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This study aimed to identify factors associated with nurses’ perceptions of patient rounding.
Methods
A descriptive cross-sectional online survey was conducted. A total of 147 nurses working in general hospital wards were recruited online. The survey assessed general characteristics, including demographic, work-related, and patient rounding-related characteristics; patient rounding educational needs; and organizational factors, including nursing workload and nursing work intensity. Factors associated with nurses’ perceptions of patient rounding were analyzed using multiple regression analysis.
Results
Nurses’ perceptions of patient rounding were positively associated with patient rounding educational needs (β=.38, p < .001), total clinical career (β=.16, p=.022), performance of rounding at recommended times (β=.15, p=.028), and the number of Level I patients assigned during the current shift (β=.14, p=.038). In contrast, relative work intensity (β=-.15, p=.043) and absolute work intensity (β=-.16, p=.036) were negatively associated with nurses’ perceptions of patient rounding.
Conclusion
Nurses’ perceptions of patient rounding were associated with both individual and organizational factors. These findings support the need for structured rounding education and organizational strategies that account for nurses’ workload, work intensity, and patient acuity to facilitate patient rounding in clinical practice.
Recently, with the ongoing economic growth and successive viral outbreaks, there has been an increasing focus on public health and awareness of its importance, leading to rising expectations for healthcare services [1]. Among these, the nursing department holds the largest share of manpower within hospital organizations and plays an essential role in the delivery of healthcare services. Since nursing personnel are involved in every aspect of patient care and directly interact with patients, efforts to enhance the quality of nursing services are imperative, as they are directly linked to the hospital’s productivity and promotion of patient safety [2]. In particular, the coronavirus disease 2019 (COVID-19) pandemic has brought about changes in nursing environments and services, such as stricter infection control, increased workload, and limited caregiver access, which may have affected how patient rounding is perceived and practiced [3].
Among nursing services, patient rounding is an intervention aimed at enhancing patient safety and meeting the fundamental care needs of hospitalized patients by identifying their underlying care requirements [4]. This is conducted through regular bedside visits at set intervals to assess patients’ basic care needs and overall conditions, thereby promoting their well-being [5]. Previous research has shown that hospitals that implement patient rounding protocols experience improved patient outcomes and increased satisfaction levels among both patients and staff [6]. However, sustaining these improvements is challenging, primarily because of a lack of awareness regarding the necessity of patient rounding, insufficient education on patient rounding, and the burden of nursing work [7,8]. Therefore, to efficiently implement patient rounding, it is essential to provide relevant education to enhance nurses’ understanding and compliance and develop patient rounding protocols and task checklists for patient care.
Previous research has primarily focused on assessing patient outcomes and satisfaction following the implementation of patient rounding [1]. Although these studies have identified positive results in terms of patient satisfaction and clinical conditions, comprehensive research that considers diverse factors influencing the implementation of rounding remains limited [9]. In particular, there is a dearth of studies examining nurses’ perceptions of patient rounding from multiple perspectives, including both individual and organizational factors. From an organizational perspective, nursing workload and nursing work intensity are representative factors that may affect whether nurses can perform rounding as intended. From an individual perspective, factors such as nurses’ educational needs regarding patient rounding and their perceived competency and attitudes toward rounding may also influence their intention and ability to implement it consistently; however, these aspects have received relatively little attention.
Among organizational factors, nursing workload and work intensity were representative. Nursing workload refers to the total number of nursing activities, including direct patient care, indirect nursing activities, and personal tasks performed by a nurse during a specific period [10]. Higher nursing workload affects the recognition and performance of patient rounding [11]. Ko and Park [12] perceived patient rounding not as a preventive process for patient care but as an additional task, creating a sense of pressure and burden among nurses. Consequently, nurses reported experiencing difficulties in prioritizing patient rounding over other tasks, leading to challenges in implementation [9,13].
Nursing work intensity indicates direct nursing activities included in nurses’ efforts, judgement, and time [12,14]. It was observed that a higher nursing work intensity was associated with a lower perception of patient rounding [6]. This was primarily attributed to the severity of patient conditions and shortage of nursing staff, leading to the allocation of more time to severely ill patients, and consequently, fewer patient rounding for those with relatively lower severity [15]. Consequently, decreased perception of patient rounding has led to lower implementation rates [16]. It was reported that 29.8% of study participants felt that the time to complete their tasks during working hours was insufficient [13]. Additionally, the shortage of nursing staff has been linked to patient rounding [17]. This discrepancy between the number of patients for which nurses are responsible and available nursing staff has been identified as a contributing factor [11].
Nurses’ perceptions of patient rounding are related to their beliefs, values, and attitudes toward the practice, and a higher level of perception and positive attitude toward patient rounding can lead to increased engagement in rounding [18]. When nurses maintain a positive and proactive attitude toward patient rounding and take ownership of the process, they can reduce obstacles to patient rounding [11]. This can result in increased trust in the nurse–patient relationship, reduced fall rates, decreased pressure ulcer incidence, prevention of infections related to medical equipment and catheters, and other positive outcomes [19]. Therefore, it is essential to identify both organizational and individual factors that can positively influence nurses’ perceptions of patient rounding, including their educational needs related to rounding, in order to promote its effective and sustainable implementation.
This study aimed to investigate and identify the factors associated with nurses’ perceptions of patient rounding. These factors included general characteristics, such as demographic characteristics, work-related characteristics, and patient rounding-related characteristics, and patient rounding educational needs and organizational factors, such as nursing workload and nursing work intensity. This study provides foundational data to activate and enhance patient rounding by understanding the factors associated with nurses’ perception of patient rounding.
METHODS
1. Study Design
This descriptive survey aimed to explore factors associated with nurses’ perceptions of patient rounding in clinical settings.
2. Study Setting and Participants
The participants were nurses working in a general hospital ward who voluntarily agreed to participate in the study. The G*Power 3.1.9.7 program (Heinrich-Heine-Universität Düsseldorf) was utilized to determine the required sample size [20,21]. Based on a significance level of .05, a medium effect size of .15 [22] for multiple regression analysis, a power of .80, and 15 predictor variables (13 general characteristics and 3 independent variables), the minimum required sample size was calculated to be 139. Considering a dropout rate of 10%, the target number of participants was set at 150. Recruitment was conducted online via voluntary participation, resulting in 150 participants. Of these, data from 147 participants were used in the final analysis, excluding three cases with identical IP addresses.
1) Inclusion/exclusion criteria
The inclusion criteria specified that participants must be staff nurses working in general wards who had at least 6 months of clinical experience, including participation in patient rounding. The minimum clinical experience was set at 6 months because, during the 3- to 5-month probationary period, nurses do not directly provide patient care [23]. Nurses working in intensive care units and emergency departments were excluded because their care environments and rounding practices differ substantially from those of general wards [24,25]. In addition, nursing managers (e.g., head nurses, team leaders, administrators) were also excluded because their primary responsibilities focus on administrative and leadership tasks [26] rather than direct patient care, and they generally do not participate in routine bedside rounding.
3. Measurements
1) General characteristics
The general characteristics of the participants were assessed using 13 items, including three items for demographic factors (gender, age, and educational level), five items for work-related characteristics (total clinical career, ward experience, job position, working department, and number of patients assigned per nurse by acuity category during the current shift), and five items for patient rounding-related characteristics (recommended rounds time, round count per duty, rounds protocol, patient rounds intention, and performance at recommended times). In addition, the number of patients assigned per nurse by acuity category was assessed based on the hospital’s internal patient classification system. Participants were asked to report the total number of patients they were responsible for during the current shift and the number of level I (low-acuity), level II (moderate-acuity), and level III (high-acuity) patients. Level I patients were those requiring relatively low-intensity nursing care and minimal monitoring; level II patients required moderate levels of nursing care and periodic monitoring; and level III patients were those with high acuity who required intensive nursing care, continuous monitoring, and frequent nursing interventions. The values presented in Table 1 represent the mean and standard deviation of participants’ responses.
2) Nursing workload
Nursing workload was operationalized using the demands at work domain of the Korean version of the Copenhagen Psychosocial Questionnaire II (COPSOQ-K) [27], which is an adaptation of the Copenhagen Psychosocial Questionnaire developed by Bjorner and Pejtersen [28]. The demands at work domain of the COPSOQ-K assess three subscales: quantitative demands (four items), work pace (three items), and emotional demands (four items). Responses to the COPSOQ-K items are collected using a 5-point Likert scale (“always,” “often,” “sometimes,” “seldom,” “never/almost never”), with each item scored as 0, 25, 50, 75, or 100 points; scores are reverse-coded for positively worded items [27]. Higher mean scores indicate that nurses perceive greater nursing workload, meaning that they experience the demands at work (quantitative demands, work pace, and emotional demands) more frequently and at a higher level. In the original COPSOQ-II, Cronbach’s α values for the demands at work domain ranged from .82 to .87 [28], whereas in the COPSOQ-K they ranged from .71 to .80 [27]. In this study, Cronbach’s α values for the demands at work subscales of the COPSOQ-K ranged from .75 to .85.
3) Nursing work intensity
The work intensity questionnaire was adapted from the tool developed by Kim [15] based on Kang et al. [29]. This tool was further customized for nurses considering the specific requirements of the nursing profession [15]. The questionnaire is divided into sub-factors, including absolute work intensity (six items), relative work intensity (six items), and flexibility (six items) [15]. Of these, five items are reverse-coded. Each item is rated on a 5-point Likert scale, with responses ranging from “Not at all” (1 point) to “Very much” (5 points). The total score ranges from 18 to 90, with higher scores indicating higher work intensity. The overall reliability of the work intensity tool was measured with a Cronbach’s α of .75 [15]. The Cronbach’s α values for the sub-factors were as follows: absolute work intensity α=.83, relative work intensity α=.64, and flexibility α=.36. In the current study, the overall reliability of the work intensity tool was Cronbach’s α=.74, with sub-factor reliability of absolute work intensity α=.73, relative work intensity α=.86, and flexibility α=.78.
4) Patient rounding educational needs
Patient rounding educational needs were assessed using a 13-item questionnaire developed by the researcher based on the standardized operating guidelines for comprehensive nursing care service wards [30]. Each item asked how necessary the respondent perceived education on a given aspect of patient rounding, and responses were rated on a 5-point Likert scale (1=not at all necessary, 5=very necessary). Higher scores indicate greater educational needs regarding patient rounding. In this study, prior experience of education related to patient rounding (yes/no), educational content, and educational methods were assessed separately as general characteristics of participants and were not included in the calculation of the educational needs scores. The scale demonstrated high internal consistency in this study (Cronbach’s α=.91).
5) Nurses' perception of patient rounding
Nurses’ perceptions of patient rounding were assessed using the Nurses’ Perceptions of Patient Rounding Scale, originally developed by Neville et al. [18] and adapted into Korean [5]. Permission to use the tool was obtained from the authors. The sub-factors of nurses’ perceptions of patient rounding included Communication (15 items), Nurse Benefits (eight items), and Patient Benefits (nine items) [5]. In addition, eight items related to cultural and ethical confidentiality were not part of any sub-factor. The questionnaire comprised 40 items. Responses are collected using a 5-point Likert scale ranging from “not at all” (1 point) to “very much” (5 points). Higher scores indicate a more positive perception of patient rounding. In a previous study, Cronbach’s α value was .86 [5], and Cronbach’s α was .82 in this study.
4. Data Collection
Data for this study were collected from November 1, 2020, to February 28, 2021. The study used an online survey through Google Forms, and recruitment for the research was conducted by presenting recruitment documents on nursing communities, social media platforms, and social networking sites. Nurses who voluntarily chose to participate were the target audience. Prospective participants were able to access the recruitment documents and follow a link to the study’s participation explanation and consent guidelines. After reviewing the material, the individuals who agreed to participate completed the survey. To prevent duplicate responses, only one survey was submitted per IP address, and participants were required to respond to all survey questions. To avoid multiple responses to a single item, the settings were adjusted to allow only one response per item.
5. Data Analysis
The collected data were analyzed using IBM SPSS version 23.0 (IBM Corp.), and the general characteristics of the participants were analyzed using frequencies, percentages, means, and standard deviations. The degree of nursing workload, nursing work intensity, demand for patient rounding education, and perceptions of patient rounding were analyzed using descriptive statistics. Differences in nurses’ perceptions of patient rounding based on participant characteristics were assessed using independent t-tests and one-way analysis of variance. The relationships among participants’ characteristics, nursing workload, nursing work intensity, nurses’ patient rounding educational needs, and nurses’ perceptions of patient rounding were examined using Pearson’s correlation coefficients. Multiple regression analysis was employed to analyze the factors influencing the participants’ perceptions of patient rounding.
6. Ethical Considerations
This study was conducted after receiving approval from the Institutional Review Board of Gachon University (No. 1044396-202009-HR-172-01, October 5, 2020; 1044396-202009-HR-172-02, January 7, 2022). While a waiver for written consent was granted, research participation explanations and consent information were provided on the online survey platform. Participants were allowed to participate voluntarily in the online survey if they agreed to the study terms. The research explanation and online consent information specified for the study’s purpose, details on completing the survey, voluntary participation, precautions, and an assurance that the collected data would be used only for research purposes. It was also clarified that the participants could discontinue the survey at any time without facing any disadvantages.
RESULTS
1. General Characteristics of the Participants
The study included a total of 147 nurses. The majority were female (n=146, 99.3%), and the mean age was 28.3±3.8 years. The participants had an average total clinical career of 4.67±3.78 years and an average ward experience of 2.70±2.23 years. Regarding education, 79.6% (n=117) held a bachelor’s degree, followed by diploma holders (10.2%) and those with a master’s degree or higher (10.2%). Most participants were staff nurses (91.2%), while 8.8% were charge nurses. The distribution of departments was 40.1% in medical wards, 29.3% in surgical wards, and 30.6% in integrated medical-surgical wards. Regarding rounding-related characteristics, the mean patients per nurse was 11.76±4.08. Specifically, the mean patients by acuity category were 5.41±3.70 for level I (low acuity), 3.53±2.18 for level II (moderate acuity), and 2.80±2.86 for level III (high acuity). The recommended rounds time was 2.13±1.02 hours. Additionally, 72.8% of nurses had the intention to perform patient rounds, and 63.3% performed rounds at the recommended times (Table 1).
2. Degree of Research Variables
The mean score for nursing workload was 56.73±11.88 (range, 37.73–100). Among its sub-dimensions, work pace was the highest (59.65±12.65), while emotional demands were the lowest (51.40±13.29). The mean score for nursing work intensity was 65.64±7.22 (range, 47–85), with absolute work intensity at 20.51±3.63 and relative work intensity at 22.77±2.60. Nurses reported a high level of patient rounding educational needs, with a mean score of 4.02±0.58 (range, 1–5). The overall mean score for nurses’ perceptions of patient rounding was 3.77±0.32 (range, 2.83–4.95). Among the sub-domains of perception, cultural and ethical confidentiality scored the highest (3.83±0.48), whereas nurse benefits scored the lowest (3.40±0.51) (Table 2).
3. Nurses’ Perceptions of Patient Rounding by Participant Characteristics: Group Differences and Correlations
In the analysis of correlations between participant characteristics and perceptions of patient rounding, age (r=.18, p=.030) and total clinical career (r=.18, p=.033) showed significant positive correlations. Additionally, the number of low-acuity (level I) patients per nurse (r=.17, p=.046) and the recommended rounds time (r=.17, p=.046) were positively correlated with perception scores. Regarding group differences, nurses who had the intention to perform patient rounds showed significantly higher perception scores compared to those who did not (t=2.07, p=.040). Similarly, nurses who performed rounds at the recommended times demonstrated significantly higher perception scores than those who did not (t=2.04, p=.042). No significant differences were found based on educational level, job position, department, or the rounds protocol (Table 1).
4. Correlations among the Study Variables
Pearson’s correlation analysis revealed significant associations between the key study variables. Nurses’ perceptions of patient rounding showed the strongest positive correlation with patient rounding educational needs (r=.49, p<.001). Conversely, perceptions of rounding were significantly negatively correlated with nursing work intensity (r=-.28, p<.001), absolute work intensity (r=-.27, p<.001), and relative work intensity (r=-.26, p<.001). However, nursing workload and its sub-dimensions (quantitative demands, emotional demands, work pace) did not show statistically significant correlations with nurses’ perceptions of patient rounding (Table 3).
5. Factors Influencing the Nurses’ Perceptions of Patient Rounding
A multiple regression analysis was conducted to identify the factors influencing participants’ perceptions of patient rounding. The independent variables included total clinical career, the number of patients per nurse (level I), performance at recommended times, absolute work intensity, relative work intensity, and patient rounding educational needs, while the perception of patient rounding was set as the dependent variable. The variable regarding performance at recommended times was treated as a dummy variable. The regression model was statistically significant (F=13.75, p<.001) and explained 34.0% of the variance in the dependent variable. In verifying the assumptions for the regression analysis, the Durbin-Watson statistic was 2.08. Although this value slightly exceeds the reference value of 2, it is not close to 1 or 4, indicating no autocorrelation among the residuals. The tolerance values for the variables ranged from .79 to .98, all exceeding 0.1, and the variance inflation factor values ranged from 1.01 to 1.26, remaining well below 10. Thus, it was confirmed that there were no multicollinearity issues. The analysis revealed that patient rounding educational needs (β=.38, p<.001), total clinical career (β=.16, p=.022), performance at recommended times (yes) (β=.15, p=.028), patients per nurse (level I) (β=.14, p=.038), relative work intensity (β=-.15, p=.043), and absolute work intensity (β=-.16, p=.036) significantly influenced the perception of patient rounding (Table 4).
DISCUSSION
This study aimed to determine factors associated with nurses’ perceptions of patient rounding. We found that nurses with more clinical experience, those who performed patient rounding at the recommended intervals, those caring for more level I patients, those with lower absolute and relative work intensity, and those with a higher educational need for patient rounding tended to have more favorable perceptions of the benefits and importance of patient rounding.
Among the general characteristics, total clinical career and the number of level I patients per nurse were associated with nurses’ perception of patient rounding. Nurses with shorter clinical experience may have less confidence in integrating patient rounding into routine practice [9,13], and nurses caring for more level I patients may have relatively more opportunities to conduct patient rounding than those caring for patients requiring more intensive nursing care [15]. Previous studies have shown that caring for patients with higher acuity increases nurses’ workload and limits the time available for patient rounding [6,15]. The results related to the recommended time for conducting patient rounding may be challenging to compare directly with those of previous studies, including those conducted in Korea, owing to limited research in this specific area. However, Han and Kim [5] reported that participants conducting rounding at intervals of 2 hours or less had a higher perception of patient rounding. In the present study, the average recommended interval was 2.13 hours. The survey results indicated that 63.3% of the participants conducted patient rounding at the recommended intervals and those who followed the recommended time had a more positive perception of patient rounding, supporting previous research findings [31]. This is likely because in many foreign countries, the time intervals for patient rounding are typically set to 1 or 2 hours or less. Furthermore, based on previous overseas studies, where patient rounding was conducted every 2 hours and was shown to be effective in preventing pressure ulcers during position changes, it is advisable to perform rounds at 2-hour intervals to enhance the perception of rounding. Neville et al. [18] found that conducting patient rounding every hour was perceived to be beneficial to patients and families. Walker et al. [11] found that periodic rounds resulted in reduced use of patient call bells, decreased fall rates, and higher patient satisfaction. In addition, nurses reported that efficient patient rounding allowed them to perform their duties smoothly without interference with routine tasks, contributing to team workflow improvement and better prioritization [9,12]. Therefore, it is necessary to establish protocols with defined periodic rounding intervals rather than waiting for scheduled rounds to provide high-quality nursing care. Developing protocols for patient rounds is crucial for addressing these considerations and enhancing the overall effectiveness of patient care.
Nurses’ perceptions of patient rounding were significantly associated with absolute work intensity, relative work intensity, and educational needs for patient rounding. In particular, the negative associations of both absolute and relative work intensity, alongside the positive association of the number of level I (low-acuity) patients, suggest that managing patient acuity is closely tied to nurses’ perceptions of rounding. Although it is understood that patient rounding should be conducted uniformly for all patients, increased time allocated to severely ill patients owing to high work intensity may lead to the neglect of routine rounding [15]. However, when nurses are assigned a higher proportion of level I patients, their overall work intensity becomes more manageable. Lower work intensity means nurses are less forced to prioritize urgent or life-saving tasks over routine care, preventing rounding from competing with these high-stress demands. This preserves the time and cognitive capacity available for meaningful rounding, thereby enhancing its perceived feasibility and value. Moreover, as work intensity decreases, patient rounding is no longer perceived as an overwhelming additional burden, contributing to a more positive perception of it [6]. The comparable impact of absolute and relative work intensity suggests that both the objective workload and nurses’ perceived work intensity are significant factors. Even when task volume is equivalent, nurses who perceive their work as less intense—often facilitated by caring for more low-acuity patients—are more likely to view patient rounding as an essential and manageable process rather than a burdensome option. Therefore, interventions to enhance rounding should address not only task volume but also perceived intensity through appropriate task allocation, scheduling, and support systems. It is crucial to acknowledge that maintaining the same level of attention to all patients becomes challenging when work intensity is excessively high. Therefore, to reduce nursing work intensity and foster a positive perception of rounding, it is necessary to maintain an optimal balance of patient acuity by appropriately allocating level I patients per nurse. Adequate staffing is required to ensure that patient rounding is conducted effectively for all patients, thus contributing to an improved perception of patient rounding [32].
From an educational perspective on the perception of patient rounding, high demand for education on patient rounding implies a positive perception of patient rounding. However, when the demand for education is low, it suggests a lower perception of patient rounding among nurses. To enhance the understanding and positive perception of patient rounding, it is essential to develop programs aimed at increasing perception, considering the benefits for both nurses and patients. This educational initiative can contribute to providing high-quality healthcare services [33]. In the development of such programs, it is crucial to tailor them to specific departments, such as general wards, integrated nursing care units, and specialized departments. Efficient educational content should be developed based on each department’s specific needs [34]. While existing studies measure nurses’ educational needs, there is limited research specifically addressing patient rounding educational needs.
Therefore, future studies should assess nurses’ educational needs for patient rounding while taking into account differences in work characteristics and the findings should be used to develop and refine patient rounding education programs that are tailored to the specific needs of each clinical setting. In addition, in units where patients have higher acuity, it is important not only to secure an adequate number of nursing staff to reduce nursing work intensity, but also to expand nurses’ direct care time by appropriately delegating non-nursing or indirect tasks to assistive personnel. Such strategies may help nurses secure sufficient time for patient rounding, thereby facilitating consistent implementation of rounding and contributing to improvements in the overall quality of nursing care.
This study has several limitations. First, the participants were limited to nurses working in inpatient wards, and therefore the findings may not fully reflect the experiences of nurses in other departments. Future studies should include a larger and more diverse sample from various hospitals and regions to enhance the generalizability of the results. Second, the study relied on self-reported data collected through questionnaires, which may be subject to response bias and could have led to overestimation or underestimation of certain variables. Third, since data were collected during the COVID-19 pandemic, strengthened infection control measures, increased workload, non-face-to-face interactions, and restrictions on caregiver and visitor access may have influenced nurses’ workload, work intensity, and their perceptions and performance of patient rounding. Therefore, these factors should be considered when interpreting the findings. Fourth, although nursing workload and work intensity are likely to change over time, this study adopted a cross-sectional design that captured only a single time point, which limits the ability to draw causal inferences. Future research should employ longitudinal designs to examine changes over time and experimental designs to more clearly identify causal relationships among variables. Fifth, the educational needs tool for patient rounding used in this study was developed by the researcher based on the standardized operating guidelines for comprehensive nursing care service wards, which may limit the generalizability of the findings.
Despite these limitations, our findings have several important implications for future studies and for nursing management and policy. Although overall nursing workload did not emerge as a significant factor in nurses’ perceptions of patient rounding, the number of level I (low-acuity) patients was a significant predictor. Therefore, management and policy efforts should prioritize adjusting nurse staffing and work allocation based on patient acuity rather than focusing solely on aggregate workload.
First, patient-acuity-based workload and intensity management can help nurses better control their workload and reduce stress from overwork. In particular, nurse staffing standards and nurse–patient ratios should be revised to account for patient acuity, thereby promoting a more balanced distribution of workload and reducing excessive work intensity. In addition, additional support staff may be assigned to care for critically ill patients [12]. Furthermore, managers should consider reorganizing skill-mix and delegation patterns (e.g., use of nursing assistants or support staff) to ensure that registered nurses can focus on complex care needs and maintain consistent patient rounding for all patients.
Second, training programs for patient rounding should be improved to ensure that nurses possess the most recent knowledge and skills. Regular training programs cover topics such as the importance of patient rounding, the latest nursing techniques, and patient safety management. Additionally, hands-on simulation training or workshops can help nurses gain practical experience in rounding [35]. These educational programs may also include content on prioritization strategies for patient rounding according to patient acuity.
Third, work environments should be improved so that nurses can work in safer and more comfortable settings. A prior study recommended improving nurses’ working conditions [36]. In addition, the appropriateness of the current 2-hour patient rounding interval in real-world clinical settings should be critically reviewed. Tailored rounding protocols that differ by unit type (e.g., general wards vs. integrated nursing care units) and by patient acuity level may be needed, so that rounding frequency and content are realistically aligned with the clinical context and available staffing.
Fourth, policies and support systems should be established to manage nurses’ workload and intensity and meet their educational needs. For example, there are advances in human resource management, including the improvement of nurse-patient ratios, workflow processes, and the work environment [37]. Policy makers and hospital administrators should explicitly incorporate patient‑acuity indicators into staffing models and rounding policies to support patient rounding in clinical practice.
Fifth, performance should be evaluated and continually improved. Regularly evaluating the effectiveness of patient rounding education programs and work environment improvement measures helps to measure performance and identify areas for continuous improvement [38]. Based on the evaluation results, continue to improve education programs and work management policies and reflect feedback from nurses to make practical changes. Future evaluations should specifically examine whether acuity‑based staffing adjustments and unit‑ or acuity‑specific rounding protocols lead to improvements in nurses’ perceptions of rounding, patient outcomes, and safety indicators, and the results should be used to refine both educational content and organizational policies.
CONCLUSION
This study aimed to explore the relationships among nursing workload, work intensity, patient rounding educational needs, and perceptions of patient rounding. Based on the results of this study, we provide insights into the various factors that contribute to nurses’ attitudes toward and understanding of patient rounding. This highlights the importance of considering these factors when planning and implementing patient rounding programs and educational initiatives to enhance their effectiveness and impact on patient care.
These findings indicate that nurse staffing and workload management should incorporate patient-acuity indicators in addition to workload measures. Staffing guidelines that consider patient acuity, in addition to workload, may better support consistent patient rounding in clinical practice. Furthermore, rounding protocols that account for patient acuity should be developed, along with educational initiatives to strengthen nurses’ clinical competence. Organizational strategies aimed at reducing work intensity should also be implemented. These efforts may contribute to more positive perceptions of patient rounding among nurses.
Article Information
Author contributions
Conceptualization: YL, WN. Methodology: YL, WN. Formal analysis: YL. Data curation: YL. Writing - original draft: YL, WN. Writing - review & editing: YL, WN. All authors read and agreed to the published version of the manuscript.
Conflict of interest
Wonjung Noh is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflict of interest relevant to this article was reported.
Funding
None.
Data availability
Please contact the corresponding author for data availability.
Acknowledgments
None.
Table 1.
Nurses’ Perceptions of Patient Rounding by Participant Characteristics: Group Differences and Correlations (N=147)
Variable
Category
n (%) or M±SD
Nurses’ perceptions of patient rounding
M±SD
t or F (p)
r (p)
Gender
Woman
146 (99.3)
-
-
Man
1 (0.7)
Age (yr)
28.3±3.8
.18 (.030)
Total clinical career (yr)
4.67±3.78
.18 (.033)
Ward experience (yr)
2.70±2.23
.11 (.201)
Educational level
Diploma
15 (10.2)
3.78±0.30
0.09 (.909)
Bachelor’s
117 (79.6)
3.78±0.31
≥Master’s
15 (10.2)
3.82±0.41
Job position
Staff nurse
134 (91.2)
3.77±0.31
-1.06 (.287)
Charge nurse
13 (8.8)
3.86±0.33
Department
Medical ward
59 (40.1)
3.76±0.29
0.68 (.506)
Surgical ward
43 (29.3)
3.81±0.36
Medical & surgical ward
45 (30.6)
3.76±0.30
Mean patients per nurse by acuity category
Level Ⅰ (low-acuity)
5.41±3.70
.17 (.046)
Level Ⅱ (moderate-acuity)
3.53±2.18
-.14 (.096)
Level Ⅲ (high-acuity)
2.80±2.86
.01 (.891)
Total
11.76±4.08
.08 (.314)
Recommended rounds time (hr)
2.13±1.02
.17 (.046)
Round count per duty
Day
5.29±2.61
.09 (.285)
Evening
5.24±2.41
.11 (.200)
Night
4.62±2.18
-.04 (.645)
Rounds protocol
Yes
67 (45.6)
3.76±0.29
-0.47 (.636)
No
80 (54.4)
3.79±0.33
Patient rounds intention
Yes
107 (72.8)
3.81±0.34
2.07 (.040)
No
40 (27.2)
3.65±0.25
Performance at recommended time
Yes
93 (63.3)
3.82±0.34
2.04 (.042)
No
54 (36.7)
3.71±0.26
M=mean; SD=standard deviation.
Table 2.
Nursing Workload, Nursing Work Intensity, Patient Rounding Educational Needs, and Nurses’ Perceptions of Patient Rounding (N=147)
X1=nursing workload; X2=quantitative demands; X3=emotional demands; X4=work pace; X5=nursing work intensity; X6=absolute work intensity; X7=relative work intensity; X8=flexibility; X9=patient rounding educational needs; X10=nurses’ perceptions of patient rounding.
Table 4.
Factors Influencing Nurses’ Perceptions of Patient Rounding (N=147)
Category
B
SE
ß
t
p
VIF
(Constant)
2.05
.22
9.36
<.001
Patient rounding educational needs
0.21
.04
.38
5.38
<.001
1.11
Total clinical career (yr)
0.00
.00
.16
2.31
.022
1.09
Performance at recommended time (yes)
0.11
.05
.15
2.22
.028
1.04
Patients per nurse (Level I)
0.01
.00
.14
2.09
.038
1.01
Relative work intensity
-0.02
.01
-.15
-2.05
.043
1.24
Absolute work intensity
-0.01
.01
-.16
-2.11
.036
1.26
R2=.37; Adjusted R2=.34; F=13.75; p<.001
Durbin-Watson=2.08, Tolerance=.79-.98.
SE=standard error; VIF=variance inflation factor.
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