Journal of e-ISSN: 2582-1512

Medical Surgical Nursing Practice and Research Volume-3, Issue-2 (July-December, 2021)

www.matjournals.com https://doi.org/10.46610/JMSNPR.2021.v03i02.002

REVIEW ARTICLE

Structured Nursing Rounds (SNR) Training Module on the Level of Patient

Satisfaction

Sheela. J1*, Malarvizhi. S 2, Mony. K3

1
Assistant Professor, College of Nursing, PIMS Puducherry, Pondicherry University, Puducherry,
India
2
Professor & HOD, Department of Medical-Surgical Nursing, College of Nursing, PIMS Puducherry,
Puducherry, India
3
Principal & Professor, Child Health Nursing, College of Nursing, PIMS Puducherry,
Pondicherry University, Puducherry, India

*Corresponding Author: scardidos@gmail.com

ABSTRACT than the advancements in treatment, or as

Structured Nursing rounds (SNR) are one
of the quality indicators for the inpatients
admitted in the Medical-Surgical care
settings. Conducting systematic nursing
care rounds is complementary to individual
holistic nursing practice. It is one way of
ensuring the highest standards in nursing
care. We can also fruitfully reap its benefits.
It improves patient satisfaction in the
delivery of the quality of care.
Keywords-- clinical bedside rounds, Patient
satisfaction, structured Nursing rounds (SNR),
quality of nursing care, Regular Nursing
rounds
INTRODUCTION
Person-centered, safe, and effective
care is at the heart of the fundamentals of care.
However, the reliable and consistent
realization of such care involves serious
challenges. Today, the sight of nurses making
regular ward rounds to check on patient care is
not common. Advanced modern medical and
information technology has reduced patients to
bed numbers and computerized data, while
monitors replace their access. All these
changes curtail the much longed-for physical
presence of the nurses to their patients. More
much as these, patients value a humane
presence, healing smile, compassionate touch,
and the chance to relate with their caregivers.
The researcher is convinced that it is overdue
that we introduce an effective structure to our
nursing practice. The new initiative in nursing
called ‘Structured Nursing Care Rounds'
(SNR) has been introduced and successfully
implemented in many countries.
Structured Nursing Care Rounds- SNCR;
what is it?
SNCR is:
 A structured process where frontline staff
regularly round on patients and reliably
perform scheduled/required tasks.
 A systemized, proactive approach to
patient care. Using this approach, nursing
staff check on each patient at least once
every hour, asking specific questions and
assessing the care environment.
What is new about SNCR?
Nurses have always assessed their
patients regularly. But what is new about the
SNCR is that it is evidence-based, predictable,
need-driven, and scripted for consistency.

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 Journal of
Medical Surgical Nursing Practice and Research
www.matjournals.com
Facts on SNCR
Each study sought to measure the
influence of hourly and bi-hourly nursing
rounds on a few or more of the following
selected outcomes:
 Proactively addressing the patient needs
 Patient-centered care
 Decreased risks for pressure ulcers and
patient falls
 Improved patient perception of care
 Significant improvement in patient
satisfaction scores.
 Less burnout and fatigue for nurses
 Improved nursing care quality
 Provided nurses with additional time for
bedside care.
Aim/Goal of SNR
The goal of the nursing care rounds is
for nursing personnel to spend meaningful
time with each patient in a controlled
environment, conveying an attentive caring
presence, addressing complaints and priorities
on time, checking on the occurrence of
avoidable adverse events like patient falls,
pressure sores, phlebitis, and intravenous
infiltration.
Purposes of SNR
The SNCR establishes structured and
scheduled patient rounds by the nursing care
team as a standard of practice within inpatient
facilities:
 To maintain a systematic review of the
patient’s nursing needs
 To offer a caring presence to all the
patients in an efficient and timely manner
 To decrease the episodes of preventable
incidents among hospitalized patients
 To improve patient satisfaction on
nursing care quality
 To enhance patient experiences of the
overall hospital services
7 Page 6-10 © MAT Journals 2021. All Rights Reserved
e-ISSN: 2582-1512
Volume-3, Issue-2 (July-December, 2021)
https://doi.org/10.46610/JMSNPR.2021.v03i02.002
Principles of SNR
 Individual holistic nursing care
 Patient satisfaction
 Structure and schedule
 Nursing care team engagement
 Nursing care team education
 RN empowerment
 Regular feedback
 Documentation
Expected outcome of SNR
 Decrease/no preventable incidents among
patients during their hospital stay
 Increase in RN satisfaction with the
practice environment
 Increase in Patient satisfaction with
nursing care provided
 Increase in patient satisfaction with
overall experiences of hospital services
Why SNR? Benefits for patients and family
1. Provides a quality assurance framework
for care
2. Preparing staff for the shift/day.
3. Face-to-face communication.
4. Immediate response to needs
5. Timely response to issues or concerns.
6. patient anxiety
7. Build patient’s trust
8. Efficient dissemination of information.
9. Increases patient satisfaction
How are Structured Nursing Rounds
performed?
A closer look at the 9 ‘P’s
A specific set of actions are addressed
during each rounding session. These actions,
generally clustered into nine areas, are
designed to meet patient needs and foster a
relationship with each patient. These 9Ps are
incorporated into the daily routines of the
units.
Journal of e-ISSN: 2582-1512
Medical Surgical Nursing Practice and Research Volume-3, Issue-2 (July-December, 2021)

www.matjournals.com https://doi.org/10.46610/JMSNPR.2021.v03i02.002

Table 1: Standard Operating procedure SNR

Keys Process Guidelines

When To Do SNR? The hourly round is reduced to bi-hourly visits at

Every hour when the patient is awake: night to facilitate sleep/rest for the patient. If the
Nursing care rounds being performed on the patient is sleeping, continue to observe and perform
Schedule

nursing care team once every hour between detailed rounds when s/he wakes up and/or is
the hours of 08.00 am and 9.00 pm. every aroused for patient care activities.
patient by any member of the care team. Nursing care should be clustered to facilitate
Every two hours at night: Nursing care patient’s sleep.
rounds will be done between 10.00 p.m. Patient rounds may need to be increased depending
and 7.00 a.m. on the condition of the patient.
A closer look at the 9 ‘P’s
Structured and standard patient rounds will be
patient-focused and will address the 9Ps:
 Person
 Plan
 Perform tasks The 9Ps and other patient needs should be
 Pain addressed at this time as well.
 Position
 Proximity
 Phlebitis
 Presence
 Patient education
Person: Knock on the door and The nurse finishing her/his shift will introduce the
address the patient by name. nurses who are starting to care for the patients.
Plan: Plan 9Ps around hourly visits to Keep the patient better informed about their plan
patients’ bedside. of care, medications, tests, and progress.
Perform scheduled tasks: Perform and Complete nursing care as needed: medications,
9Ps

explain scheduled tasks, treatments, care,
and medicinal uses.
Pain: “How is your pain? The nurse will
assess the patient’s level of pain. Ask
patients to describe their pain level on a
scale of zero to 10.
vital signs, wound dressings, check tubings,
intake, and output, back care, bed bath, etc.
After identifying patient pain intensity, the nurse
offers appropriate measures as needed, including
position changes, deep breathing exercises, diversion
activities and

The rounding nurse or nursing assistant checks

risks for fall, risks for skin break down are
Position: identified when the patient is turned, provides
skincare, massage bony prominences, fluffs and
“Are you comfortable?” or “How can I help rearranges pillows, and straightens linens.
you more comfortable?” Turning schedules are observed, with all patients
who cannot turn independently assisted with
“Would you like help with changing your repositioning at least every 2 hours and moves
position”? patients up in bed. This includes keeping heels up to
help reduce heel pressure.

When nursing personnel rounds on patients every

hour, assist with basic needs such as toileting,
hygienic needs, remains with the patient who
Proximity
requires assistance in eating and drinking, and
places the personal items within the reach of
patients.

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 Journal of e-ISSN: 2582-1512
Medical Surgical Nursing Practice and Research Volume-3, Issue-2 (July-December, 2021)

www.matjournals.com https://doi.org/10.46610/JMSNPR.2021.v03i02.002

Check IV Catheter sites-peripheral & central for

signs of phlebitis
Risk assessment & Post-intervention care
 IV fluid check
Phlebitis:
 IV site check for filtration
 drops/mt,
 s/s of phlebitis
Visual Infusion Phlebitis Scale (VIP Scale)
Communicate when you’ll return Close with
Presence: Let the patient know you are
keywords, "Is there anything else I can do for you
available and have time
while I’m here? I will be back in one hour”.
Patient education: Tips for self-care as per the condition of the patient.
Documentation

The document, any findings or care provided, in the

Document the rounds any findings or care patient's health record (E.g. nurses' progress note,
provided medication administration record, 24-hour flow
sheet)

CONCLUSION 2. Joseph, L., & Samson, R. (2016). Effect

of Structured Nursing Care Rounds
Structured Nursing Rounds is a (SNCR) on satisfaction with nursing care
process in which every hour, a nursing person and job satisfaction involving adult
(a nurse, nursing assistant, or a nursing medical surgical patients and nursing
student) enters a patient's room/bedside to personnel in a tertiary care hospital,
assess his/her needs. It is all about the nurse Kerala. International Journal of Nursing
being able to spend more time at the bedside Care, 32
of the patient. Measuring patient outcome data 3. Hignett, S., Hignett, S., Crumpton, E., &
such as falls, pressure ulcers, phlebitis, pain, Ruszala, S. (2002). Evidence-based
patient satisfaction, staff satisfaction with the patient handling: tasks, equipment, and
practice environment, nurses' perception, and interventions. Psychology Press.
use of SNR determine whether the hourly 4. Horn, S. D., Buerhaus, P., Bergstrom, N.,
rounds are successful and beneficial. The staff & Smout, R. J. (2005). RN staffing time
spending more quality time at the bedside of and outcomes of long-stay nursing home
their patients also promotes safety practices residents: pressure ulcers and other
and documentation adverse outcomes are less likely as RNs
spend more time on direct patient
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Medical Surgical Nursing Practice and Research Volume-3, Issue-2 (July-December, 2021)

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