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What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol
  1. Ruth Harris1,
  2. Sarah Sims1,
  3. Ros Levenson2,
  4. Stephen Gourlay3,
  5. Fiona Ross CBE4,
  6. Nigel Davies5,
  7. Sally Brearley1,
  8. Giampiero Favato6,
  9. Robert Grant4
  1. 1Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
  2. 2Independent Consultant, London, UK
  3. 3Kingston Business School, Kingston University, Kingston-Upon-Thames, London, UK
  4. 4Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
  5. 5Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK
  6. 6Institute of Leadership and Management in Health (ILMH), Kingston University, Kingston-Upon-Thames, London, UK
  1. Correspondence to Professor Ruth Harris; ruth.harris{at}


Introduction Intentional rounding (IR) is a structured process whereby nurses in hospitals carry out regular checks, usually hourly, with individual patients using a standardised protocol to address issues of positioning, pain, personal needs and placement of items. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff.

Methods and analysis The study will be conducted in four phases. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. Phase 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. Phase 3: case studies to explore how IR is implemented ‘on the ground’, including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. Phase 4: accumulative data analysis across the phases to scrutinise data for patterns of congruence and discordance and develop an overall evaluation of what aspects of IR work, for whom and in what circumstances.

Ethics and dissemination The study has been approved by NHS South East Coast—Surrey Research Ethics Committee. Findings will be published in a wide range of outputs targeted at key audiences, including patient and carer organisations, nursing staff and healthcare managers.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors RH conceived the study and RH and SS drafted the protocol. RL, SG, FRC, ND, SB, GF and RG contributed to reworking and refining the study objectives, design and methodology. RH drafted the paper and SS, RL, SG, FRC, ND, SB, GF and RG have reviewed and provided comments to improve the paper. All authors have read and approved the final version.

  • Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) (project number 13/07/87).

  • Competing interests None declared.

  • Ethics approval The study has been approved by NHS Health Research Authority South East Coast—Surrey Research Ethics Committee, REC reference: 14/LO/1977.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

  • Data Sharing Statement A protocol was formulated during the grant application process and submitted to NIHR HS&DR

  • Department of Health Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR, NIHR, NHS or the Department of Health.