Bishwajit Mazumder

Nursing Instructor
Dhaka Nursing College, Dhaka
E. mail: mbishwa@rocketmail.com

NURSING ROUNDS
After the class, the participants will be able to:
Describe brief teaching methods of the nursing rounds
Know the characteristics of nursing rounds
Describe how to construct the nursing rounds method
Describe the advantages and disadvantage of nursing rounds method
Introduction
The practice of nursing grand rounds is a teaching strategy that uses the
patients' bedside for direct, purposeful experiences. These experiences may involve
demonstrations, interview or discussion of patients problems and nursing care.
Rounds also afford an excellent opportunity for exchange of ideas about patient care
situations, which may involve clinical faculty, students, and staff. The use of rounds
as a teaching strategy requires planning. Planning includes obtaining permission from
patients and providing information about the nature of the rounds and the role the
patients will play. After the session, patient participation should be acknowledged and
some form of debriefing should occur, including planning for subsequent rounds
(Billings & Halstead, 2012). According to Phillip (2012) show that Nursing Grand
Rounds are one effective method of providing teaching and learning experiences for
professional nurses. Through Nursing Grand Rounds nurses collaborate and share
ideas about todays dynamic health care environment and topics relevant to clinical
nursing practice (Phillips, 2012). In clinical, the instructor introduced the client to the
student, and together they discuss the client's care. The instructor can also use this
time to appraise the students' observations, communication, and decision-making
skills (Daniels, 2004).

The characteristics of nursing grand round

Nursing grand rounds are a means of proving contact between the nurse
director and each individual in nursing service (Marquis & Huston, 1998). According
to Gaberson and Oermann (2010) show that Nursing grand rounds involve the
observation and often interview of a patient or several patients in the clinical setting, a
Webcast of grand rounds conducted elsewhere, or a multimedia program of the grand
rounds. (A webcast is a media presentation distributed over the Internet using
streaming media technology to distribute a single content source to many
simultaneous listeners/viewers. A webcast may either be distributed live or on
demand. Essentially, webcasting is broadcasting over the Internet). NGR provides
an opportunity to observe a patient with a specific condition, discuss assessment and
interpretation of data, and propose interventions and changes in the plan of care.
Nursing grand rounds may involve nursing students and staff member only or be
interdisciplinary. Rounds are valuable for examining issues facing patients, families,
and communities and for exposing students to situations they may not encounter in
their clinical experiences (Gaberson & Oermann, 2010).
Nursing grand rounds also can be used for staff education. The objective of
nursing rounds is to bring up-to-date information in monthly educational sessions to
nurses worldwide. Their grand rounds are available live in the classroom, via the
intranet ((Intranet is the generic term for a collection of private computer networks
within an organization. An intranet uses network technologies as a tool to facilitate
communication between people or work groups to improve the data sharing capability
and overall knowledge base of an organization's employee) and internet, by videotape,
and on public access television. They also can be done by independent study via the
intranet and Internet. Other settings use grand rounds for highlighting nurses' and
clinical expertise and promoting best practices (Iacono, 2008).
For grand rounds in the clinical setting, activities at the patient's bedside
should begin with an introduction of the patient to students, emphasizing the patient's
contribution to student learning. If possible, the person conducting the rounds should
include the patient and the family in the discussion, seeking their perspective of the
health problem and input in the care. The teacher's role is that of consultant, clarifying
information and assisting the student in keeping the discussion on the goals set for the

rounds. Students should direct any questions to the teacher prior to and after the grand
rounds, and sensitive issues should be discussed when the rounds are completed and
out of the patient's presence (Gaberson & Oermann, 2010).
Type of nursing rounds
Nursing rounds are a visiting into patients area involving the students'
learning experiences. Nursing rounds revealed that students responded to this method
of teaching with enthusiasm. Their interest in learning increased and they showed
ability to share ideas and knowledge with others for the benefit of patients.
Nursing rounds are given separate names according to the purpose they serve .
a) Information giving rounds : It is used to acquaint the staff with all patients
on the ward or division .
b) Instructional rounds : Here the nurse is expected to read the charts and
come to rounds with basic information in mind .
c) Problem solving rounds: This is to help the nursing staff learn to conduct
initial interviews make an assessment of patients needs and identify nursing care
problems .
Purposes of nursing rounds:
1. To demonstrate symptoms important in nursing care .
2. To compare the patients reaction to disease and study the disease
conditions.
3. To demonstrate the effects of drugs i.e. indication , actions and
reactions of drugs .
4. To illustrate the skillful nursing care.
5. To compare methods of meeting nursing needs and to have a better
understanding and to give more purposeful care to patients.
6. To illustrate successful improvisation and to give opportunity for the
use of different applications.
Planning nursing rounds in the mind:
1. To consult students previous clinical experience to avoid repetition and
to add to earlier experience.
2. Keep in mind the probable value and availability of clinical material .

3. If some demonstration is done , it should not have a deleterious effect

on the patient.
4. Explain the plan to the patient.
5. Introduce the patient to the group.
6. Make the patient feel important .
7. Have post conference for summary and further explanation .
8. Record the nursing rounds in the ward teaching records with a
summary of nursing points stressed.
Prepared by the head nurse:
1. Amount participants: a small group of staff or students preferably not
more than 4 or 5 and a leader or a teacher visit the bedside of patients.
2. The head nurse selects the patients beforehand according to the time
available. Rounds not lost longer than an hour ( 1:00).
3. The head nurse needs to read the patient histories, know the plan for
their treatment and its results the patients progress and prognosis, their nursing care
and its effectiveness.
4. The head nurse should post the time for rounds at least a week in
advance and indicate the type of preparation the nurse is to make, that in whether she
is to know thoroughly the history care and progress of her own patients or briefly that
of all patients in the ward.
5. The central figure in nursing round is the patient.
Method of Conducting Nursing Rounds:
1/ The hold a brief conference at the side of the patients room/ward
The necessary data are given. The purpose of the visit to the patient is by
the head nurse, special observation to be made or pointed out at this time.
2/ Selected for instruction include 4 to 5 patients.
3/ The head nurse may present some information by herself or she may
ask the students who are assigned to these patients to answer the questions of the
group or her questions.
4/ The students are asked to present the cases regarding other particulars.
The participants may also be involved such as counting pulse, respiration, examining
the conjunctive, pitting, edema etc.

5/ Thank patient before leaving and tidy up the bed.

6/ Post Conference
The presentation summarizes and further explanation if any, may be
given, questions are invited from the students.
Advantage
- Promote student learning about characteristics of common health problems, team
work
- Develop students' presentation skill
- Increases remember ability about disease information of patients such as sign,
symptom, and manifested in body of patient act.
- Increases the learning ability about critical, thinking of the individual students.
- Increases interest to share idea and knowledge with others
- Increase the relationship between nurses with clients, help patient comfort and feel
nature.
- Enable students to:
+ identify patient problems and issues in a clinical situation
+ Evaluate the effectiveness of nursing in interventions
+ Share clinical knowledge with peers and identify gaps in their own understanding
+ Develop new perspectives about the patient' care
+ Critical thinking about nursing care of their self and given by their peers
+ Dialogue about patient care and changes in clinical practice with peers and experts
participating in the rounds.
Disadvantage:
- Some time use long time, talk too much when assesses, intervention patient in clinic.
It can make patients uncomfortable.
- This method will not effectively if teacher, participant did not prepare knowledge
before visit patient.
Conclusion:
Nursing grand round is the effective teaching method in clinical. It can
develop learning ability student individual. Teachers can assess the students'
competence teachers provide knowledge and skill in learning process high
quality of care promotes public health. Nursing grand round provides a great

mentoring opportunity for clinical faculty, allowing development of their teaching

skills (Sherrill, 2012).
References:
Billings, M. N. & Halstead, A. J. (2012). Teaching in nursing: A guide for faculty. (4th
Ed) United States of America.
Barrette, J. (2004), Ward Management and Education, 14th edition, komark
publishers Pp:357- 368.
Daniels, R. (2004). Nursing Fundamentals: Caring and Clinical Decision-Making.
United States of America.
Gaberson, B. K., Oermann, H. M. (2010). Clinical Teaching Strategies in Nursing.
(3rd Ed). United States of America.
Iacono, M. (2008). Showcasing nursing talent: Nursing grand rounds. Journal of
Peoria-anesthesia nursing, 23, 349-354.
Marquis, B. L. & Huston, C. J. (1998). Management decision making for nurse. (3rd
Ed). Philadelphia, Lippincott Williams & Wilkins, New York.
Phillips, S. (2012). Nursing Grand Rounds-Nursing report . Retried from
http://www.bannerhealth.com/Locations/Arizona/Banner+Good+Samaritan+
Medical+Center/Health+Professionals/For+Nurses/Nursing+Grand+Rounds.
htm.
Neeraja, K. P. ( 2003 ) Text book of Nsg education Ist edition , by Jaypee brothers,
New Delhi , Pp No : 231-235 .
Sherrill, K. J. (2012). Using nursing grand rounds to enforce quality and safety
education for nurses competencies. Teaching and learning in nursing.