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Ireland’s physicians have a legal and an ethical duty to protect confidential patient information. Most healthcare records in Ireland remain paper based, so the purpose of this paper is to: assess the protection afforded to paper records; log highest risk records; note the variations that occurred during the working week; and observe the varying protection that occurred when staff, students and public members were present.

A customised audit tool was created using Sphinx software. Data were collected for three months. All wards included in the study were visited once during four discrete time periods across the working week. The medical records trolley’s location was noted and total unattended medical records, total unattended nursing records, total unattended patient lists and when nursing personnel, medical students, public and a ward secretary were visibly present were recorded.

During 84 occasions when the authors visited wards, unattended medical records were identified on 33 per cent of occasions, 49 per cent were found during weekend visiting hours and just 4 per cent were found during morning rounds. The unattended medical records belonged to patients admitted to a medical specialty in 73 per cent of cases and a surgical specialty in 27 per cent. Medical records were found unattended in the nurses’ station with much greater frequency when the ward secretary was off duty. Unattended nursing records were identified on 67 per cent of occasions the authors visited the ward and were most commonly found unattended in groups of six or more.

This study is a timely reminder that confidential patient information is at risk from inappropriate disclosure in the hospital. There are few context-specific standards for data protection to guide healthcare professionals, particularly paper records. Nursing records are left unattended with twice the frequency of medical records and are found unattended in greater numbers than medical records. Protection is strongest when ward secretaries are on duty. Over-reliance on vigilant ward secretaries could represent a threat to confidential patient information.

While other studies identified data protection as an issue, this study assesses how data security varies inside and outside conventional working hours. It provides a rationale and an impetus for specific changes across the whole working week. By identifying the on-duty ward secretary’s favourable effect on medical record security, it highlights the need for alternative arrangements when the ward secretary is off duty. Data were collected prospectively in real time, giving a more accurate healthcare record security snapshot in each data collection point.

The purpose of this paper is to examine power relations embedded in verbal and non-verbal medication communication processes that involve nurses, doctors, pharmacists and patients in two general medical wards of an acute care hospital.

This paper reports on the findings of an ethnographic study investigating medication communication processes in hospital spatial environments. It was theoretically informed by the work of Norman Fairclough. Data collection methods comprising video-recordings and video reflexive focus groups were employed. Fairclough's critical discourse analytic framework guided data analysis.

Four different forms of power relations between clinician-patient, nurse-doctor, clinician-organisation and multidisciplinary interactions were uncovered. Nurses asserted their professional autonomy when communicating with doctors about medications by offering specific advice on medical prescribing and challenging medication decisions. Video reflexivity enabled nurses to critically examine their contribution to medication decision-making processes. Clinicians of different disciplines openly contested the organisational structure of patient allocation during medical discussions about management options. Clinicians of different disciplines also engaged in medication communication interchangeably to accomplish patient discharge.

An investigation of existing power relations embedded in medication communication processes within specific clinical contexts can lead to a better understanding of medication safety practices. Video reflexive focus groups are helpful in encouraging clinicians to reflect on their practice and consider ways in which it could be improved in how power relations are played out.

The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants’ perception of each other’s role during the respective ward rounds.

A literature review of face-to-face ward rounds in medical wards was conducted. Peer reviewed journals and government publications published between 2000 and 2014 were searched. Articles were classified according to the type of round described in the study. Purposes were identified using keywords in the description of why the round was carried out. Descriptions of tasks and interactions with team members defined participant roles.

Eight round classifications were identified. The most common were the generalised ward; multidisciplinary; and consultant rounds. Multidisciplinary rounds were the most collaborative round. Medical officers were the most likely discipline to attend any round. There was limited reference to allied health clinicians and patient involvement on rounds. Perceptions attendees held of each other reiterated the need to continue to investigate teamwork.

A collaborative approach to care planning can occur by ensuring clinicians and patients are aware of different ward round processes and their role in them.

Analysis fulfils a gap in the literature by identifying and analysing the different ward rounds being undertaken in acute medical wards. It identifies the complexities in the long established routine hospital processes of the ward round.

In the changing environment of the National Health Service (NHS) medical ward rounds have become increasingly complex. With complexity comes the inevitable risk that things will go wrong. Serious failures in care can have important consequences for individual patients, their families, cause distress to health care staff and undermine public confidence in the NHS. The paper's aim is to introduce the concept of a medical ward round considerative checklist to improve ward round processes, effectiveness, reliability and efficiency, aid team working and foster better communication.

The checklist includes aspects of ward round preparation, the consultation, progress assessment, discharge planning and handover. It is a “considerative checklist” as it not simply checking if an essential component has been done but rather that it has been considered, discussed, action identified and communicated effectively and involves an “at the point of care check and correct” process.

The introduction of the checklist has provided a systemic approach to medical ward rounds, provided reassurance that quality care is given, aided active participation from all health care professionals and reignited team work. It has streamlined handover, improved patient and professional communication, improved medical documentation and provided an audit tool for ongoing improvement.

The diversity of general medicine makes standard measures of quality of care such as length of stay, morbidity and mortality outcomes hard to measure; however, qualitative data can be obtained.

The authors have developed a systemic ward round approach which ensures attention to quality and safety at the point of care, encourages team working and improvements can be documented.

This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds.

A purpose-designed survey was conducted in two acute medical and two rehabilitation wards from a metropolitan teaching hospital. Medical officers, nurses and allied health professionals participated. To understand characteristics that support collaborative ward rounds, questions developed from literature and industry experience asked: what are the enablers and challenges to teamwork; and what are clinicians’ experiences of positive teamwork? Descriptive and thematic analyses were applied to the dimensions of effective teamwork as a framework for deductive coding.

Seventy-seven clinicians participated (93% response rate). Findings aligned with dimensions of teamwork framework. There was no meaningful difference between clinicians or specialty. Enablers to teamwork were: effective communication, shared understanding of patient goals, and colleague’s roles. Challenges were ineffective communication, individual personalities, lack of understanding about roles and responsibilities, and organisational structure. Additional challenges included: time; uncoordinated treatment planning; and leadership. Positive teamwork was influenced by leadership and team dynamics.

Ward rounds benefit from a foundation of collaborative teamwork. Different dimensions of teamwork present during ward rounds support clinicians’ shared understanding of roles, expectations and communication.

Rounds such as structured rounding, aim to improve teamwork. Inverting this concept to first develop effective collaboration will support team adaptability and resilience. This enables teams to transition between the multiple rounding processes undertaken in a single ward. The emphasis becomes high-quality teamwork rather than a single rounding process.

The purpose of this paper, in the context of hospital wards, is to test a model in which the ward manager's orientation towards a given organizational climate contributes to determine the climate perceived by medical and nursing staff, and this, in turn, has an impact on patient satisfaction.

The design of the study is cross‐sectional. The manager's climate orientation, employee perceptions of organizational climate, and patient satisfaction questionnaires were administered to ward managers, medical staff, and inpatients in 57 wards belonging to ten public hospitals in Italy. The hypothesised model was tested using two‐level structural equation modelling.

Different climates impact on patient satisfaction in a different way. Evidence was found that a human relation climate augments patient satisfaction. Ward managers' orientation on specific organizational models is matched by the actual climate perceived by medical and nursing staff. Comparison between alternative nested models shows that there is evidence in favour of the mediating effect of climate between the managers' climate orientation and patient satisfaction.

The main limitation of the paper is the cross‐sectional nature of the data set, which does not allow for definitive conclusions on the direction of causality links.

Understanding the link between climate and patient satisfaction may guide hospitals towards a more conscious selection of the appropriate organizational model.

The contribution of the present paper to the extant literature is twofold. First, it verifies whether the ward manager's climate orientation is matched by the organizational climate as perceived by subordinates. Second, it investigates the mediating role that organizational climate plays between ward managers' orientations and patient satisfaction.

While there is considerable anecdotal evidence and some research indicating poor nutritional intake and high levels of food wastage in hospitals, there have been no studies relating these issues to the catering system used. The overall purpose of this study was, therefore, to measure food wastage and nutritional intake in selected hospital catering systems. Data were collected from three types of ward (elderly, medical and surgical) in four hospitals (nine wards), two in London and two in Southern England. Three wards used food cooked mainly in the hospital kitchen, six used cook‐chill and cook‐freeze dishes bought in ready prepared. Five of the wards used a bulk system where food is transported to the ward and plated, in the others, food is plated in the hospital kitchen then transported to the ward. Food sent to the ward, served to patients, and that which remained uneaten or left on the service trolley was weighed for a minimum of 24 hours in each ward; 966 patient‐meal‐days. This data enabled food wastage and nutritional intake to be calculated. Results indicate that food wastage was lower at the breakfast meal, than the midday and evening meal, 23.10 per cent, 39.99 per cent and 42.35 per cent, respectively; female wastage was higher than male, 33.91 per cent and 27.26 per cent, respectively; wastage was higher where food was plated in wards rather than in the kitchen, 57.75 per cent and 35.28 per cent, respectively; and wastage was higher where food was purchased‐in ready prepared, rather than prime cooked in the hospital kitchen. Nutritional intake was calculated for five wards and in all, energy intake was below the recommendations, the highest deficit being 58 per cent. Deficiencies were also noted for other nutrients.

This exploratory study investigated patients’ satisfaction with nursing care at a major teaching hospital in Jordan. A total of 266 in‐patients participated in the study. Patients were recruited from the medical, surgical, and gynecological wards. Pearson correlation, one‐way analysis of variance, and logistic regression analyses were used. The findings showed that patients in surgical wards had lower levels of satisfaction than patients in medical or gynecological wards. Gender, educational level, and having other diseases were significant predictors for patients’ satisfaction with nursing care. Methodological challenges, implications to nursing practice, and recommendations to nursing research are discussed.

The purpose of this paper is to investigate a boundary spanning, interprofessional collaboration between advanced practice nurses (APNs) and junior doctors to support junior doctors’ learning and improve patient management during the overtime shift.

A mixed methods evaluation of an intervention in an adult tertiary referral hospital, to enhance interprofessional collaboration on overtime shifts. Phase 1 compared tasks and ward rounds on 86 intervention shifts with 106 “regular” shifts, and examined the effect on junior doctor patient management testing a model using regression techniques. Phase 2 explored the experience of the intervention for stakeholders. 91 junior doctors participated (89 percent response rate) on 192 overtime shifts. Junior doctors, APNs and senior medical professionals/administrators participated in interviews.

The intervention was associated with an increase in self-initiated ward rounds by junior doctors, partially explained by junior doctors completing fewer tasks skilled nurses could also complete. The intervention significantly reduced doctors’ engagement in tasks carried over from day shifts as well as first year (but not more experienced) junior doctors’ total tasks. Interviews suggested the initiative reduced junior doctors’ work pressure and promoted a safe team climate, situation awareness, skills, confidence, and well-being.

Junior doctors overtime shifts (5 p.m. to 11 p.m.) are important, both for hospitals to maintain patient care after hours and for junior doctors to learn and develop independent clinical decision making skills. However, junior doctors frequently report finding overtime shifts challenging and stressful. Redesigning overtime shifts to facilitate interprofessional collaboration can improve patient management and junior doctors’ learning and well-being.

The study presents the principal results of a survey into patient information needs and satisfaction levels in a large general hospital as part of a feasibility study on the provision of a patient information service. The background to the survey is the change in the patient/doctor relationship to one of consumer/supplier, coupled with the growing awareness of the importance of patient education and information as a form of preventive medicine. The survey found that information given prior to admission increased satisfaction rates for information provision generally, but also led to more questions being asked during the stay in hospital. Patients were given information freely, though there are slight gender differences, and there is a preference for verbal rather than written information from doctors. There are implications for patient information services. A range of patient resources is provided by wards, but there are problems of co‐ordination of supply and the human resources needed to manage them effectively.