the facts so that all women, regardless of status, can access quality maternity care.

The platform also provides training on an aspect of maternal health that is often overlooked – perinatal mental health, which Ms. Saini believes is critical to the overall health of mother and child.

Overcoming challenges in remote locations

And there’s another benefit to the Safe Delivery App – it functions offline, even in remote locations. Ms. Saini described how this helps her colleagues to deliver quality care where it is needed the most: “I remember when I went to Gujarat, it was a tribal and remote area. I recommended this app to the community health officer who was working there and she was astonished to see that such apps are available – she became very happy.”

To provide even easier access to information in real time, a new AI-powered conversational smartbot called NeMa, developed by  Neuvo Inc. Global , is currently being piloted in India. The initiative was facilitated by UNFPA and funded by Organon, a global health-care company focused on women’s health.

With  almost 300,000 women and 2.4 million newborns  losing their lives due to pregnancy complications every year, there is an urgent need to find solutions. When midwives are empowered to improve their knowledge and skills, they can ensure that mothers in some of the world’s most fragile settings can give birth safely.

Of all the happy moments Ms. Saini has experienced in the labour ward, one stands out as her favourite: As she made the rounds of the collaborative care unit one evening, a woman who had been admitted with contractions observed her kindness with another expecting mother. As she was preparing to finish her shift, Ms. Saini was approached by the woman with a special request: she wanted her to assist her with her own delivery.

"I was done with my duty, but I stayed for the night so that I could help that mother to deliver. Afterwards, she told me that it was only because of me that she was able to deliver a healthy baby," said Ms. Saini.

"That is one of the unforgettable moments of my profession, and I will always remember it. She even had the same name as me – I am Lovepreet and she was also Lovepreet."

This news item was originally published on unfpa.org .

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New Covid Shots Were Approved. But Who Will Get Them?

Many older Americans, including those in nursing homes, aren’t getting booster shots.

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By Benjamin Mueller and Noah Weiland

The Food and Drug Administration on Thursday approved the latest slate of annual Covid vaccines, clearing the way for Americans 6 months and older to receive updated shots in the midst of a prolonged summer surge of the virus.

Pfizer and Moderna, the vaccine makers, are expected to begin shipping vaccines to pharmacies and doctors’ offices within days. The shots are tailored to a version of the virus that took off this spring before giving way to closely related variants, all of which appear to spread faster.

For the frailest Americans, who have been dying of Covid in growing numbers this summer, the shots could offer a reprieve from a virus that disproportionately endangers those whose vaccinations are out of date.

But the approval is occurring months after wily new variants began driving up infections, a matter of consternation for some scientists who have urged faster turnarounds for updated shots.

In recent weeks, people have been hospitalized with Covid at a rate nearly twice as high as during the same time last summer. By late July, Covid was killing roughly 600 Americans each week, a substantial drop from this winter but double the number from this spring.

The availability of boosters has not translated into actual vaccinations. By spring, only one in five adults had received last year’s updated Covid vaccine. Even older Americans, who are at far greater risk of being severely sickened, largely spurned the shots, with only 40 percent of people 75 and older taking last year’s vaccine.

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A high-powered CEO puts her career and family on the line when she begins a torrid affair with her much younger intern. A high-powered CEO puts her career and family on the line when she begins a torrid affair with her much younger intern. A high-powered CEO puts her career and family on the line when she begins a torrid affair with her much younger intern.

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