Contextual Factors and Intentional Rounding in Acute Hospitals: Understanding What Works, for Whom, in What Settings: A Realist Synthesis
4 affiliations
- 1Royal College of Surgeons in Ireland (RCSI), School of Postgraduate Studies RCSI University of Medicine and Health Sciences Dublin Ireland
- 2Healthcare Outcomes Research Centre RCSI University of Medicine and Health Sciences Dublin Ireland
- 3School of Physiotherapy RCSI University of Medicine and Health Sciences Dublin Ireland
- 4Graduate School of Healthcare Management RCSI University of Medicine and Health Sciences Dublin Ireland
Abstract
Aim: To synthesise published literature to understand how, when and under what circumstances Intentional Rounding in acute hospital settings improves patient safety and make recommendations for implementation in real‐world settings.
Background: Inpatient falls often result in injury due to complex interactions between the hospital environment and patient risk factors. Intentional Rounding (IR) is a structured process whereby nurses and care staff carry out regular checks with individual patients to address their needs in hospital.
Design: Realist Synthesis.
Methods: Searches were conducted in six bibliographic databases until February 2026. A total of 34 studies were included, and 18 references from grey literature were appraised and included.
Results: Fourteen initial programme theories were identified and refined throughout the synthesis to identify five mechanisms which support implementation of IR in an acute hospital setting, with six programme theories developed. The mechanisms included motivation, accountability, engagement, consistency, comprehensiveness, and critical thinking. Contextual factors that may constrain the implementation of IR include the organisational support and availability of resources. Based on our findings, we have seven recommendations for consideration when designing and implementing an IR programme in the acute hospital setting.
Conclusion: This synthesis has provided programme theories and recommendations that can guide research design when implementing an intervention at ward level.
Implications for the Profession and Patient Care: IR has been used in hospitals as an intervention to improve patient safety and reduce adverse events, such as falls.
Reporting Method: Realist And Meta‐narrative Evidence Syntheses: Evolving Standards (RAMESES—1).
Patient or Public Consultation: An in‐person stakeholder engagement workshop was facilitated in March 2025, with patient representatives, hospital staff and members of the public. This engagement assisted the process of theory refinement to ensure research findings were clear and useful for those involved in providing and receiving IR in a hospital setting.
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BibTeX
@article{hetherton2026contextual,
title = {{Contextual Factors and Intentional Rounding in Acute Hospitals: Understanding What Works, for Whom, in What Settings: A Realist Synthesis}},
author = {Aileen Hetherton and Jan Sorensen and Frances Horgan and Siobhan McCarthy},
journal = {Journal of Clinical Nursing},
year = {2026},
month = jul,
doi = {10.1111/jocn.70458},
url = {https://doi.org/10.1111/jocn.70458},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Contextual Factors and Intentional Rounding in Acute Hospitals: Understanding What Works, for Whom, in What Settings: A Realist Synthesis
AU - Aileen Hetherton
AU - Jan Sorensen
AU - Frances Horgan
AU - Siobhan McCarthy
PY - 2026
DA - 2026/07/21
JO - Journal of Clinical Nursing
DO - 10.1111/jocn.70458
UR - https://doi.org/10.1111/jocn.70458
AB - Aim: To synthesise published literature to understand how, when and under what circumstances Intentional Rounding in acute hospital settings improves patient safety and make recommendations for implementation in real‐world settings. Background: Inpatient falls often result in injury due to complex interactions between the hospital environment and patient risk factors. Intentional Rounding (IR) is a structured process whereby nurses and care staff carry out regular checks with individual patients to address their needs in hospital. Design: Realist Synthesis. Methods: Searches were conducted in six bibliographic databases until February 2026. A total of 34 studies were included, and 18 references from grey literature were appraised and included. Results: Fourteen initial programme theories were identified and refined throughout the synthesis to identify five mechanisms which support implementation of IR in an acute hospital setting, with six programme theories developed. The mechanisms included motivation, accountability, engagement, consistency, comprehensiveness, and critical thinking. Contextual factors that may constrain the implementation of IR include the organisational support and availability of resources. Based on our findings, we have seven recommendations for consideration when designing and implementing an IR programme in the acute hospital setting. Conclusion: This synthesis has provided programme theories and recommendations that can guide research design when implementing an intervention at ward level. Implications for the Profession and Patient Care: IR has been used in hospitals as an intervention to improve patient safety and reduce adverse events, such as falls. Reporting Method: Realist And Meta‐narrative Evidence Syntheses: Evolving Standards (RAMESES—1). Patient or Public Consultation: An in‐person stakeholder engagement workshop was facilitated in March 2025, with patient representatives, hospital staff and members of the public. This engagement assisted the process of theory refinement to ensure research findings were clear and useful for those involved in providing and receiving IR in a hospital setting.
SN - 0962-1067
SN - 1365-2702
ER -