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Asian Nursing Research 8 (2014) 282e285

Contents lists available at ScienceDirect

Asian Nursing Research


journal homepage: www.asian-nursingresearch.com

Research Article

Impact of Regular Nursing Rounds on Patient Satisfaction with Nursing


Care
Reza Negarandeh, MScN, PhD, 1 Abbas Hooshmand Bahabadi, MScN, 2
Jafar Aliheydari Mamaghani, MScN, PhD student 2, *
1
2

Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran
Faculty of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran

a r t i c l e i n f o

s u m m a r y

Article history:
Received 18 July 2013
Received in revised form
24 April 2014
Accepted 23 June 2014

Purpose: The purpose of the study was to determine the impact of regular nursing rounds on patient
satisfaction with nursing care.
Methods: This was a controlled clinical trial in which 100 hospitalized patients in a medical surgical ward
were allocated to control and experimental groups through convenience sampling. The experimental
group received regular nursing rounds every 1e2 hours. Routine care was performed for the control
group. Patient satisfaction with the quality of nursing care was assessed on the second and fth days of
hospitalization in both groups using Patient Satisfaction with Nursing Care Quality Questionnaire.
Results: On the second day, patient satisfaction scores of the two groups had no signicant difference
(p .499). However, the intervention was associated with statistically signicant increased patient
satisfaction in the experimental group compared to the control group (p < .001).
Conclusion: Implementing regular nursing rounds had a positive impact on patient satisfaction. This
method may hence improve patient-nurse interactions and promote the quality of nursing care and
patient satisfaction.
Copyright 2014, Korean Society of Nursing Science. Published by Elsevier. All rights reserved.

Keywords:
communication
needs assessment
nurse's practice patterns
patient satisfaction

Introduction
While the focus has been on slowing the growth of health care
costs, new emphasis is being given to improve the quality and
outcomes of health care. On the other hand, to improve the quality
of health care, accessible and reliable indicators of quality are
needed. Various indicators such as hospital mortality, length of
stay, readmission, and rate of disease recurrence are used to evaluate the quality of hospital services. Besides all these indicators,
patient satisfaction scores have been used as an index for guiding
quality improvement projects (Lo, Stuenkel, & Rodriguez, 2009).
Thus, patient satisfaction has become an established outcome indicator of the quality and efciency of the health care systems
(Merkouris et al., 2013).
In view of the fact that nurses play a crucial role in patients'
experience of hospitalization, patient satisfaction with nursing care
comprises a signicant part of the overall satisfaction with the

* Correspondence to: Jafar Aliheydari Mamaghani, BScN, MScN, PhD student,


Faculty of Nursing and Midwifery, Tehran University of Medical Science, Nosrat St.,
Tohid Sq., Tehran 1419733171, Iran.
E-mail address: aliheydari@razi.tums.ac.ir

quality of provided services. Truthfully, many researchers have


suggested the satisfaction with nursing care as the most important
index in predicting patient satisfaction with the overall provided
care (Han, Connolly, & Canham, 2003). Mrayyan (2006) dened the
patient satisfaction as a degree of agreement between the expected
quality of nursing care and the actual received care.
Most of studies conducted concerning patient satisfaction in
Iran and other countries indicated that generally nursing services
could not fully satisfy patient needs. For instance, a national study
in university hospitals of selected cities in Iran showed that only
39.7% of the patients were fully satised with nursing services
(Joolaee, Givari, Taavoni, Bahrani, & Reza Pour, 2008).
The factors related to patient satisfaction are varied (Lo et al.,
2009). Among different factors, effective and continuous interaction and communication are critical determinants in patients'
satisfaction, hospital stay, and recovery (Chant, Jenkinson, Randle,
& Russell, 2002). The perceived quality of the interactions between the patient and nurse has been found to be related to patient
satisfaction (Doran, 2010).
To improve patient satisfaction, many initiatives such as training
courses and coaching strategies have been developed and introduced successfully in a number of settings to teach staff about the

http://dx.doi.org/10.1016/j.anr.2014.10.005
1976-1317/Copyright 2014, Korean Society of Nursing Science. Published by Elsevier. All rights reserved.

R. Negarandeh et al. / Asian Nursing Research 8 (2014) 282e285

necessity of establishing a connection with patient (Toma, Triner, &


McNutt, 2009). In this regard, Langen, Myhren, Ekeberg, and
Stokland (2006) found a positive correlation between patient
satisfaction and nurses' communication with patients and their
support. Woodard (2009) showed that availability and responsiveness of nurses correlated to patients' understanding of the
quality of nursing care.
Nurses perform their role through communication. King believes that nurse-patient interaction is the cornerstone of nursing
profession and also positive nurse-patient communication can be
vital in quality of nursing care (McCabe, 2004). However, research
has revealed unfavorable levels of communication between nurses
and patients (Sobaski, Abraham, Fillmore, McFall, & Davidhizar,
2008). It has been claimed that only 32.8% of the care provided
by nurses is direct care and 67.2% belongs to other types of care
(Desjardins, Cardinal, Belzile, & McCusker, 2008).
Nursing clinical rounds allow nurses to interact with patients,
respond to their concerns, and modify the unsatisfying conditions.
More precisely, regular nursing rounds provide an opportunity to
identify and fulll patient needs via active nursing procedures.
Although hospitals employ various methods of rounds for hospitalized patients, the main components of all rounds are pain
management, toileting, changing position, and environmental
managementecomfort (Meade, Bursell, & Ketelsen, 2006). It seems
that improving nurse-patient communication can improve patients' outcome including their satisfaction with nursing care.
Therefore, this study aimed to determine the impact of regular
clinical nursing rounds on patient satisfaction rate.
Methods
Study design
This clinical trial with non-equivalent control group was conducted in Shariati Hospital afliated to Tehran University of Medical
Sciences (Tehran, Iran) in 2012.
Setting and samples
The Shariati hospital serves as one of the largest teaching hospitals in Tehran, with a variety of different wards and specialties. It
provides 530 active beds and its current human resources include
105 physicians and 536 full time nurses. Present study conducted in
the selected medical surgical ward includes 27 full-time nurses and
contains 40 active beds.
Eligible patients who consented to participate were enrolled
through convenient sampling. The sample size was estimated at 50
subjects for each group (making a total of 100 participants) after a
pilot study and according to the sample size formula. The inclusion
criteria were more than 18 years of age, ability to communicate,
staying in surgical ward for at least 72 hours, and absence of mental
illnesses or treatments altering psychological and mental processes. In order to eliminate the effects of environmental factors,
experience and therapeutic approaches of the medical staff, and
other confounding factors, patients admitted during the rst few
weeks were allocated to the control group and their information
was collected. After a 2-week interval (to ensure the discharge of
the control group), 50 participants were selected to form the
experimental group and receive the designed intervention.
Ethical considerations
The study was performed after obtaining approval from the
Ethics Committee of Tehran University of Medical Science. All
ethical codes of conduct were observed; including voluntary nature

283

of participation in the study, being free to leave the study, the riskfree nature of the intervention, not forfeiting the standard care
procedure, and condentiality.
Instruments
A self-administered questionnaire on demographics was used to
assess age, sex, marital status, education level, and hospitalization
frequency of participants. Patient satisfaction was evaluated by the
Patient Satisfaction with Nursing Care Quality Questionnaire
(PSNCQQ). The PSNCQQ was developed and tested by Laschinger,
Hall, Pedersen, and Almost (2005). The questionnaire was modied after obtaining permission to use and modify it. The modied
version comprised 21 questions based on a 5-point Likert scale
(weak to excellent). The total score of each questionnaire (ranging
between 21 and 105) was calculated by summing up all scores. Each
item of the PSNCQQ consists of a phrase to designate the content of
the question or signpost, followed by a more detailed question or
descriptor (Reck, 2010). For example, in the rst item of the instrument, information you were given is used as a signpost for the
descriptor that follows, How clear and complete the nurses' explanations were about tests, treatments, and what to expect.
Below are a few of the other items of the questionnaire:
Attention of nurses to your condition: How often nurses
checked on you and how well they kept track of how you were
doing.
Nursing staff response to your calls: How quick they were to
help.
Daily routine of nurses: How well they adjusted their schedules
to your needs.
Coordination of care: The teamwork between nurses and other
hospital staff who took care of you.
This questionnaire was used and validated in previous Iranian
studies (Negarandeh, Mohammadi, Zabolypour, & Ghojegh, 2012).
In order to evaluate the reliability of the PSNCQQ through testretest, 15 patients completed it twice with a 3-day interval. The
intraclass correlation coefcient of the questionnaire was
conrmed with r at .91.
Data collection
PSNCQQ was completed on the second and fth days of hospitalization for two reasons: (a) in assessing patients' satisfaction, it is
necessary to let patients have enough experience with nursing services, and (b) the mean length of hospital stays of patients in this
ward was 5.5 days. In the experimental group, nurses undertook
regular clinical rounds as a communicative method. They individually visited patients every 1e2 hours (at least every 2 hours) from 8
a.m. until 10 p.m. They not only communicated with patients, but
also assessed their needs by focusing on their pain, comfort, assistance, and training needs. The nurses were taught to perform their
rounds during a 20-minute training session and were supervised by
the researcher to ensure their correct performance throughout the
rounds. Although the researcher presented in the ward, he remained
as an observer and provided help only if necessary.
The control group received the ward's usual care. In this ward
nurses provide care according to functional method. Functional
nursing, sometimes referred to as task nursing, places emphasis on
tasks which are distributed according to levels of expertise. This
method has an inert weakness as it places emphasis on tasks rather
than providing patient-centered care.

284

R. Negarandeh et al. / Asian Nursing Research 8 (2014) 282e285

Data analysis

Table 2 Comparisons between Mean Patient Satisfaction Scores on Second and Fifth
Days in Experimental and Control Groups.

The collected data were analyzed using independent t test, chisquare test, and Fisher's exact test in SPSS for Windows 16.0 (SPSS
Inc., Chicago, IL, USA). A p less than .05 was considered signicant.
Results

Based on obtained data, 50% of patients in control group and


36% of patients in experimental group were 31e50 years old. The
majority of patients in control (58%) and experimental (56%) groups
were female; 68% and 74% of patients were married in control and
experimental groups, respectively. Regarding the level of education
among study participants, most of them were under diploma in
both groups. In addition, most of the patients had a history of
admission to the hospital (44% in control and 46% in experimental
group). Chi-square test and Fisher's exact test showed that the two
groups were identical and had no signicant difference in terms of
demographic characteristics and history of hospitalization during
the past 2 years (Table 1).
Differences in mean satisfaction scores
Moreover, the results of independent t test suggested no signicant difference between the mean satisfaction scores of two
groups on the second day of hospitalization (p .499). On the fth
day, however, the mean satisfaction scores differed signicantly
between the two groups (p < .0001). On the other hand, comparisons between the mean patient satisfaction scores on the fth and
second days revealed a signicant increase in experimental group
and a signicant reduction in control group (p < .05) (Table 2).
Discussion
The purpose of the present study was to determine the impact of
regular nursing rounds on patient satisfaction with nursing care.
The ndings of the study suggested the benecial effects of regular
nursing rounds on patient satisfaction with nursing care. This was

Table 1 Comparison of Demographic Characteristics of Patients in Experimental and


Control Groups.
Characteristics

Categories

Control
group

Age

18e30
31e50
51e70
71
Female
Male
Single
Married
Widowed/
divorced/
separated
Illiterate
Primary
Diploma
Collegiate
No
Once
Twice
3

12
25
8
5
29
21
11
34
5

(24)
(50)
(16)
(10)
(58)
(42)
(22)
(68)
(10)

14
18
15
3
28
22
8
37
5

(28)
(36)
(30)
(6)
(56)
(44)
(16)
(74)
(10)

7
17
12
14
22
16
6
6

(14)
(34)
(24)
(28)
(44)
(32)
(12)
(12)

6
20
13
11
23
17
6
4

(12)
(40)
(26)
(22)
(46)
(34)
(12)
(8)

n (%)

Marital
status

Educational
status

History of
hospitalization
(in the past
2 years)

Control group

Experimental group

Second day of hospitalization


Fifth day of hospitalization
p

59.8 16.3
55.3 12.7
<.022b

57.5 17.6
68.8 8.8
<.0001b

p
.499a
<.0001a

Note. aIndependent t test; bpaired t test.

Participant characteristics

Gender

Mean satisfaction score

Note. aChi-square test; bFisher's exact test.

Experimental
group

c2/f

0.730a

.467

0.040b

.840

1.212a

.797

0.720a

.908

0.781a

.797

n (%)

in accordance with studies which indicated the positive impact of


nursing rounds on improving patient-nurse interaction, reducing
number of bed falls, decreasing hospitalization duration, and
increasing patient and nurse satisfaction (Bourgault, et al., 2008;
Davies, 2010; Sobaski, et al., 2008). Communication is one of the
major roles of nurses whereby they can provide assured and quality
care (Neville, Lake, LeMunyon, Paul, & Whitmore, 2012).
Similar to our ndings, a study by Meade, Kennedy, and Kaplan
(2010) showed that undertaking hourly rounds by nurses and halfhourly rounds by technicians signicantly increased the scores of
patient safety and satisfaction. It can be considered as a result of
predicting and managing the fundamental needs of patients at the
right time (Meade et al., 2006). Likewise, Bourgault et al. (2008)
reported that performing nursing rounds every 1e2 hours signicantly increased patient satisfaction in oncology, general surgery,
renal, orthopedics, neurology, progressive care, and intermediate
wards. On the other hand, Kalman, Olrich, and Nigolian (2008)
found that nursing rounds decreased the rates of falls and call
light use and increased patient satisfaction. However, the differences were not signicant.
It should be borne in mind that patient satisfaction is inuenced
by many factors including treatment structure, process and
outcome, and patients' soci demographic characteristics, mental
and physical conditions, and expectations (Von Essen, Larsson,
Oberg, & Sjoden, 2002). Moreover, making noticeable changes to
increase patient satisfaction is much more difcult in wards where
patients are highly satised.
In the present study, the mean satisfaction scores of the control
group had a signicant 4-point reduction on the fth day compared
to the scores on the second day. This can be attributed to the experiences of patients gained during their hospitalization. Researchers suggested an inverse relationship between length of
hospital stay and patient satisfaction which means longer hospital
stay is associated with lower patient satisfaction (Borghans,
Kleefstra, Kool, & Westert, 2012). Moreover, since the control and
experimental groups were evaluated at different times, the scores
might be affected by environmental factors.
Nursing rounds in the present study included the assessment of
pain, comfort, assistance, and training needs. Meade et al. (2010)
also used a similar method to perform rounds in their study.
Sobaski et al. (2008) and Woodard (2009) took the assessment of
pain, need for position change and potty into consideration. The
common benets of all mentioned rounds were facilitating effective nurse-patient communication and reducing patient concerns
about the fulllment of their needs during hospitalization. In fact,
regular nursing rounds promote the mutual interaction between
nursing staff and patients, increase attention to patient needs, and
eventually enhance the potential for fullling their needs (Sobaski
et al.). Nursing care will be more efcient if the fundamental needs
of patients are predicted and managed at the right time. Such a
positive understanding of nursing care might be interpreted as high
patient satisfaction with the entire hospital (Meade et al., 2006).
Moreover, nursing round is a structured intervention which
potentially provides nurses with the opportunity to solve patients'
problems and identify their needs. It can also improve the nurses'
ability of decision-making based on clinical observations and

R. Negarandeh et al. / Asian Nursing Research 8 (2014) 282e285

patient-centered care (Aitken, Burmeister, Clayton, Dalais, &


Gardner, 2011).
Limitations
The most important limitations of the present study were
absence of random assignment, nonequivalent control group, and
interval between evaluating the control and experimental groups
(which was inevitable due to the nature of the intervention).
The researcher tried to be present in the ward and supervise the
appropriate implementation of the rounds. Accordingly, this could
create a Hawthorne effect which remained as a limitation of the
study. Besides, as this study was only conducted in an internal
surgical ward, the generalizability of its results is also subject to this
limitation. Therefore, similar studies in other wards are recommended for more generalizable results.
Conclusion
As a communicative method, performing regular nursing
rounds can play an important role in increasing patient satisfaction
with quality of nursing care. Accordingly, in order to enhance patient satisfaction, nursing managers are recommended to use the
ndings of the present study and design and perform regular
rounds.
Conict of interest
The authors declare no conict of interest.
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