The Nurse as the Discussion Opener During Ward Rounds: An Observation Study in the Wards of a Finnish University Hospital

Background: Ward rounds serve as a forum for sharing information between the patient and health care professionals. In order to ensure the multiprofessional nature of the rounds, the nurse’s expertise and knowledge of the patient’s situation is needed. The nurse’s presence during the ward rounds is necessary to ensure patient satisfaction and the quality of the patient’s treatment, even though nurses rarely participate in discussions during the ward rounds.

Aim: To describe how active nurses are as discussion openers during ward rounds and to compare the activity of nurses working in different specialities as discussion openers, in addition to investigating the significance of background factors.

Methods: The data were collected in a Finnish university hospital in 2012-2013 by observing ward round situations with patients (N=365) on different speciality wards using an observation form.

Results: The nurses were fairly passive in initiating discussions about the patient’s physical status and passive in opening a discussion on the patient’s psychological status. The nurses were passive in opening discussions concerning the planning or evaluation of the patient’s treatment. Nurses specializing in gastric surgery or internal medicine in gastroenterology initiated discussions more actively than nurses in other specialties. Nurses opened discussions more often in the context of emergency care patients than in connection with patients who had arrived at the hospital for an elective procedure.

Conclusion: Nurses should use their expertise in opening discussions on the patient’s physical and psychological state, as well as decision-making regarding the planning and evaluation of treatment. Support from managers in different professional groups is important for increasing the participation of nurses during ward rounds. In the future, it would be interesting to study the shared experience of nurses, physicians and patients regarding the ward rounds, as well as the patients’ own experiences.

Author(s): Kaija Leino, Elina Mattila, Pekka Collin and Juhani Sand

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