1. NURSES WARD ROUND AND NURSES WARD REPORT: An Effective Tool for Enhancing Quality Patient Care. BY: Nr. Almustapha Lawal Ahmad RN, RNE, BNSc. (Kebbi State College of Nursing Sciences, Birnin Kebbi) Presented @ The Conference Hall of General Hospital Yauri During the 5 th Nurses Week. On Tuesday, 22 nd Day of December 2020.

2. OUTLINE  Background  Definition  Types and stages  Nurses’ role on Ward Rounds  Nurses Report  Purpose and principles of report writing  Conclusion

3. Objectives At the end of this presentation, audience should be able to;  understand the concept of ward round and ward report  explain the types and stages of ward round  identify the purpose and principles of ward round

4. NURSES’ PLEDGE  I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully;  I will abstain from whatever is deleterious or mischievous and will not take or knowingly administer any harmful drug.  I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling.  With loyalty will I endeavor to cooperate with other workers and professionals on this work and devote myself to the welfare of those committed to my care.’’ MAY GOD HELP ME AMEN

5. Background  Ward rounds are a routine in hospitals around the world.  Nurses are the backbone of the medical community.  A nurse cares for the patient 24/7 and is required to create an informative history of injury and or care via the nursing reports.  Every nurse needs to know how to write a nursing report.  Doctors use nursing reports to follow the patient’s progress once treatment has been prescribed.  More than that, nurses need to learn how to write nursing reports that accurately reflect every action taken on the patient’s behalf.

6. Ward round Vs individual patient review  The traditional ward round, which took place perhaps once a week, is outdated.  Rounds now take place more frequently - sometimes twice a day - to reflect the pace of patient turnover.  It is important to distinguish between ward rounds and ad-hoc individual clinical reviews of individual patients: unlike clinical reviews, ward rounds should involve the multidisciplinary team, while individual clinical reviews which are additional to ward rounds take place when the specialist (perhaps a consultant or nurse specialist) needs to review specific investigations with the patient in question.

7. Definition of Ward Round  Ward rounds are visits paid by healthcare team members in the hospital to each of the patient in their care or in a particular ward  It is also defined as a tool for supervision, evaluation and teaching.  A ward round is an essential organizational process providing a link between patients’ admission to hospital and their discharge or transfer elsewhere.

8. Types of Ward Round  Health Care Team Round  Doctors round  Nurses round  Pharmacist round

9. There are three distinct stages to ward rounds, each of which has equal importance.  Antecedent Stage (Before)  Critical Attributes Stage (During )  Consequences Stage (After) Stages of Ward Round

10. Antecedent Stage (Before) Activities involve in this stage includes:  Establishing result of investigation  Preparing patient; in most cases this simply involves letting them know the round will be taking place.  Encourage patient to think of questions and prepare to ask questions that are important to them.  Prepare for any multidisciplinary perspectives of care to discuss during the round

11. Critical Attributes (During) This refers to the key activities, and perhaps type of structure, that is integral to a ward round:  Review of unstable or deteriorating patients  Decision making and documentation of care  Review of patients going home (pre- discharge);  Review of patients’ progress during their inpatient stay.

12. Consequences (After) Once the ward round is over, a number of activities will be necessary:  Team organization  Progression of task  Communication  Repetition of information to the patient  Motivation of the ward team

13. Nurses’ role on Ward Rounds  There should be no debate about whether or not nurses should be involved in ward rounds.  The only debate, perhaps, is how to reinvigorate the nurse’s role among what are often regarded as competing priorities such as drug administration, Pre-operative review and observations, particularly if these are due to take place at the same time as the ward round.  However, the presence and participation of registered nurses increases their commitment to patient-centered care.

14. Nurses role on ward round  The key role of nurses on ward round can be defined using acronym ACTION  A- ADVOCATES  C- CHAPERONE  T- TRANSITION  I-INFORMATIVE  O- ORGANIZER  N- NURSE CENTERED

15. Advocate  As members of the ward team attending the round, nurses need to know their patients. “Knowing” arises from taking a nursing handover and looking after a group of patients, so handovers and ward rounds are inextricably linked if nurses are to successfully represent those patients in their care (Jugessur, 2019). Being an advocate involves:  Adequately preparing for the ward round (safeguarding patients’ interests);  Empowering patients to ask questions on the ward round.

16. Chaperone As with any other examination or intervention, protecting patients’ dignity and privacy is a priority for nurses during ward rounds (Lambert, 2010). If this role is delegated to another team member, that person should be aware that chaperoning involves;  Preparing the patient for examination through communication and positioning;  Taking responsibility for dignity and privacy;  Minimizing any anxiety and potential embarrassment;  Respecting cultural wishes throughout the process.

17. Transition The continuity and safe transition of information between care settings depends on the nurses who participate in the ward round, making sure all relevant information is communicated (Hindmarsh & Lees, 2012). This may involve the following:  Noting any ongoing investigations and communicating these to the patient and likewise the team.  For patient transfers, documenting any incomplete investigations/actions on a handover checklist;  For patient discharges, documenting any relevant information on the discharge checklist. The aim is to promote transparency and continuity, and to reduce potential duplication or omissions of care during transitions.

18. Informative Nurses also play a crucial role in ensuring patients have realistic expectations of ward rounds, receive and understand all the relevant information about their care. Where possible, patients should be actively involved in making decisions about their care rather than being passive recipients. In order to execute this process, nurses should:  Reiterate information during or after a ward round;  Prepare the patient for the next steps in the care pathway;  Explain anything (along the way) that the patient may not understand;  Encourage the patient to ask questions or express concerns;

19. Organizer All team members will have their own jobs to complete during the ward round. Organizing the outputs emerging from ward rounds ensures nurses can assess information and communicate as needed to the family, depending on the complexities of patient care. The organization of activities can involve:  Delegating effectively to different team members;  Requesting specific items of equipment that are required;  Organizing care packages.

20. Nurse Centered  Nurses at the bedside during ward rounds must be clinically competent to understand and anticipate the complexities of multifaceted patient situations.  Having a nurse at the bedside during ward rounds is pivotal to enable and empower the team. Although there will be some variation according to how the ward is organized and how the nursing team works.

21. Nurses Ward Round

22. Types of Nurses Ward Round There are three types of nurses rounds during each shift:  Nurse Leader round on direct reports/staff.  Ward Nurse round on patients.  Introductory and hourly round (which can include bedside shift report),

23. The Introductory and hourly round  A round to introduce the incoming nurse by the outgoing nurse. The process allows the incoming nurse to take over from her colleague who is leaving and increases the patient’s confidence on the incoming nurse.  The outgoing nurse introduces the incoming nurse by highlighting the nurse’s strengths.  An example of this is: “Hello, Mr. Jones, I’m going home now, but I wanted to introduce Nrs Kelly, who will be taking care of you today. She has worked here for three years and is an excellent nurse, one of our best. She will take very good care of you today.”  A statement like this from the outgoing nurse sets up the incoming nurse as competent and lets patients feel they are in good hands.

24. NURSES REPORT

25. Concept  A proper nurses report is a compilation of details recorded by a patient’s nurse.  Report is written by nurses who are wrapping up their shifts and provided to those nurses beginning the next shift, these details should include a patient’s current medical status, along with his or her medical history, individual medication needs, allergies, a record of the patient’s pain levels and a pain management plan, as well as any discharge instructions.  Without these details, a nurse could potentially endanger a patient’s life.

26.  A nursing report is a document that nurses hand over to others at shift change to let them know the patient's conditions.  It can also be a report to explain something during a legal investigation. A report during the refer or transfer of a patient to another unit in a hospital is necessary because another team will take over the care.

27. PURPOSES OF WRITING REPORTS  To show the kind, quantity and quality of service rendered.  To show the progress in reaching goals.  As an aid in studying health conditions.  As an aid in planning.  For research purposes

28. Principles of an Effective Nursing Report  Nurses should develop their own method of expression and form in record writing.  Records should be written clearly, appropriately and legibly.  Records are valuable legal documents and so it should be handled carefully, and accounted for.  Record Everything  Review Orders  When in Doubt, Ask for Clarification  Records are confidential documents.  Reserve Time to Answer Questions

29. Formatting Nurses Report With all the necessary information to include, the task of writing ward report that’s clear and easy to read can be a challenge. Consider the following format to help you stay organized and communicate the right information in a concise and professional manner.

30. The PACE Format This format involves a straightforward organizational technique. PACE is an acronym standing for Patient, Actions, Changes and Evaluation, all of which serve as sections in the report.  Patient: List all of the patient’s personal information, including age, medical history details, current condition and latest symptoms.  Actions: Include a step-by-step account of nurses intervention.  Changes: Detail the patient’s ongoing needs and list all actions the incoming nurse should take during his or her shift.  Evaluation: Provide notes on the patient’s reaction to treatment, along with any other important observations you make during your shift.

31. From near and far we have gathered with one goal To uphold the good name of our PROFESSION  N – For Neatness and Splendor  U – For Understanding  R – For Responsiveness  S – For Selfless Service  I – Innovative and Initiative  N – For nobility  G – Gentleness and Love

32. Conclusion  Purposeful and timely ward round is a best practice intervention to routinely meet patient care needs and ensure patient safety.  Nurses knowledge regarding purposeful ward round is essential components for consistency in providing patient centered care.  Nurses have the ability to improve patient satisfaction and patient safety outcomes by utilizing nursing round interventions which serve to improve patient communication and staff responsiveness.

33.  Be objective when writing a nursing report. Be precise. Understand that doctors and lawyers are who will be looking at your reports to confirm or argue about care rendered.  You should not write a nursing report that has limited information and find that you will be answering questions you may not have the answer to or an explanation for when asked.  Incomplete or inaccurate nursing reports leave everyone at the facility vulnerable to legal proceedings long after the care was given. Conclusion

34. Thank You for Listening Contact @ 08038495597 elmustaphalawal@yahoo.com elmustaphalawal@gmail.com