What role should nurses play in ward rounds?

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Kunle Emmanuel
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What role should nurses play in ward rounds?

Unread post by Kunle Emmanuel »

The Francis report has highlighted that nurses have a vital role to play in ward rounds and it is critical that they attend.

•What role should nurses play in ward rounds?
•How can patients benefit from increased nursing involvement?
•How could you encourage colleagues to prioritise ward rounds?
•The author acknowledges that often the wider multidisciplinary team does not prioritise nurse involvement. How can this be changed?
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Re: What role should nurses play in ward rounds?

Unread post by Kunle Emmanuel »

The role of the nurse includes supporting the patient, supplementing the doctor and if possible ensuring that the patient retains confidence in the health care system.
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Re: What role should nurses play in ward rounds?

Unread post by Kunle Emmanuel »

The Ward Round is the key vehicle for coordinating care for every hospital inpatient; the information shared is crucial to the ongoing care plan.

The ward environment is busy and complex as are the needs of the patient; re-establishing the multi-disciplinary Ward Round will ensure the delivery of quality, safe, efficient, compassionate patient care. The best practice principles set out below by the RCP and RCN show how this can be achieved:

Hospital Culture

A successful Ward Round structure will enhance patient experience, facilitate speedy discharge, avoid harm and improve team communication. Its importance needs to be recognised from executive to ward level:

1. Co-location: Bed allocation should minimise outliers.

2. Staffing: Staffing levels should ensure that multi-disciplinary staff can attend the morning Ward Round.

3. Coordination: Ward Rounds should be timetabled to avoid clashes.

4. Equipment: Access to facilities for the Ward Round must be prioritised (e.g. a designated computer and mobile trolley).

5. Clinical Records: There should be one set of notes for all multi-disciplinary documentation

6. Training: Ward Round practice should be included in new staff inductions.

Pre-ward round

For a Ward Round to be productive preparation is necessary:

1. Briefing: All team members should participate in a pre-Ward Round briefing.

2. Documentation: The team need to ensure all clinical records and request forms are centrally available.

3. Leadership: The person leading the Ward Round (usually the consultant) needs to introduce and assign tasks to all attending. The purpose of the Ward Round (which may vary for each patient visited) needs to be identified.

4. Patient: The patient should be helped to prepare the issues to ensure their views are heard.

Roles on the Ward Round

All of the multi-disciplinary team are integral to the Ward Round process, as a minimum a doctor and nurse should be present:

1. Doctor: Leads the round, updates the patient and team, reviews all information.

2. Senior Nurse: Updates on current status and performs safety checks. Assists some patients in communicating their needs and coordinates ward care.

3. Pharmacist: Reviews the medication and venous thromboembolism (VTE) prophylaxis.

4. Allied Health Professionals (AHP): Updates on care and discharge planning.

5. Carers/Advocates: Participates in bedside discussions where a patient wishes (especially with vulnerable patients).

At the bedside

The Ward Round enables patients and team to exchange information and build trust. Objectives of the interaction include:

1. Introductions: The consultant introduces the patient to the team and ensures the patients dignity is respected.

2. Stated Aims: Using a ‘situation, background, assessment, recommendation’ (SBAR) structure the team should discuss the clinical scenario.

3. Review: Using safety checklists the team members will review the clinical status and care according to their assigned tasks.

4. Goal setting: The Ward Round lead will summarise the daily plan for the patient.

5. Educational opportunity: An educational point maybe highlighted by the Ward Round lead.

Post Ward Round

The Ward Round should set the daily agenda. A Ward Round debrief will focus on:

1. Task allocation: Ensure all tasks are allocated to a team member.

2. Patient information: Written summaries of discussion maybe helpful for patients (e.g. discharge planning, new diagnoses).

3. Meeting arrangement: patient/carers may book a time for in depth discussion.

4. Board rounds: An evening board round can follow up issues arising from the Ward Round.
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Re: What role should nurses play in ward rounds?

Unread post by Kunle Emmanuel »

From Facebook group:
Oyadele Bola Lanre
Is it OK for nurses to leave their duties & follow drs during drs ward round?
Ngwu Joy Ginika: I guess if you meant the general ward round being carried out in wards,, which should be a multi-disciplinary affair comprising of Drs, Nurses, dietitian ,Physiotherapist, social welfare & others in some Hosp,while in some it is only the Drs & Nurses . We know our patients & their needs better than them,, we should be their mouth piece so to say... So I don't think there is anything wrong following them for a round BUT not carrying pt's folders as some Nurses do
Kingsley Iyke In ideal situation, the rounds should be for all the health team and professionals involved directly in managing the patients. But is called Doctors rounds. It is suppose to be participatory and all inclusive, contributions from every member of health care team. But is unfortunate that is not applicable here in Nigeria, also some Doctors look down on other members of health team. But there nothing wrong in joining them, sharing information, ideas, knowledge together. Learning takes place and you learn everyday from anybody. But don't carry folders and files for them, don't allow them to intimidate you, don't play servant role or be radicule.
Nigerian Nurses lighting up the world one candle at a time.

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