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Patients' views of the ward round: a survey

  • Rupert White (a1) and Bakir Karim (a2)
Abstract
Aims and Method

As part of the total experience of hospital admission, it is important to ensure that ward rounds are efficient and acceptable to patients. Self-completed questionnaires relating to the conduct of the ward round were given to a consecutive series of 100 in-patients admitted to four psychiatric wards serving one half of the population of Cornwall.

Results

Twenty-two patients disliked being seen in their own bedrooms, 54 disliked large ward rounds and three-quarters liked having an exact appointment time. There was a group of patients who felt particularly anxious before or during the ward round.

Clinical Implications

It is important to reconsider the conduct of the ward round, and in so doing to balance the preferences of the patient with the needs of the multidisciplinary team.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Sainsbury Centre (1988) Acute Problems: a Survey of the Quality of Care in Acute Psychiatric Wards. London: Sainsbury Centre for Mental Health.
Seo, M., Tamura, K., Morioka, E. et al (2000) Impact of medical round on patients' and residents' perceptions at a university hospital in Japan. Medical Education, 34, 409411.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Patients' views of the ward round: a survey

  • Rupert White (a1) and Bakir Karim (a2)
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eLetters

Ward rounds: for one or all?

John S. Price, Retired
20 June 2005

Hodgson et al. (2005) point out that little is known about ward roundpractice, and White & Karim (2005) found that 46 out of 100 patients experienced anxiety in relation to ward rounds.

Some years ago in Milton Keynes we tried a communal ward round, whichall available staff and all the team’s in-patients (usually between 6 and 10) attended. After words of welcome and introducing the staff, the patients were told that if they wished to see the team on their own, they could do so at the end of the round, and could either stay till then or come back later (very few patients requested this). Then we went round the patients in turn, and their key worker would report on the week’s progress, discuss medication, level of observation, leave arrangements andplans for discharge

There were several advantages. There was saving of time, as the welcoming and introduction of staff only had to be done once. Also, explanations of drug actions, side-effects and other matters which often affected more than one patient, could be done once for all. Patients had less anxiety, because no one had to go in and confront the team alone, andno one was left wondering when, and even if, he or she would be summoned. An unexpected benefit was the sometimes powerful intervention of fellow patients, for instance if one wanted leave or was reluctant to take medication, sometimes the other patients would try to set him right, saying, for instance, “Do you remember what happened yesterday? That shows you are not ready for leave yet”, and this social pressure from peers was often more effective than advice from the team.

There were some disadvantages. New patients could not be presented in detail because of confidentiality, so they were dealt with at a separate meeting. It was not an appropriate forum for spouses and family members to attend, and they were seen separately.

Most patients preferred the communal meeting, but this may have been because the unit was run on group lines, and, for instance, had a ward meeting every morning, so the patients were accustomed to groups; in another type of setting it might have been less acceptable.

Personally, I found these group ward rounds more efficient and also more enjoyable than seeing patients one by one. My regret is that we did no formal audit. Perhaps someone else might try it.

John Price (Retired) Odintune Place, Plumpton, BN7 3AN (e-mail:johnscottprice@hotmail.com).

HODGSON, R., JAMAI, A. & GAYATHRI, B. (2005) A survey of ward round practice. Psychiatric Bulletin, 29, 171-173.

WHITE, R. & KARIM, B. (2005) Patients’ views of the ward round: asurvey. . Psychiatric Bulletin, 29, 207-209.

Declaration of interest: none

Word count 454
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Conflict of interest: None Declared

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Ward rounds- A New Approach

Partha Gangopadhyay, Senior House Officer
16 June 2005

I read with interest the two articles by Hodgson et al about survey of ward round practice (Psychiatric Bulletin, May 2005, 29, 171-173) and White et al about patients’ views of the ward round (Psychiatric Bulletin,June 2005, 29, 207-209). It was thought provoking to note the views of both consultants as well as service users and this knowledge can enable usto balance the preferences of the patient with the needs of the multidisciplinary team.

Our ward round is usually attended by nursing colleagues, occupational therapy, psychotherapist, social worker, community psychiatric nurses, family therapist, doctors and the patient alone or usually with their representatives. One of the great advantages of having colleagues present from different professions is the ability to have cumulative thoughts regarding care of our patients thus leading to better patient-care. It is also better utilisation of working hours as several minutes which otherwise would have been in lost in contacting or referringpatients to colleagues is thereby avoided.

However one aspect that I feel is probably neglected in our therapeutic approach is addressing the spiritual concerns of our patients.Spirituality is seen by many service users as extremely important in helping them to cope with mental illness. A spiritual assessment performedduring a medical encounter is a practical way to begin incorporating spirituality into medical practice and inviting clinical chaplain/community spiritual leader to our ward rounds can make a start. This will take us nearer towards our goal of providing holistic medical care and probably also satisfy an unexplored need of many of our patients.

(Word Count- 259)

Declaration of Interest- None
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