Research shows (Snyder, Kessler, Hitchings, et.al., 2007), that specific actions made by nursing rounds reduced frequency of call lights and falls as well as created increased satisfaction with the nursing care. However, to reap these benefits meant hourly rounds by the staff. The study by Snyder et.al. (2007) addressed pain, position, and personal needs done by hourly rounding. They found a decrease in call lights and falls and an increase in patient satisfaction. Falls were decreased significantly and overall patient satisfaction went from the 3rd quartile to the 1st. This was further supported by a study done by Orr, Tranum, and Kupperschmidt, (2007) showing the same basic results. They showed decreased falls and much improved results in pain control. In 2007 a study was reported in Clinical Nurse Specialist again, supporting the same results. Johnson, and Topham (2007) reported a decrease in patient falls by 46% as they found that most patient falls were attributed to patients getting up to go to the bathroom. Hourly rounding improved this kind of fall drastically. All of these results indicate a quality, safety and cost effective way to improve patient outcomes. Initiating this change may be difficult as it not only is a change but disrupts nursing routine and asks them to follow through on their day completely different than they are used to doing. Anytime a process comes with that much change is not only difficult to make the change but difficult to maintain the change.
Middle Range Theory
Middle range theories are described as theories that are best used by emerging disciplines (McEwen &Wills, 2007). The suggestion is made because they are theories that are more readily operationalized than they others. They work well in nursing for that very reason. Practice often is affected by theory but on the average nursing does not recognize it. With the advent of advanced education for nursing, some of that has changed. However, operationalizing a theory is very important(MeEwen, et.al., 2007). McEwen (2007) tells the reader that there are several standard characteristics of a middle range theory. The principle ideas of the theory are simple, straightforward, and general. They consider a limited number of variables or concepts and they usually have a particular focus. They, like the studies observed have the ability to be empirically tested. Practice for nursing today must be studied and tested as evidence based practice is more important than ever before.
The nursing problem of rounding, chosen for this paper can be analyzed using a middle range theory. The middle range theories derived from research and practice are the set of theories most likely to work well with this process. Grounded theory and qualitative methods are especially helpful. In the case of rounding there was qualitative research used, concept analysis, and quantitative analysis. The Newman Systems Model of prevention as intervention seems to be the be theory to apply in this case (McEwen, 2007, pg231). Concepts in Neuman' s theory are important here. "Environment is composed of both internal and external forces surrounding