Increasing patient satisfaction is becoming crucial for health facilities looking to increase revenue. One way of improving patient satisfaction is by ensuring patient safety and high-quality care to patients as a way of maintaining a healthy environment. A health facility can achieve high patient satisfaction by changing the organizational culture and adopting a more patient-centered approach that focuses on meeting the needs of patients ( Wright et al., 2018) . An area that requires a patient-centered approach is the obstetric unit as it deals with delicate cases of labor and surgery. Implementing a rounding policy in the group can help improve patient safety and experience in the obstetric unit while improving patient satisfaction.
Background of proposal
There are risks of unintended harmful events in the obstetric unit such as pressure ulcers or hospital-acquired infections which can affect the recovery of patients as well as the quality of life. These complications may be caused by a lack of hourly rounding and the ineffectiveness of physicians to provide an appropriate response to patient requests. Adopting hourly rounding in obstetric units can increase patient safety and experiences within the facility by creating harm-free care ( Wright et al., 2018) . This is a preventive strategy that can be initiated in obstetric units to reduce the number of complications that may arise, where physicians check on patients regularly to meet their needs. As such, it is a proactive approach to increase patient safety and satisfaction.
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PICOT statement
Developing a PICOT statement is one way of evidence-based practice that can help clinical practice. The PICOT format is used to formulate clinical questions supported by evidence-based practice literature that can help find evidence to incorporate into practice and effect appropriate clinical change. The PICOT question for this evidence-based project is: In an obstetric unit with in-patient care (P), does establish an hourly rounding schedule between the patient and the nurse (I) compared to no rounding program (C ) increase patient safety and experience (O) over a labor period (T)?
Healthcare organizations have been facing pressure to increase the quality of care provision and reduce costs. Patient satisfaction is one metric of quality care provision which can be achieved through hourly rounding in the obstetric unit. The method for developing and implementing this initiative is the evidence-based practice improvement model that delineates steps for identifying a problem and implementing the solution. The clinical practice problems addressed by this clinical question are patient safety and experience that defines their satisfaction in the health facility ( Wright et al., 2018) . The goal of the project is to enhance patient outcome in the obstetric unit and the overall healthcare experience for the patients, with evidence from literature studies supporting the use of hourly rounding in obstetric units to prevent errors and improve patient outcomes.
Hourly rounding is a structured process that involves nurses carrying regular checks with individual patients using a standardized protocol to address issues of personal needs, positioning, and placement of items (Brosey & March, 2015). It is a process that involves the performance of regular checks on all patients following a standardized protocol. This proposal aims his proposal aims to improve patient safety and experience within the obstetric unit by changing bedside nurse behavior. Establishing an hourly rounding schedule can help physicians in the obstetric unit to address the basic needs of patients and improve their safety and experience. Currently, the obstetric group is not meeting its strategic goals for patient satisfaction and is open to utilizing evidence-based interventions to improvements in patient care. Rounding program is therefore needed to increase patient safety and experience expressed in the form of satisfaction scores. A such, the purpose of the project is to improve HCAHPS score on patient satisfaction ( Wright et al., 2018) .
The chief nurse executive is responsible for the overall patient care including quality and patient outcomes, and will, therefore, take precedence in implementing the program. Other stakeholders include patients, staff nurses, direct, and patient families. Implementing the rounding program is to ensure that each stakeholder benefits from the outcomes such as patient safety, reduced readmissions and more patient satisfaction ( Lobatch, 2017) . The population of interest in this initiative is in-patients in the obstetric unit with hospital stays of more than three days over 18 years of age. It comprises of both male and female patients with a functional level of consciousness and thus can make medical decisions as determined by medical assessments. The use of hourly rounding entails applications of both primary care and team nursing models where physicians work together in shifts to facilitate the care program. The nurses work in shifts using a bedside report model.
At the same time, this project has to consider several ethical and legal factors that might affect its implementation. Ethical issues involved in this clinical practice include confidentiality and informed consent from patients, as well as respecting core principles of autonomy, beneficence, justice, and non-maleficence. Non-maleficence entails not performing a treatment that will result in net harm to the patient while beneficence is when treatment is provided with the intent to help the patient in the best way possible, which may include developing and maintaining clinical skills and knowledge to provide care (Brosey & March, 2015). The principle of beneficence that entails doing good rather than harm guides this project where hourly rounding will help identify concerns that patients have regarding care provision.
Autonomy is when decisions are made based on the values of patients without coercion. According to the social policy statement of ANA, the interaction between nurses and patients involves the participation of both in the process of care provision. Some patients may consider not to call on physicians when experiencing problems, which may leave nurses in a dilemma since they have to advocate for the wellbeing of patients but are affected by their demands ( Lobatch, 2017) . Providing the hourly rounding program can also help in establishing patient-physician relationship in the obstetric unit which can influence the overall perception of satisfaction. While patients are capable of making their independent decisions for healthcare, their choices are affected by the relationship they have with the physician.
Patient preferences include personal values and what women care in the context of their families. Culture can influence patient choices of medical care delivery and can determine the effectiveness of hourly rounding program. In this regard, nurse administration has to incorporate the patient’s dynamic personality and background attributes and how they can relate to the nurse-patient relationship. Obstetricians must become comfortable addressing the ethical issues involved in clinical obstetrics, which entails understanding the elements of clinical medical ethics ( Wright et al., 2018) .
The nurse administration can implement the hourly rounding program by setting meaningful and achievable goals than educating physicians on how to execute the plan. The success of this project depends on the participation of and physicians and nursing staff who needs the skills and expertise. As such, nursing administration needs to provide the necessary training for the nursing staff regarding how to carry out the rounding program with clear and consistent communication.
A transformational management style can help in implementing this project. This style entails encouraging employees into adopting the change proposal through motivation, innovative thinking, and individualized consideration ( Lobatch, 2017) . Nurse leaders need to understand how adverse events during childbirth can contribute to patient dissatisfaction and those which increase the risk for postpartum depression. They also need to understand the importance of hourly rounding for patients to enhance care provision. Improving patient satisfaction is linked to decreased rates of readmission and therefore more revenue for the health facilities
Conclusion
The process of conducting rounding as a timed and planned intervention by physicians in the obstetric unit can help address specific elements of nursing care for the patient. Implementing hourly rounding programs can help deal with the crisis in maternal care including an escalating cesarean rate and increase in maternal morbidity and mortality (Brosey & March, 2015). This project focused on understanding whether hourly rounding in the obstetric unit can improve patient safety and increase their satisfaction compared to purposeful rounding. Literature studies have shown that hourly rounding in the obstetric unit can help improve patient safety as well as satisfaction by reducing the number of injuries and infections in patients. The plan can assist physicians in the obstetric unit to organize their workload and be in a better position to provide systematic and reliable care to patients.
References
Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159.
Lobatch, E. (2017). Impact of Hourly Rounds on Obstetric Patients' Perception of Care.
Wright, A., Suderman, M., Moyer, D., Grimm, K., & Morin, K. H. (2018). Perspectives of Nurses, Nurse Leaders, and Women Regarding Anticipatory Rounds in the Postpartum Period. Journal of Obstetric, Gynecologic & Neonatal Nursing , 47 (4), 479-489.
