A survey of ward round practice

Ward round competences in surgery and psychiatry - a comparative multidisciplinary interview study

BACKGROUND

The ward round is a key element in everyday hospital inpatient care irrespective of the medical speciality. The underperformance in conducting ward rounds of junior clinicians has already been described. Therefore, necessary skills and competences of clinicians need to be defined, taught and delivered for curricular instruction. In addition to published data on ward round competences in internal medicine this study aims to determine the common competences for surgical and psychiatric ward rounds in order to find differences depending on the speciality.

METHODS

Semi-structured interviews with surgical (N = 30) and psychiatric ward staff (N = 30) of a university hospital and five community hospitals were conducted. Competences necessary for performing ward rounds as well as structural aspects were identified by systematic content analysis and frequency analysis, supported by adequate statistics.

RESULTS

Relevant competences for both fields are: collaborative clinical reasoning, communication with the patient and the team, organization, teamwork, management of difficult situations, self-management, error-management, teaching, empathy, nonverbal communication, patient-management and professionalism. Clinical skills were mentioned more often in surgical interviews, while nonverbal communication was described more often in psychiatric interviews. Empathy and communication with the team were more frequently attributed to psychiatric residents.

CONCLUSION

The competences which were identified as necessary for conducting a ward round in surgery and psychiatry are similar and correspond to previously reported competences in internal medicine. Clinical skills are of greater importance in surgery than in psychiatry. Concerning empathy and nonverbal communication, further research is needed to determine whether they are of minor importance in surgery or whether there is a lack of awareness of these competences.

Are psychiatric team meetings patient centred? A cross-sectional survey on patient views regarding multi-disciplinary team meetings

OBJECTIVES

The system of weekly psychiatric ward rounds is being challenged and multi-disciplinary team meetings (MDTMs) involving inpatients have been developed. These aim to improve integration between medical and social services and increase patient involvement in their care. However, such large meetings are potentially threatening to the patient. This survey aimed to examine inpatient experience of MDTMs and identify factors that significantly alter this experience.

METHODS

In this cross-sectional survey we assessed patient opinion regarding patient inclusive MDTMs in a psychiatric inpatient unit. A total of 27 participants (response rate 90%) were included. We utilised descriptive statistics and Fisher's exact test for non-parametric data where appropriate.

RESULTS

In all, 85% (n=23) of patients identified the consultant psychiatrist as a member that they would like to have present at the MDTM. The ward nurse was identified by 63% (n=17) of patients. In all, 48% (n=13) of patients reported feeling anxious/threatened at the MDTM. In all, 70% (n=19) of patients stated that they would have felt less threatened at the MDTM if there were fewer people in attendance. A significant number of voluntary patients (n=11) felt threatened/anxious at the MDTM compared with involuntary patients (n=2) (χ 2=4.921, df=1, p=0.026).

CONCLUSION

The central findings of this study are that patients would prefer fewer people at the MDTM and would feel less threatened/anxious if they participated in selecting those in attendance. These findings suggest that greater patient involvement in preparation for the MDTM could result in a less anxiety filled experience for them.

Views of pharmacists on involvement in ward rounds in selected public hospitals in Limpopo Province

Background: Pharmacist participation in ward rounds is of increasing interest for better pharmaceutical care, yet most pharmacists do not engage in this activity.Objective: The objective was to obtain public sector pharmacists’ views and perceptions on their involvement in ward rounds.Method: A rapid assessment was conducted using a semi-structured questionnaire sent to five hospitals in Limpopo Province.Results: There were 55 respondents (61.8% female), mainly from the Polokwane-Mankweng Hospital Complex (69.1%); 45 (82%) were young pharmacists aged 25 to 34, whilst experience varied from 0 ≤ 5 years (69.1%), 5 ≤ 10 years (16.4%) to > 10 years (14.5%). The respondents included interns (n = 21), community service pharmacists (n = 7) and junior pharmacists (n = 8). Most had trained at University of Limpopo (n = 49), with a few from North-West University (n = 4), Wits (n = 1) and Durban–Westville (n = 1). The majority (94.5%) felt that it was necessary for pharmacists to be involved in ward rounds. Twenty-seven respondents (49.1%) said that pharmacists were involved in ward rounds and 21 of these (77.8%) said ward visits were to check on drug stocks, but not for direct patient care. Proposals to prepare pharmacists better for ward rounds included pre-service training (34.9%), internship (37.2%), community service (4.7%), post-graduate courses (8.1%) and continuing professional development (15.1%).Conclusion: Pharmacists in the public hospitals studied in Limpopo were willing to be involved in clinical ward rounds and suggested that this be introduced during undergraduate training. These findings support the plans for the Turfloop BPharm programme to introduce clinical ward rounds. Agtergrond: Die teenwoordigheid van aptekers tydens saalrondtes is van toenemende belang vir beter farmaseutiese sorg, maar baie aptekers is nie betrokke by by hierdie aktiwiteit nie.Doelstelling: Die doel van die studie was om die menings en persepsies van aptekers in die openbare sektor te verkry oor hulle betrokkenheid by saalrondtes.Metode: ’n Vinnige assessering was gedoen met behulp van ’n semi-gestruktureerde vraelys wat na vyf hospitale in Limpopo gestuur is.Resultate: Daar het 55 respondente aan die studie deelgeneem (61.8% vroue). Die meerderheid was van die Polokwane-Mankweng hospitaalkompleks (69.1%). Daar was 45 (82%) jong aptekers tussen die ouderdomme van 25 en 34, terwyl ervaring gewissel het van 0 tot 5 jaar (69.1%), 6 tot 10 jaar (16.4%), tot 10 jaar of meer (14.5%). Die respondente het die volgende ingesluit: interns (n = 21), gemeenskapsdiensaptekers (n = 7) en junior aptekers (n = 8). Die meeste het hul tersiêre opleiding aan die Universiteit van Limpopo verkry (n = 49), met ’n paar van die Noord-Wes Universiteit (n= 4), Wits (n = 1) en Durban-Westville (n = 1). Die meerderheid (94.5%) het gevoel dat dit wel nodig is vir aptekers om in saalrondtes betrokke te wees. ’n Totaal van 27 respondente (49.1%) het aangedui dat aptekers betrokke is by saalrondtes, maar 21 uit die 27 (77.8%) het saalbesoek omskryf as die nagaan van saalvoorraad en nie direkte pasiëntesorg nie. Voorstelle om aptekers beter voor te berei vir saalrondtes het die volgende ingesluit: pre-diens opleiding (34.9%), internskap (37.2%), gemeenskapsdiens (4.7%), nagraadse kursusse (8.1%), en deur middel van voortgesette professionele ontwikkeling (15.1%).Gevolgtrekkings: Aptekers in die openbare hospitale bestudeer in Limpopo was bereid om in die kliniese saalrondtes betrokke te wees en het voorgestel dat dit tydens voorgraadse opleiding ingestel word. Hierdie bevindings ondersteun die planne vir die Turfloop BPharm program om kliniese saalrondtes in te stel.

Once-a-week psychiatric ward round or daily inpatient team meeting? A multidisciplinary mental health team's experience of new ways of working

Evidence indicates that while service users are dissatisfied with current ward round practices, studies of how professionals experience this practice are sparse. This study highlights staff view of the once-a-week psychiatric ward round compared to a reformed ward round taking place every weekday. Interviews were conducted at one acute psychiatric ward in north-west England. Our analysis revealed a core theme, 'forming a new way of working', which could be understood from three themes. The theme, 'bound by tradition', emphasized how the traditional ward round represented a double-edged sword: it provided a safe structure, but it also highlighted a shared awareness of an urgent need to leave old ways of working behind. The process of change became discernable in the themes 'juggling the change' and 'light at the end of the tunnel', which showed that restructuring the traditional ward round was both possible and valued. We found that staff views on ward rounds are more complex than had been earlier understood, but new ways of working can be implemented, if the impact of tradition, the process of change, and the time to bed down are taken into account.