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format.3,4 Research has even been

conducted to explore whether serv-

ing food affects participation in med-

ical grand rounds.5

The case study format is a pres-entation style that is regaining favor

in both medical grand rounds and

NGRs.6 Presenting a case study of a

particular patient enables nurses to

systematically examine a specific

patient’s episode of care, review the

pathophysiology, evaluate the nurs-

ing care provided, and relate the

“doing” of nursing care to evidence

and science. It further allows nursesto extrapolate nursing care measures

that colleagues can apply to their

nursing practice.

The purpose of this article is to

describe the development of NGRs

guided by a clinical nurse specialist

(CNS) at a large, tertiary-care hospital

and to provide a template for imple-

mentation of NGRs at other hospitals.

BackgroundOur organization began consid-

ering pursuing accreditation from

the American Nurses Credentialing

Center as a Magnet hospital for pro-

viding nursing excellence and qual-

ity care. Through discussions with

staff, it became apparent that our

nurses needed ways to translate

Rochelle R. Armola, RN, MSN, CCRN

Jan Brandeburg, RN, BSN, MNEd

Deb Tucker, RN, MSN

A Guide to DevelopingNursing Grand Rounds

Nursing Grand Rounds

PRIME POINTS

• This debut article inthe Nursing GrandRounds column describesthe development of nurs-ing grand rounds at alarge hospital.

• Nursing grand roundscan be developed on the

basis of an intriguing caseand supported throughevidence-based practice.

• Participation of bed-side nurses should beencouraged in an effort tomentor and support pro-fessional development.

W

ith the evolu-

tion of nursing

as a profes-

sion, nursing

research andevidence-based practice have also

advanced significantly. As many

hospitals are in pursuit of or have

obtained Magnet accreditation, nurs-

ing grand rounds (NGRs) have seen

a resurgence. NGRs are a presenta-

tion given by nurses who share

nursing care and focus on a partic-

ular case or group of cases. NGRs

offer a venue for nurses to meetthe objectives of the Magnet initia-

tive through teaching and profes-

sional development.

Although NGRs have been cited

in the literature since the 1960s,1

not much work has been published

in this area. Some consider that

NGRs may have descended from

medical grand rounds.2 Although

medical grand rounds have endured

over decades, some have had limited

success at attracting participants

and maintaining attendance. Med-

ical journals have addressed the

lack of attendance at medical grand

rounds that use a lecture-by-expert

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Care Nurses doi: 10.4037/ccn2010486

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Magnet concepts to the daily prac-

tice of nursing. The hospital dis-

tilled the Magnet concept to a phrase,

“it’s all about us,” with the “us” being

nursing. Nurses come to work each

day and “do.” Many nurses did not

consider the uniqueness of what theyhave contributed to their patients’

care. When pressed to describe the

essence of daily work in critical care

nursing, a frequent response was

“it’s just what we do.” The question

then became how to facilitate our

bedside nurses’ view of their contri-

butions to patient care as unique

and as demonstrating the art of nurs-

ing. As critical care nurses, we are

participatory and engage in dynamic

processes. We are not passive learn-

ers. The strategy to refocus on the

how and why of nursing would have

to embrace the active style of criti-

cal care nurses.

As we considered how to gener-

ate excitement in the uniqueness of

nursing and engage bedside nurses

in the process, NGRs surfaced as a

strategy. Providing nursing educa-tion and communication in a lecture

format was ingrained in our organi-

zation’s culture. Regardless of the

topic, the attendance at these offer-

ings was paltry, with most of the

attendees being management team

members, not bedside nurses. Lec-

turing to our critical care nurses

about the nursing process and

refining the activities of critical

care nursing as distinct from medi-

cine, yet integrated with it, would

have been the organization’s tradi-

tional approach.

NGRs have existed in variousforms for several decades. Perhaps

NGRs have survived the decades

because of the value and meaning

NGRs have for bedside nurses. Some

publications have also suggested that

regularly scheduled educational

opportunities for nurses are associ-

ated with increased professional-

ism and improved outcomes for

patients.7-9 Wolak et al10 discovered

that presentations in NGRs were

an effective format to improve

knowledge acquisition. Furlong et

al11 identified their NGRs as an

opportunity for nursing expertise

to be shared, a process that pro-

moted professional development.

For all of these reasons, we decided

to try NGRs as a tool to enhance

nursing practice.

The critical care CNSs supportedthe concept of NGRs. We anticipated

doing the bulk of the work for the

first presentation while providing a

role model for and coaching the

bedside nurses. Surprisingly, the

nurses quickly embraced the case

study concept and took ownership

of the presentation. The CNSs

became consultants and mentors to

the bedside nurses who had cared

for the patient being presented in

the case study.

In her textbook From Novice to

Expert ,12 Patricia Benner describes

the expert nurse as providing nurs-ing care without necessarily break-

ing down the steps of that nursing

care. Bedside critical care nurses

provide expert care as evidenced by

beneficial outcomes for patients.

These experts do not break nursing

care into identifiable elements that

can be logically sequenced so that

the “take-aways” can be identified

for colleagues. One of the CNSs’

aims was to use NGRs as a tool to

assist nurses at all levels of expertise

to examine the nursing care given

and break this care into messages

that would be shared with other

nurses and disseminated among

their peers. Benner describes the

use of exemplars to share expert

knowledge and assist nurses to

move through the 5 levels of skill

acquisition: (1) novice, (2) advancedbeginner, (3) competent, (4) profi-

cient, and (5) expert. Portraying

exemplars in the NGRs format fol-

lowed Benner’s idea to enhance

career development and education.12

Initially the nurses tended to

focus on the patient’s medical care

and pathophysiology. Through

mentoring and coaching, nurses

acknowledged the importance of

the medical care while focusing on

the impact of the nursing care on

the patient’s outcome. Nursing care

played a significant role in the

patient being free of permanent

physical deficits, having the patient’s

family remain hopeful and feel sup-

ported, and addressing the psycho-

logical and spiritual needs of both

Rochelle R. Armola is a critical care clinical nurse specialist at The Toledo Hospital inToledo, Ohio.

Jan Brandeburg is a cardiac service line administrator at St Vincent Infirmary in Little Rock, Arkansas.

Deb Tucker is a critical care clinical nurse specialist at The Toledo Hospital in Toledo, Ohio.

Corresponding author: Rochelle R. Armola, RN, MSN, CCRN, The Toledo Hospital, 2142 North Cove Blvd, Toledo,OH 43606 ([email protected]).

To purchase electronic or print reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 8 99-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, [email protected].

Authors

56 CriticalCareNurse Vol 30, No. 5, OCTOBER 2010 www.ccnonline.org








the patient and the patient’s family.

The use of specific exemplars engaged

the bedside nurses in the process of

sharing the patient’s history, review-

ing the pathophysiology and the

medical care, and chronicling the

nursing challenges and the nursinginterventions. They evaluated the

care they had provided and described

the patient’s outcomes.

Design at The ToledoHospital

The Toledo Hospital (TTH) is a

level I trauma center that serves

Northwest Ohio and Southeast

Michigan. It is a tertiary care center

of nearly 800 beds within the highly

integrated ProMedica Health Care

System. The development of NGRs

at TTH grew out of a desire to engage

bedside critical care nurses in pre-

senting interesting or complicated

cases that challenged or rejuvenated

their clinical practice and expertise

in some manner. The presentation

to be developed for NGRs would

then focus on identifying evidence-based practice and ways to improve

patients’ outcomes through nursing

care. With support from the admin-

istrative nursing director of critical

care and chief nursing officer, the

first step taken was to identify the

goals for NGRs and the general

design of the presentations. For TTH,

the original goals centered on recog-

nition of staff members who demon-

strated expertise in the management

of a critical care patient, encourage-

ment of professional development,

and presenting NGRs as an opportu-

nity for learning.

The first NGRs presentation was

delivered in a case study format and

highlighted a fascinating case of a

32-year-old mother of 4 who had

severe sepsis and multiorgan failure.

We actively recruited 2 nurses from

the coronary intensive care unit to

be the first presenters. These 2 nurses

created a strong PowerPoint presen-

tation that highlighted the perspec-

tives of an experienced critical carenurse and a new graduate nurse on

the nursing management and emo-

tional strain in dealing with such a

highly complicated and challenging

case. The administrative nursing

director set an attendance goal of

30 nurses for the first NGR. The

CNSs implemented several strate-

gies to ensure achievement of this

goal. The topic, time, and location

were publicized several weeks in

advance. Each nursing manager

had 4 tickets to the presentation.

The nurse managers were responsi-

ble for having coverage for the unit

so that a minimum of 4 bedside

nurses could attend the hour-long

presentation at lunch time. Further-

more, a continuing education credit

was awarded, lunch was provided

by nursing administration, and raf-fle prizes were donated by staff and

vendors. The small auditorium was

filled to standing room only. Sur-

prisingly, 51 nurses attended our

first NGRs, and we quickly outgrew

our space.

At this first presentation, the

patient and her family were eager

participants. After the presenters

spoke, the patient and her family

recounted aspects of the critical care

experience, which had a powerful

effect on the audience. Nurses com-

mented that having the patient

attend NGRs “humanized” the

experience. Details of this young

mother’s near-death experience and

the nursing care provided left many

nurses tearful and moved by the

presentation. The enthusiasm was

palpable. No one left the presenta-

tion before it concluded. Nurses

stayed to speak with the patient

and her family as well as to congrat-

ulate the presenters. Nurses from

the coronary intensive care unithad stepped up to present the first

NGR and had gained the respect

of their peers.

The goal of having 1 presentation

at NGRs each quarter was achiev-

able because of the enthusiasm of

the critical care nurses in each of

the 5 adult intensive care units.

The excitement of the attendees,

the pride of the presenters, and the

captivating patient scenarios gener-

ated a self-sustaining momentum

among the critical care units. Each

unit began to look for the shining

examples of nursing care that they

wanted to showcase for their col-

leagues. As additional NGRs were

developed in the division of critical

care, interest in sharing a patient’s

story was increasing in other divi-

sions throughout the institution.By the sixth presentation, our NGRs

had encompassed nursing partici-

pants and presenters from the

county emergency medical system,

our emergency department, an

intensive care unit, and the pro-

gressive care unit. By 2009, all

NGRs were presented as TTH

NGRs and no longer by the division

of critical care. A continuing educa-

tion hour has continued; lunch is

provided with vendor support; and

raffle prizes are awarded after the

presentation. Throughout the trans-

formation of NGRs, more specific

goals and tools also were developed

to assist the presenting bedside

nurses. Table 1 outlines the current

goals of NGRs at TTH, and Table 2









highlights a sample guide provided

to the staff nurse for creating the

presentation.

ImplementationRole of the Clinical Nurse

SpecialistWith expansion of NGRs to care

across the continuum, it became

necessary for the 2 critical care

CNSs and 1 progressive care CNS

to form a team to coordinate the

NGRs. The 3 CNSs ensure coordina-

tion of the presentation, vendor

support, lunches, prizes, and atten-

dance. Table 3 provides an example

of a timeline to address requirements

and deadlines, and Table 4 shows a

sample outline for specific assign-

ments that is similar to the process

outlined by Iacono.14

Advertisement and marketing

strategies with flyers and word of

mouth on the units are imperative

to ensure continued healthy atten-

dance. If necessary or requested,

the patient and family who are being

presented are contacted by 1 of theCNSs to obtain an authorization to

disclose health information and to

invite them to attend. Patients

and/or their families are offered the

opportunity to submit pictures for

the presentation or to speak briefly

at the end of the presentation. Com-

pleting the documentation forms to

request a continuing education credit

is another function of the CNSs.

Developing the PowerPoint presen-

tation and giving the presenters

feedback for editing during dry-run

presentations are also accomplished

by this team. To engage the bedside

nurses, the CNSs review the record

of the patient to be presented and

approach nurses who have provided

the care. To promote support for

Table 1 Goals of nursing grand rounds

• Recognize staff who demonstrate expertise in the management of a patient

• Support professional development and growth opportunities

• Enhance the knowledge of the attendees by presenting in a case study format andidentifying “take-away” messages

• Provide bedside staff nurses a learning opportunity to enhance their clinical assessment skills• Build collaboration and respect through cross-unit and cross-division involvement

• Improve retention of experienced nurses and promote pride in the nursing profession

Table 2 Guideline for a presentation during nursing grand rounds

Introduction• Presenters and units involved• Topic and why chosen

Case study• SBAR (situation, background, assessment, recommendations) format13

• Pathophysiology• Nursing diagnosis• Multiple teaching approaches: visual examples, nurses presenting, panel format• Audiovisual: PowerPoint, DVD clips, sound effects, posters, radiology films, etc• Nursing care through the continuum

Nursing challenges encountered• Interdisciplinary involvement• Patient or family challenges

Nursing solutions or approaches used• Directly from the bedside nurses• Outcomes and benefits• Evidence-based practice

Take-away messages• Clinical practice application for nurses

• Positive clinical effects that the care of the patient had on the staff

References for further reading• Available for participants

Table 3 Sample timeline before the date of the presentation at nursing grandrounds

Weeks before presentation

8-10

6-8

5-6

5-6

4-5

2-3

1

Presentation day

Tasks

First meeting, make assignments

First presentation draft completed in PowerPoint or Word;send by e-mail

Title and objectives completed

Meet at 1 PM in classroom to review presentation as a group

Submit contact hour documentation form

Second presentation draft due and full practice runMeet at 1 PM in classroom

Review and make final changes to presentation

Arrive at auditorium at 9:30 AM

- Complete final practice run at 10:30 AM

- Presentation at 12 PM









attendance at meetings, the direc-

tors of the units are notified of nurses

desiring to be involved in the pres-

entation. Collaboration with the

directors of the units helps to pro-

vide flexibility with unit scheduling

for the day of the presentation as

well as attendance at the prepara-

tion meetings.

The CNSs also coordinate with

the audiovisual department tovideotape each presentation. A copy

of the digital video disc is provided

to each presenter and his or her unit

director. Additional discs are main-

tained in the CNSs’ and educators’

offices with notification in newslet-

ters on how to obtain a copy for

viewing. Audiovisual personnel also

assist with the computer, video, and

sound system setup the day of the

presentation.

Evaluation of the presentation’s

objectives and each speaker’s rating

on knowledge, content, and teach-

ing methods is compiled after each

NGRs. Feedback is provided by the

CNSs to the staff nurse presenters,

and areas are identified where

improvements can be made for

future NGRs. Modifications havebeen made on the basis of the eval-

uations to enhance each subse-

quent presentation.

Role of the Staff Nurse

Once the nurse presenters are

identified, an initial meeting is

arranged to plan the presentation

and divide the work. Deadlines and

meeting dates are set at the initial

meeting. The bedside nurses must

commit time to attend scheduled

meetings. Guidelines for the pres-

entation are given to the nurses

(Table 2). They need to review the

chart and develop a portion of the

case presentation. They are given

the option of submitting their part

in Microsoft Word or PowerPoint.

It takes a commitment to rehearsetheir segment of the presentation in

their spare time. Each nurse is given

support in the form of mentoring

from a CNS because it is often their

first experience of speaking to a

large audience. Peers or patient care

supervisors often provide care for

the nurses’ patients to facilitate

attendance at practice sessions.

Table 4 Sample assignment outline for a peripartum cardiomyopathy case

Abbreviations: CNS, clinical nurse specialist; RN, registered nurse.

Specific assignment Person responsible Presentation time goal, min Due date

Medical intensive care unit (MICU)Pathophysiology, MICU admission

MICU RN 10 August 3, 1st draftSeptember 1, 2nd draft

Labor and delivery (L&D)Fetus concerns and pathophysiology,

L&D care in ICU

2 L&D RNs 10

Surgical ICU (SICU)Postoperative care of peripartum cardiomyopathy

patient

SICU RN 5

Progressive care unit (PCU)Progressive care of peripartum cardiomyopathy

patient

PCU RN 8

Coronary ICU (CICU)Heart failure readmission, air ambulance to

outlying transplant center

CICU RN 5

Emergency center (EC)Third heart failure admission, transfer to transplant

center, left ventricular assist device education,heart transplant

EC RN and EC educator 10

Contact patient’s family and obtain medical recordrelease if needed

CNS July 16

PowerPoint, pulling together CNS August 10

Continuing nursing education request CNS August 17

Vendor confirmation CNS August 31

Flyer, handouts Clerical/CNS assist August 14, September 11

Presentation day All September 14









Although preparing for NGRs seems

like a great deal of extra work for a

nurse to do, nurses who have been

involved in the process have described

feelings of pride and satisfaction

with the experience.

Budget

Many institutions are often faced

with a struggle to promote nursing

education yet be fiscally responsible,

and the CNSs at TTH were cognizant

of this dilemma. CNSs are generally

in an excellent position because of

the educational component of their

role to speak with vendors and

administrators seeking assistance

with the cost of such events. It isimperative, however, to check with

your state board of nursing or pri-

mary nurse planner for your contin-

uing nursing education provider

unit to identify any regulations that

are required for commercial support

for a continuing education presenta-

tion. Although it is the responsibil-

ity of the representative from a

company to be aware of specific reg-

ulations set forth by the government

and his or her employer, it is also

helpful for the coordinator of NGRs

to be aware of these regulations to

avoid placing such potential bene-

factors in a compromising situation.

Currently, our NGRs are con-

ducted in a manner similar to many

nursing conferences with audiovi-

sual support, and they are held in a

large education center auditorium

that accommodates up to 200 people.

Vendor displays and nursing poster

presentations are arranged outside

the auditorium for review before

and after the presentation. Staff who

are doing ongoing nursing researchand performance improvement

projects are invited to display posters

outlining their results.

At least 2 months in advance, a

letter is sent to several vendors and

potential poster presenters inform-

ing them of the upcoming NGRs.

Support from vendors is requested

in the form of a display table fee,

provision of lunches for the nurses,

or providing gifts to be raffled. The

money obtained from the table fees

is used to purchase lunches from

the hospital cafeteria or raffle items

from the hospital gift shop. Lunches

are best supplied as a boxed meal.

Boxed lunches help expedite move-

ment of a large number of attendees

into the auditorium without long

lines while trays of hot food become

cold. From the vendors’ table fees, a

small budget can be built; this money

can provide resources when vendor

support may be lower in a particu-

lar month, for example, at the end

of the year.

Benefits and OutcomesOur institution has seen high

attendance levels among nurses and

moderate levels of attendance among

other health care professionals such

as physicians, respiratory therapists,

speech pathologists, hospital chap-

lains, and local firefighters and

paramedics. Figure 1 includes the

N o .

o f p e r s o n s

180

160

140

120

100

80

60

40

20

0

Sepsis Pulmonaryarterial

hypertension

HypothermiaTraumaTraumaticbrain injury

Cardiactamponade

Organdonation

Peripartumcardiomyopathy

Figure 1 Attendance at nursing grand rounds.

Total registered nurses Total attendance









exceptionally highly when reviewed.

Each presentation has received a

basic evaluation from the individual

attendees to determine if objectives

were met and to rate the presenters

on a Likert scale from 4 (excellent)

to 1 (poor). Figure 2 illustrates the

overall high satisfaction with the

presenter’s knowledge, content pre-

sented, and teaching effectiveness.We also have nurses attend during

their hospital orientation program

to promote nursing professionalism.

In addition to the excellent evalua-

tions, when bedside nurses approach

us to share an interesting patient

case and request it be a future NGRs

presentation, we know that the pro-

gram has been a success. Implemen-

tation of NGRs has afforded us anadditional step to support our insti-

tution on the journey to Magnet sta-

tus. Our Magnet core team is using

NGRs as an example of activities

that support some of the model

components of Magnetism such as

exemplary professional practice and

new knowledge, innovations, and

improvement.

Future Directions/Recommendations

Given the success of our current

NGRs, we plan to continue the

conference style with the bedside

nurses as the presenters. Consider-

ation is being made for the next

NGRs to be more interactive, with

questions and answers entwined

throughout the presentation.Monthly NGRs have been dis-

cussed as an option, but a concern

was to avoid losing the desired

effect and excitement for the atten-

dees. Some institutions do success-

fully complete monthly NGRs, and

this option may be feasible in the

future as clinical support increases.

Expanding the scope of NGRs to

other hospitals and services offeredwithin the ProMedica Health Sys-

tem is planned for the future. Ideas

include presenting a case that

involves a patient who starts at

one of our smaller hospitals, is

transferred to TTH (our tertiary

care hospital), and is discharged to

our rehabilitation facility. An

option being considered for review

total attendance and the attendance

among staff nurses at NGRs up to

the date of submission of this arti-

cle. The high attendance by staff

nurses and the presentation by bed-

side nurses have promoted profes-

sional development at our hospital.

Not only is it exciting to mentor

a bedside nurse to complete a pres-

entation for the first time, NGRsalso enhance patient care delivery

by advancing the knowledge of all

attendees. After a detailed case

description and a review of evidence-

based practice, take-away messages

are discussed at the end of the pres-

entation. The messages capture those

important pieces of nursing care that

you want other nurses to learn from

your experience. Different nursingspecialties have been highlighted,

for example, cardiac, labor and

delivery, trauma, and pulmonary

nurses. This diversity enhances learn-

ing and mutual respect for colleagues

who practice in other clinical areas.

Although most presenters at

our NGRs are novice speakers, our

presentations have been rated

S c o r e

o n

L i k e r t s c a l e

4.0

3.5

3.0

2.5

2.0

1.5

1.0

Figure 2 Attendees’ overall evaluation of presentations during nursing grand rounds.

Knowledge Content Teaching effectiveness

Sepsis Pulmonaryarterial

hypertension

HypothermiaTraumaTraumaticbrain injury

Case presented during nursing grand rounds

Cardiactamponade

Organdonation

Peripartumcardiomyopathy









would capitalize on eICU, ProMed-

ica’s unique perspective as an

adjunctive critical care telemedicine

program. Examination of its ability

to facilitate transfer from the com-

munity hospital ICU to the tertiary

care ICU has been proposed, butalso looking at its role before, dur-

ing, and after transfer.

The current literature reveals lit-

tle in the area of research related to

NGRs. Conducting nursing research

to evaluate the effects of NRGs on

obtaining the goals identified is

another possible direction for the

future. Evaluating different formats

for presentations and staff satisfac-

tion with NGRs (presenters and

attendees) would also be addi-

tional options to research. Potential

research questions could examine if

NGRs promote retention of nursing

staff, including both nurses who

give presentations and nurses who

attend them. Additionally, a survey

could be provided to nurses who

attend NGRs to examine further

whether format, objectives, topics,and the discussion met their learn-

ing needs. Effectiveness to change

practice on the basis of knowledge

enhancement from NGRs presenta-

tions could be evaluated through a

pretest/posttest design.

Conclusion NGRs at TTH were initially

established to help us attain Magnet

status, and these presentations have

far exceeded our expectations. The

use of a team of CNSs to facilitate

coordination of a conference style

program and mentor bedside nurses

as they plan the presentation of

nursing care across the continuum

has been very successful. Continued

staff involvement, administrative

support, and assistance from vendorshave taken the idea of NGRs from a

plan to a flourishing activity. CCN

Financial Disclosures None reported.

References1. Mercadante RV. Nursing grand rounds.

Nurs News. 1964;12:33-36.2. Lannon S. Nursing grand rounds: promoting

excellence in nursing. J Nurs Staff Dev. 2005;21(5):221-226.

3. Mueller PS, Litin SC, Sowden ML, et al.Strategies for improving attendance at med-ical grand rounds at an academic medicalcenter. Mayo Clin Proc. 2003;78:549-553.

4. Martin M. Grand rounds: what is the point? J Obstet Gynaecol Can. 2005;27(5):511-514.

5. Segovis CM, Mueller PS, Rethlefsen ML, et al.If you feed them, they will come: a prospec-tive study of the effects of complimentaryfood on attendance and physician attitudesat medical grand rounds at an academic med-ical center. BMC Med Educ. 2007;7(22):1-6.

6. Hebert RS, Wright SM. Re-examining thevalue of medical grand rounds. Acad Med.2003;78(12):1248-1252.

7. Bibb S, Malebranche M, Crowell D, et al.Professional development needs of regis-tered nurses practicing at a military com-munity hospital. J Contin Educ Nurs. 2003;34(1):39-48.

8. Tang J. Evidence-based protocol: nurseretention. J Gerontol Nurs. 2003;29(3):5-14.

9. Vaughn R. Simple steps to satisfaction. Nurs Manag. 2003;34(15):20-24.

10. Wolak ES, Cairns B, and Smith E. Nursinggrand rounds as a medium for the continu-ing education of nurses. J Contin Educ Nurs.2008;39(4):173-178.

11. Furlong KM, D’Luna-O’Grady L, Macari-Hinson M, et al. Implementing nursinggrand rounds in a community hospital.Clin Nurs Spec. 2007;21(6):287-291.

12. Benner P. In: From Novice to Expert: Excellenceand Power in Clinical Nursing Practice. Com-memorative edition. Upper Saddle River, NJ:Prentice-Hill, Inc; 2001:13-41,173-194.

13. Haig KM, Sutton S, Whittington J. SBAR:a shared mental model for improving com-munication between clinicians. Joint Comm J Qual Patient Safety. 2006;32(3):167-175.

14. Iacono MV. Showcasing nursing talent:nursing grand rounds. J Perianesth Nurs.2008;23(5):349-354.

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Just visit www.ccnonline.org and click “Respond toThis Article” in either the full-text or PDF view of the article.

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Nursing Rounds” by Jodi E. Mullen in Crit-ical Care Nurse, 2002;22:66-68. Available atwww.ccnonline.org.








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Rochelle R. Armola, Jan Brandeburg and Deb TuckerA Guide to Developing Nursing Grand Rounds

Published online http://www.cconline.org© 2010 American Association of Critical-Care Nurses

2010, 30:55-62. doi: 10.4037/ccn2010486Crit Care Nurse

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