Intensive and Critical Care Nursing 40 (2017) 35–43

Contents lists available at ScienceDirect

Intensive and Critical Care Nursing

journal homepage: www.elsevier.com/iccn

Clinical research article

Intensive care nurses’ perceptions of Inter Specialty Trauma Nursing

Rounds to improve trauma patient care—A quality improvement project
a,∗
Fiona L. Jennings , Marion Mitchell a,b
a
Princess Alexandra Hospital, Intensive Care Unit, Ipswich Road, QLD 4102, Australia
b
Centre of Health Practice Innovation, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, 170 Kessels Road Nathan, QLD 4111,
Australia

articleinfo Methods: The project included structured, weekly rounds that were conducted at the
bedside. Nursing experts and others collaborated to assess and make changes to
Article history: trauma patients’ care. The rounds were evaluated to assess the nurse’s perception of
Received 15 April 2016 improvement.
Received in revised form 1 December 2016 Accepted 1 January 2017 Results: There were 132 trauma patients assessed. A total of 452 changes to patient
care occurred. On average, three changes per patient resulted. Changes included
Keywords: nursing management, medical manage ment and wound care. Nursing staff reported
Bedside teaching an overall improvement of trauma patient care, trauma knowledge, and collaboration
Collaboration with colleagues.
Critical care Conclusions: Inter Specialty Trauma Nursing Rounds utilizes expert nursing
Intensive care knowledge. They are sug gested as an innovative way to address the clinical
Nursing rounds challenges of caring for trauma patients and are perceived to enhance patient care
Trauma rounds
and nursing knowledge.

Implications for clinical practice

abstract

Background: Trauma patient management is complex and challenging for nurses in

the Intensive Care Unit. One strategy to promote quality and evidence based care
may be through utilising specialty nursing experts both internal and externalto the
Intensive Care Unitin the form of a nursing round. Inter Specialty Trauma Nursing
Rounds have the potentialto improve patient care, collaboration and nurses’
knowledge. Objectives: The purpose of this quality improvement project was to
improve trauma patient care and evaluate the nurses perception of improvement. © 2017 Elsevier Ltd. All rights reserved.

•
ISTNR utilizes expert nursing knowledge in managing trauma patient care.
•
ISTNR provide individualised bed-side education for nursing staff in the care of trauma patients.
•
ISTNR improved inter-departmental collaboration around trauma patient care.
•
Changes to trauma patient care was directly due to ISTNR.

ity of trauma patients’ injuries requires multiple speciality medical

Introduction Trauma patients admitted to the Intensive Care Unit (ICU) frequently
present with complex and clinically challenging care needs including
significant life-changing scenarios. The complex-
∗
Corresponding author.
E-mail address: Fiona.jennings@health.qld.gov.au (F.L. Jennings).
http://dx.doi.org/10.1016/j.iccn.2017.01.002
36 F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43
et al., 2010) and nurses may benefit from support to implement best practice
to effectively care for complex trauma patients. Nursing Rounds provide a
process by which patients are dis cussed on an individual basis to identify
challenges and issues. Exchanges of information among team members
occur (Catangui and Slark, 2012; Dodek and Raboud, 2003) and educational
oppor tunities within a specific patient context provide meaningful,
contemporaneous patient-centred care (Catangui and Slark, 2012; Gardner
et al., 2010; Vincent, 2005).
Nursing Rounds have been previously described to consist of nursing
specialists from the ward in which the patient resides. Attendees potentially
include the nurse in charge, other experi enced nurses and direct patient
care nurses (Catangui and Slark, 2012; Costa et al., 2014). They have been
lauded as effective in insti gating changes to ICU patient care (Aitken et al.,
2010). Intensive Care nurses and patient care may benefit from drawing on
expert nursing knowledge from other areas such as emergency depart
ments, orthopedic units, spinal and trauma services. We have coined these
as Inter Specialty Trauma Nursing Rounds (ISTNR), defined as a nursing
round with expert specialty nurses from across the hospital together with ICU
nurses who collectively discuss the best care options for the trauma patient
at the bed-side.
The aim of this study was to improve trauma patient care. ICU direct care
nurses’ perceptions of ISTNR was assessed in terms of patient benefits and
quantified the subsequent patient care changes.
Method
A Quality Improvement (QI) project was selected as appropriate as these
projects focus on site-specific identified issues (Oermann et al., 2014). They
aim to improve patient care by staff partic ipation, systematic investigation
and measurement of outcomes (Connor, 2014). One method to improve
quality in health deliv ery is the Plan, Do, Study and Act (PDSA) model
(Taylor et al., 2014). Taylor et al. (2014) describes PDSA as a four stage
cycle that can be used when structuring a study or intervention for change
and improvement. The Squire guideline (Standards for Quality Improvement
Reporting Excellence, 2015) provides a useful frame work for reporting QI
projects and these are used where possible (Ogrinc et al., 2008).
Setting
The QI project was conducted in a large metropolitan public adult hospital
within Australia that has Magnet accreditation. The hospital is a tertiary
referral, accredited Level 1 Trauma Centre. The ICU is a 25 bed mixed
surgical/medical unit, which admits patients from all major specialties
including solid organ trans plantations, medical and surgical cardiac patients
and people with spinal injuries. Patients with burns and obstetric conditions
are not admitted. There are approximately 2300 admissions per year with
roughly 300 trauma patients.
Patients are nursed in a one to one registered nurse: patient ratio.
Trauma patients are admitted if they require mechanical ventilation,
advanced hemodynamic monitoring, resuscitation or inotropic support.
Admissions include classified major trauma cases with an Injury Severity
Score (ISS) of >12 (the average ISS for the ICU is 25).
Participants
The participants involved in the ISTNR included ICU experienced nurses,
researchers, direct care nurses, allied health staff and expert nurse
specialists external to the ICU.
Planning and doing the intervention
REASON
0964-3397/© 2017 Elsevier Ltd. All rights reserved.
teams to provide specific care (Rose, 2011). Effective communica tion and
inter speciality collaboration is essential to enhance the quality of patient care
as the focus needs to be on the patient as a whole and not one aspect of
their injury (Costa et al., 2014; O’Leary et al., 2011).
Providing optimum nursing care to complex ICU trauma patients is
equally challenging as nurses have varying levels of skill and knowledge.
Patient care is contingent upon the nurses’ abil ity to make effective evidence
based clinical decisions (Gardner
The decision to trial ISTNR received support from the senior nursing
team. The ISTNR were held on a specific day and time every week. Effective
team leadership of the ISTNR was recognized to be important and the
Trauma Clinical Facilitator (TCF) coordi nated the rounds. The role of the
TCF was to identify two trauma patients who presented complex
management issues. An ISTNR form was developed to assist the direct care
nurse’s preparation and participation (see Fig. 1). The TCF invited specialty
nurses from outside the ICU specific to the patient’s injuries. That is, a
traumatic brain injured patient with multiple orthopedic and chest injuries and
a splenic injury would have invited expert nurses from the emergency
department; operating theatre; orthopedic ward; sur gical unit; neurology
wards and the Trauma Service as they could potentially provide input into the
injury and ongoing care.
Each patient was allocated approximately 30 minutes. The ISTNR
occurred with attendees clustering near the patient bed. This occurred in a
collegial manner where each attendee introduced themselves and their role.
The direct patient care nurse presented the patient journey from the
mechanism of injury; injuries sus tained; clinical course and challenges in
care, broadly following the ISTNR form (see Fig. 1).
A systematic discussion followed using a structured approach to promote
a comprehensive patient review and physical assessment. A standard
checklist guided patient assessment (see Fig. 2). Atten dees contributed their
specialised knowledge with suggestions and recommendations documented
in the patient chart where appro priate. On completion of the ISTNR the TCF
followed-up with aspects of care that required actioning.
Evaluation of the ISTNR occurred on five randomly timed occa sions
throughout a 19-month period. The evaluation forms (see Fig. 3) were
distributed to attendees at the conclusion of an ISTNR for completion. The
anonymous forms were handed to an indepen dent person to reduce bias
and for future collation.
Ethical considerations
Participation in Nursing Rounds was routine practice in the study site.
The focus on trauma patients was deemed within usual practice parameters.
No identifying data were collected on patients or staff attending ISTNR or via
the evaluation survey. Consent was implied if the staff completed the
anonymous evaluation surveys.
Data collection
Data was collected and recorded during each ISTNR by the TCF. The
data included numbers and designation of staff attending patient care and
initiated changes.
Data analysis
Descriptive statistics were generated using a spreadsheet with numbers
and percentages. Qualitative data were analyzed using content analysis
where data were grouped around central, recur rent ideas (DeSantis and
Ugarriza, 2000; Graneheim and Lundman, 2004). Emerging themes and
meaningful units were described within and across ISTNR (Graneheim and
Lundman, 2004) by way of discussion and agreement between the two
authors. Illustrative quotes are provided to enhance the trustworthiness and
credibil ity of the qualitative results (Annells and Whitehead, 2007). The
descriptive and qualitative data were combined to allow for evalu ation of the
ISTNR (Creswell, 2009; Jones and Bugge, 2006).
F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43 37
 Briefly outline the reason for admission to ICU

OBSERVATIONS

Briefly outline information pertaining to the patient’s observations

Identify any abnormalities and potential problems/nursing issues for discussion

UNDERSTANDING

Compile any questions /comments to be discussed and therefore an opportunity

to understand and provide education

NURSING ISSUES

Identify any nursing issues/ questions and potential solutions for the patient

DISCUSSION

Participate in guided discussion

SUGGESTIONS

Take note of discussions and subsequent suggestions

Clinical notes will be input into the computerised chart by the ISTNR Facilitator

Fig. 1. ISTNR patient presentation form.

Table 2
Table 1
Characteristic of reviewed patients (N = 132). expert nurses from the Trauma Service,
Attendees designation (N = 812).
Demographic Characteristic
Designation n (%)
Age (years) 41.2 (mean; range 14–84) Male n = 106 (80.3%) Length of stay ICU (days) 6.8
(median) (range 1–38.9) ICU registered nurses 235 (30%) Nurse experts external to ICU 190 (23.3%) ICU
Nurse experts 148 (18.2%) Registered nurses external to ICU 136 (16.7%) Student
Mechanism of Injury n (%)
nurses 48 (5.9%) Research nurses 38 (4.7%) Allied health 16 (2%) ICU Medical
Motor vehicle 50 (37.9%) Consultant 1 (0.12%)
Motorbike 21 (15.9%)
Falls>1 m 17 (12.9%)
Bicycle incidents 10 (7.5%)
Pedestrian vs vehicle 9 (6.8%) perioperative services; emergency department, orthopedic ward and
Crush 6 (4.5%) neurological ward (see Table 2).
Assault 2 (1.5%)
Livestock incident 2 (1.5%)
Farming Equipment 2 (1.5%) Patient care changes
Other 13 (9.8%)
A total of 452 changes to trauma patient care occurred dur ing the study.
On average, three changes per patient resulted from ISTNR (see Table 3 for
categories and examples of implemented changes). These changes fell into
seven broad categories with the most changes occurring in nursing
Results management. Of interest, the need for medical follow-up was the second
highest category.
One hundred and thirty-two patients were reviewed during 66 ISTNR over
a 19-month period during 2012/2013 (see Table 1). The majority of patients Staff survey evaluations
were male with a median age of 41 years.Motor vehicle incidents (37.9%)
were the main mode of mechanism of injury followed by motorbike incidents. Over the study period five randomly timed evaluation surveys were
There were 812 staff attendees atthe 66 ISTNR(mean = 11; range 4–20). conducted. ISTNR attendees on the day were invited to com plete the
Attendees included direct care nurses, ICU registered and expert nurses evaluation survey developed by the authors. Following the first evaluation,
(e.g. Clinical Nurse Consultant and the TCF). Other regular attendees were the tool was altered to increase the choice options
38 F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43

from three to seven options to provide more detailed feedback. The patient benefited from the ISTNR. Universally the respon ders considered
evaluation assessed the process and outcome measures (see Fig. 3). No that the suggestions from the staff external to the ICU were helpful, and 72%
identifying demographic data were collected. (n = 34) felt their knowledge of trauma patient care improved.
Importantly, more than 80% (n = 39) of respondents believed that the There was an opportunity to provide additional comments on the
evaluation form. The comments from the respondents were grouped into
three categories; nurse perception, collaboration and educational
opportunities.
Nurse perception of inter specialty trauma nursing rounds
The ISTNR provided a unique opportunity for ICU direct care nurses to
garner knowledge and strategies on how they could improve care for
individual trauma patients.
“ICU trauma nursing round is excellent especially in improving and
providing quality patient care.”
“It was fantastic to be able to draw on the knowledge of other specialties,
and I definitely think it improved my patient’s plan of care.”
“It’s great to have these nurse rounds, because I feel the patient has
some extra care from all over the hospital, from all aspects.”

Trauma Nursing Rounds

Date: UR: Bed Number:

Feeding □ Yes □No

____________________________________________________

Access______________________________________________________________

__

Sedation____________________________________________________________

___

Thrombosis prophylaxis □Heparin □Teds □SCUDS___________________________

Head of Bed Elevation___________________________________________________

□Yes □No _______

Ulcer prophylaxis ______________________________________

Glucose control □Stress □Diabetic_________________________________________

Stools (Bowels Open) □Yes □No Aperient ordered □ __________________________

Confusion Assessment Method (CAM) ____________________________________

Patient Challenges ______________________________________________________

Wounds ______________________________________________________________

Stomal therapy intervention_______________________________________________

Dressings _____________________________________________________________

Sutures/Staples_________________________________________________________

Cast (plaster technician referral, circulation.obs ervations) _______________________

Fig. 2. ICU ISTNR Patient Care Checklist.

A collaborative experience “Great integration of multi-disciplinary team, patients benefit
F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43 39 greatly from the round.”
The site ICU can only be accessed by an intercom to gain entry or by a
Documentation (orders, photo □Yes □No )____________________________________
ICU staff swipe card. This limited access acts as a barrier and is isolating. By
creating an inviting, collaborative environment, nurses from other specialty
areas had access and were welcomed into the ICU and they willingly
Surgery_______________________________________________________________
attended and participated by sharing their expert knowledge.

“The atmosphere was very collegial.”

Communication ________________________________________________________
“Loved the team collaboration across units.”
“[The] ICU round was very informative and inclusive.”
Pre morbid state________________________________________________________

Educational opportunities
Limitations____________________________________________________________

Trauma patient care is complex and by involving specialty nursing

experts, patients and staff benefited from the shared knowledge.
Social _______________________________________________________________
Opportunistic teaching at the bedside by the expert nurses enhanced nursing
knowledge.
Family support_________________________________________________________

Home location_________________________________________________________

Social work referral_____________________________________________________

Psychosocial

Alcohol withdrawl

____________________________________________________ Alcohol and

Drug dependency _____________________________________ ______

Referrals

Occupational

therapy____________________________________________________ Prothetics

and Orthotics__________________________________________________

Medical____________________________________________________________

___

Management plan/follow up _____________________________________________

Fig. 2. (Continued)
40 F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43

“[It was] very interesting talking about all aspects of complex injuries. valuable to patients.”
[There was] lots of new information from other special ities.”
“I found it really interesting. Gave me a new way of thinking of specific
“[The] experience was valuable in that it increased awareness of how ICU injuries.”
patients are cared for holistically and interdisciplinary trauma
communication is facilitated.” Coordination of care [that is] pre-emptive,
intervention planning and escalation of issues to relevant people is Discussion
 The authors believe these ISTNR, where expert nurses exter nal to the
ICU combine with ICU nurses, have not previously been reported. The
study’s resultsdemonstratedthe benefits ofinter spe cialty nursing
collaboration in this setting as perceived by direct care nurses and the
changes to patient care. As a Magnet hospital
the nurse-led ISTNR embodies the Magnet model of exemplary pro fessional
practice and to improve patient outcomes (A New Model for ANCC’s Magnet
Recognition Program, 2015).
Trauma patients are complex, frequently of high acuity and present
continued challenges to critical care nurses (Crossan and Cole, 2013).
Patients may present with multifaceted injuries includ ing traumatic brain
injury, multiple orthopedic fractures, softtissue and thoracic injuries requiring
ventilation and hemodynamic sta bility. ISTNR are potentially an innovative
way of meeting the needs of patients by improving care strategies and ICU
nurses’ knowledge by providing expert knowledge and collaboration in a
collegial and supportive environment.
As health professionals we understand the importance of patient
assessment for decision making, through visualizing and physically
examining the patient (Catangui and Slark, 2012). ISTNR occurred at the
bedside to better appreciate the patient’s specific care requirements; wounds
and injuries (Rose, 2011; Salentiny Wrobleski et al., 2014). During ISTNR
nursing experts provided best practice information to support changes to
patient care.

Item Evaluation criteria Responses

1 How helpful was Not at all Extremely helpful 1(n=0) 2(n=0) 3(n=0) 4(n=3)

it to you to 5(n=6) 6(n=18) 7(n=21)

introduce staff

before the

trauma round

commenced?

(n=48)

2 How much No knowledge Lots of knowledge 1(n=1) 2(n=0) 3(n=2) 4(n=8)

general clinical 5(n=17) 6(n=16) 7(n=3)

knowledge did

you gain today

from the

trauma

round?

(n=47 )

3 How much No knowledge Lots of knowledge 1(n=1) 2(n=0) 3(n=0)

trauma 4(n=12) 5(n=14) 6(n=15) 7(n=5)

management

knowledge did

you gain today

from the trauma

round?

(n=47 )

4 How much do Not at all Great benefit 1(n=0) 2(n=0) 3(n=5) 4(n=4) 5(n=10)

you think the 6(n=16) 7(n=13)

patient

benefited from

the trauma

round?

(n=48)
 Fig. 3. Cumulative results of survey evaluations by ISTNR attendees (N = 49).

Table 3
F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43 41 (n=47)
5 How supportive Not at all Completely supportive 1(n=0) 2(n=0) 3(n=3) 4(n=0)

did you find the 5(n=6) 6(n=16) 7(n=24)

Fig. 3. (Continued)
environment

during the

trauma round?

(n=49)

6 How much did Not at all Lots of discussion 1(n=0) 2(n=0) 3(n=0) 4(n=3)

the trauma 5(n=5) 6(n=25) 7(n=16)

round

encourage

relevant group

discussion?

(n=49)

7 How helpful Not at all Extremely 1(n=0) 2(n=0) 3(n=0) 4(n=3) 5(n=6)

were the 6(n=22) 7(n=16)

suggestions

from the

visiting staff?
receiving. The risk however, is that some families may find ISTNR overwhelming. Therefore, it was important to gauge the family’s
Changes to patient care (N = 452).
Categories • Orthopedic mobility orders for transfer.
(n = (%) • Identifying wounds that require medical intervention
Bed-side education uses problem-solving and real-
• Target sedation & other parameters
Nursing Management (n = 125; 27.6%) life situa tions as a way to engage learners – in this
• Wound specific dressings case, the direct care nurse and others. Knowles’
• Wound treatment Adult Learning Theory explains how when people
Medical Management (n = 72; 15.9%)
have a ‘need to know’, they are more likely to engage
• Allied health teams (social work service, acute pain service) in learning (Knowles, 1990). This was the case with
• Plaster technician ISTNR where clinical discussion revolved round the
Wound Care specific needs of the patient that day and into the
• Pressure relieving devices
(n = 66; 14.6%) • DVT reduction devices
future. Knowles’ theory highlights the impor tant role
• Specilalised equipment (Cryo cuff, splints and braces) thatlife experience plays in understanding issues and
Referrals how group discussion augments learning (Knowles et
(n = 58; 12.8%) • Deep Vein Thrombosis & ulcer prophylaxis • Pain management al., 2005).
• Anti emetics and aperients The group discussion during ISTNR, centred on the
Equipment
prior expe riences and knowledge of the direct care
• Implementing trauma protocols
(n = 54; 11.9%) - Spinal collar care
nurse and their learning needs. Knowles Adult
• Pin site care Learning Theory has been applied to other
desire (or otherwise) to be included and to provide continuing professional development situations
information prior to the round and support (Hopstock, 2008; Mayer et al., 2005) and also to
Medication patient education (Mitchell and Courtney, 2005) and
throughout.
(n = 40; 8.8%)
An unexpected benefit of ISTNR was the opportunity thus exhibits broad applicability. Bed-side education,
for atten dees from outside the ICU to gain an during ISTNR, provided a unique approach to improv
Nursing Care Plan (n = 37; 8.2%) understanding of the patient situation before they ing patient care and clinical knowledge (Aldeen and
Changes Implemented were transferred from ICU to their ward. ISTNR Gisondi, 2006; Dalmaso et al., 2015; Laibhen-Parkes
provided a unique and valuable overview of the et al., 2015). Along with improved knowledge,
• Patient positioning to reduce pain & pressure injury patient and their needs prior to transfer and insight teamwork and good communication
• Communication strategies into the care challenges and solutions in preparation

The patients’ families were invited to attend ISTNR if they were with the
patient at the time of the round. This facilitated improved communication
(Schiller andAnderson, 2003) which is consistently cited by families as an
important area for improvement (Mitchell et al., 2009). Anecdotally, families
described participation as a valu able experience −they added to the patient history
and gained a greater understanding of the injuries and care their relative was
are important factors in providing safe and effective patient care ( Frakes,
42 F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43
2009; Kalisch and Begeny, 2005; O’Leary et al., 2011; Rose, 2011). There is
much evidence that supports inter profes sional collaboration (Costa et al.,
2014; Gonzalo et al., 2014; Rose, 2011) and multidisciplinary rounds (Dodek
and Raboud, 2003; O’Mahoney et al., 2007) within ICU. Moreover, nursing
rounds and nursing grand rounds are acknowledged as an important model
for

nurse education and promoting improved patient care (Gardner et al., 2010;
Laibhen-Parkes et al., 2015). However, until now, there appears to be no
evidence of nursing rounds utilising an inter specialty nursing round model
for improved trauma patient care within the ICU.
Showing respect and valuing attendee’s contribution was sup ported by
the initial introductions, active listening and the fact that any question was
valid, promoting a safe and collaborative envi ronment (A New Model for
ANCC’s Magnet Recognition Program, 2015). The nurses readily engaged
with the ISTNR process and enjoyed the cross-unit collaborations.
The nurse experts had specialist knowledge that they shared and applied
to each patient situation to promote improved patient care (McCullough et al.,
2014; Rose, 2011). This information dis seminated during the ISTNR
improved the knowledge of the direct care nurses and others and could
subsequently be applied to other patient care situations.
The complexity of caring for high acuity trauma patients in ICU is
undeniably challenging;innovative and flexible ideas are needed to improve
nursing care. ISTNR are suggested as an innovative nurse led QI to enhance
nurse knowledge in trauma patient care. ISTNR utilizedexpertnursing
knowledge fromspecialtynurses bothinter nal and external to ICU. The
benefits of ISTNR were clear with a collegial forum and collaborative team
environment in which nurses shared their knowledge and skills.
ISTNR have provided specific education for nursing staff in the
management of the complex trauma patients. ISTNR have provided a
strategy to bridge communication between nursing staff, hospital specialty
nurses and families of trauma patients in the ICU. ISTNR continue as normal
practice in the site ICU and thus demonstrate sustainability.
Conflict of interest

Strengths
It was importantfor the sustainability ofthe ISTNR to have them
conducted efficiently. A facilitator was important to provide lead ership and
motivation and an appreciation ofthe value ofthe round to patients and staff.
It was important that external experts were made aware of their clinical
contribution and the value of their input. Endorsement from nursing
management was also consid ered essential.
Limitations
This project was conducted in a large metropolitan ICU that was well
resourced with clinical experts who were committed to the project and the
results may not be generalisable to other ICUs. Patient outcomes such as
ICU length of stay and pressure injury or other adverse events were not
measured.
Conclusion
Author confirms there are no known conflicts of interest asso ciated with
this manuscript and there are no financial disclosures associated with this
manuscript.
Ethical statement
Participation in Nursing Rounds was routine practice in the study site.
The focus on trauma patients was deemed within usual practice parameters.
No identifying data were collected on patients
or staff attending ISTNR or via the evaluation survey. Consent was implied if
the staff completed the anonymous evaluation surveys.
Acknowledgements
The authors would like to thank the staff in the Princess Alexan dra
Hospital Intensive Care Unit for all the support provided. We also would like
to thank the nursing staff external the Intensive Care Unit who participated in
this quality improvement project.
 References
A New Model for ANCC’s Magnet Recognition Program, 2008. http://www.
nursecredentialing.org/Documents/Magnet/NewModelBrochure.aspx, (Accessed 04
September 2015).
Aitken, L.M., Burmeister, E., Clayton, S., Dalais, C., Gardner, G., 2010. The impact of nursing
rounds on the practice environment and nurse satisfaction in the intensive care unit: pre-test
and post-test comparative study. Int. J. Nurs. Stud. 48, 918–925,
http://dx.doi.org/10.1016/j.ijnurstu.2010.10.004.
Aldeen, A.Z., Gisondi, M.A., 2006. Bedside teaching in the emergency department. Acad.
Emerg. Med. 13 (8), 860–866.
Annells, M., Whitehead, D., 2007. Analysis data in qualitative research. In: Schnei der, Z.,
Whitehead, D., Elliot, D., Lobiondo-Wood, G., Haber, J. (Eds.), Nursing & Midwifery
Research: Methods and Appraisal for Evidence-Based Practice. , third ed. Elsevier, Sydney,
pp. 138–155.
Catangui, Slark, J., 2012. Nurse-led ward rounds: a valuable contribution to acute stroke care.
Br. J. Nurs. 21 (13), 801–805.
Connor, B., 2014. Differentiating research, evidence-based practice, and quality improvement.
Am. Nurse Today 9 (6), http://www.americannursetoday.com/ differentiating-research-
evidence-based-practice-and-quality-improvement/, (Accessed 04 September 2015).
Costa, D.K., Barg, F.K., Asch, D.A., Kahn, J.M., 2014. Facilitators of an interprofessional
approach to care in medical and mixed medical/surgical ICUs: a multicentre qualitative
study. Res. Nurs. Health 37, 326–335.
Creswell, J.W., 2009. Research Design: Qualitative, Quantitative and Mixed Methods
Approaches. Thousand Oaks Sage Publications, California.
Crossan, L., Cole, E., 2013. Nursing challenges with a severely injured patient in critical care.
Nurs. Crit. Care 18 (5), 236–244.
Dalmaso, K., Weber, S., Eley, R., Spencer, L., Cabilan, C.J., 2015. Nurses perceived benefits of
trauma nursing rounds (TNR) on clinical practice in an Australian emergency department: a
mixed method study. Aust. Emerg. Nurs. 18, 42–48.
DeSantis, L., Ugarriza, D.N., 2000. The concept oftheme as used in qualitative nursing research.
WJNR 22 (3), 351–372.
Dodek, P.M., Raboud, J., 2003. Explicit approach to rounds in an ICU improves com munication
and satisfaction of providers. Intensive Care Med. 29, 1584–1588. Frakes, P., 2009. Effective
teamwork in trauma management. Emerg. Nurs. 17 (8), 12–17.
Gardner, G., Woollett, K., Daly, N., Richardson, B., Aitken, L.M., 2010. Innovation in clinical
learning for the acute hospital environment: nursing grand rounds. Nurs. Educ. Today. 30,
737–741.
Gonzalo, J.D., Kuperman, E., Lehman, E., Haidet, P., 2014. Bedside interprofessional rounds:
perceptions of benefits and barriers by internal medicine nursing staff, attending physicians
and housestaff physicians. J. Hosp. Med. 9 (10), 646–651.
Graneheim, U.H., Lundman, B., 2004. Qualitative content analysis in nursing research:
concepts, procedures and measures to achieve trustworthiness. Nurs. Educ. Today 24 (2),
105–112.
Hopstock, L.A., 2008. Motivation and adult learning: a survey among hospital per sonnel
attending a CPR course. Resuscitation 76 (3), 425–430.
Jones, A., Bugge, C., 2006. Improving understanding and rigour through triangula tion: an
exemplar based on patient participation in interaction. J. Adv. Nurs. 55 (5), 612–621.
Kalisch, B.J., Begeny, S.M., 2005. Improving nursing unit teamwork. JON 35 (12), 550–556.
Knowles, M.S., 1990. The Adult Learner: A Neglected Species, fourth ed. Gulf Pub lishing
Company, Houston.
Knowles, M.S., Holton, E.F., Swanson, R.A., 2005. The Adult Learner: The Definitive Classic in
Adult Education and Human Resource Development, sixth ed. Elsevier, Amsterdam.
Laibhen-Parkes, N., Brasch, J., Gioncardi, L., 2015. Nursing grand rounds: a strategy for
promoting evidence—based learning among pediatric nurses. J. Pediatr. Nurs. 30, 338–
345.
Mayer, C., Andrusyszyn, M.-A., Iwasiw, C., 2005. Codman award paper: self-efficacy of staff
nurses for health promotion counselling of patients at risk for stroke. Axon 26 (4), 14–21.
McCullough, A.L., Haycock, J.C., Forward, D.P., Moran, C.G., 2014. Early management of the
severely injured major trauma patient. Br. J. Anaesth. 113 (2), 234–241. Mitchell, M., Chaboyer,
W., Burmeister, E., Foster, M., 2009. Positive effects of a nurs ing intervention on family-
centered care in adult critical care. Am. J. Crit. Care 18 (6), 543–552.
Mitchell, M.L., Courtney, M., 2005. Improving transfer from the intensive care unit: the
development, implementation and evaluation of a brochure based on Knowles’ Adult
Learning Theory. Int. J. Nurs. Pract. 11 (6), 257–268.
F.L. Jennings, M. Mitchell / Intensive and Critical Care Nursing 40 (2017) 35–43 43

Oermann, M.H., Turner, K., Carman, M., 2014. Preparing quality improvement, research, and
evidence-based practice manuscripts. Nurs. Econ. 32 (2), 57–69. Ogrinc, G., Davies, L.,
Goodman, D.,Batalden, P., Davidoff, F., Stevens, D., 2008. SQUIRE 2.0 (standards for quality
improvement reporting excellence): revised publica tion guidelines from detailed consensus
process. BMJ Qual. Saf. 17 (Suppl. 1), i13–i32.
O’Leary, K.J., Buck, R., Fligiel, H.M., Haviley, C., Slade, M.E., Lander, M.P., et al., 2011.
Structured interdisciplinary rounds in amedicalteaching unit.Arch.Intern.Med. 171 (7), 678–
684.
O’Mahoney, S., Mazur, E., Charney, P., Wang, Y., Fine, J., 2007. Use of multidisci plinary
rounds to simultaneously improve quality outcomes, enhance resident education and
shorten length of stay. J. Gen. Intern. Med. 22 (8), 1073–1079.
Rose, L., 2011. Interprofessional collaboration in the ICU: how to define? Nurs. Crit. Care 16 (1),
5–10.
Salentiny-Wrobleski, D.M., Joswiak, E.M., Dunn, D.F., Maxson, P.M., Holland, D.E., 2014.
Discharge planning rounds to the bedside: a patient centered approach. Med. Surg. Nurs.
23 (2), 111–116.
Schiller, W.R., Anderson, B.F., 2003. Family as a member of the trauma rounds: a strategy for
maximised communication. J. Trauma. Nurs. 10 (4), 93–101. Standards for Quality Improvement
Reporting Excellence. http://www.squire statement.org, SQUIRE2.0, (Accessed 04 March 2015).
Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., Reed, J.E., 2014. Systematic review
of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Q.
Saf. 23 (4), 290–298.
Vincent, J.-L., 2005. Give your patient a fast hug (at least) once a day. Crit. Care Med. 33 (6),
1225–1229.