Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey

Nurses' experience of integrating evidence-based changes into their practice: A qualitative study

AIM

To explore the experiences of neonatal and NICU nurses on participating in evidence-based changes in their neonatal pain management practice.

DESIGN

It is a qualitative conventional content analysis.

METHODS

A purposive sample with nurses working in neonatal and NICUs was used. The data were collected through 11 semi-structured in-depth individual interviews, five focused group discussions, and observations and analyzed using the conventional content analysis method based on the Elo and Kyngäs model. The COREQ checklist was used for writing the report.

RESULTS

Analysis of gathered data led to the emergence of four themes, including 'being in a supportive and encouraging atmosphere', 'a journey from resistance to adherence', 'achieving multi-dimensional improvements', and 'facing obstructive challenges'.

Shift change handovers between nurses in Critical Care Units

AIM

To know the characteristics of the handover performed by nurses working in Critical Care Units in Spain.

METHODS

Descriptive and cross-sectional study, whose population was nurses working in Critical Care Units in Spain. An ad hoc questionnaire was used to explore the characteristics of the process, the training received, the information forgotten and the influence of this activity on patient care. The questionnaire was online and dissemination was done through social networks. The sample was selected by convenience. A descriptive analysis was performed according to the nature of the variables and comparison of groups through ANOVA with R software version 4.0.3 (R Project for Statistical Computing).

RESULTS

The sample was 420 nurses. Most of them answered that (79,5%) perform this activity in an individual way, from outgoing nurse to incoming nurse. Location varied according to the size of the unit (p<0,05). Interdisciplinary handover was rare (p<0.05). In the last month, with regard to the time of data collection, 29,5% had to contact the unit due to forgetting relevant information, using WhatsApp as the first channel to transmit this information.

CONCLUSIONS

There is a lack of standardization in the handoff between shifts, in terms of the physical space where it is done, tools to structure the information, participation of other professionals and the use of unofficial communication channels to contact for omitted information during the handover. Shift change was identified as a vital process to ensure continuity of care and patient safety, so further researchs are important for patients handoffs.

Informing the standardising of care for prolonged stay patients in the ICU: A scoping review of quality improvement tools

OBJECTIVES

To inform design of quality improvement (QI) tools specific to patients with prolonged intensive care unit (ICU) stay, we determined characteristics (format/content), development, implementation, and outcomes of published multi-component QI tools used in ICU irrespective of length of stay.

RESEARCH METHODOLOGY

Scoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022).

RESULTS

We screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at ICU admission except 3 tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles, and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes QI tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %), and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect - increased ICU length of stay and increased ICU days with pain and delirium.

CONCLUSION

Although we identified numerous QI tools for use in ICU settings, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged ICU stay patients. Tools that address these needs are urgently required.

SYSTEMATIC REVIEW REGISTRATION

The review protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE.

Measuring Nurses' Transition to Electronic Handover: Validation of the Perception and Adaptation Readiness of Electronic Handover Systems Scales

The transition from traditional handover methods to electronic handover is extremely stressful to nurses. This psychometric evaluation study tested the validity and reliability of the perception and adaptation readiness of electronic handover system scales for hospital nurses. A total of 253 Taiwanese nurses from a medical center participated in this study from January to March 2018. The perception and adaptation readiness of electronic handover system scales were self-developed, and content validity was tested via content validity index of the scale. Exploratory factor analysis and confirmatory factor analysis were utilized to test construct validity, while reliability was tested by Cronbach's α coefficient. Four factors explained 50.77% of the total variance in the perception of electronic handover system scale. Three factors accounted for 53.43% of the total variance in the adaptation readiness of electronic handover system scale. The confirmatory factor analysis results indicated a three-factor construct for both scales. Cronbach's α coefficients were 0.83 and 0.91 for the perception and adaptation readiness of the electronic handover system scale, respectively. The scales could be used to assess nurses' perceptions and adaptation readiness of electronic handover, while the assessing result serves as a reference for implementing educational and supportive interventions to facilitate adaptation in nurses.

Implementation of an Evidence-Based Practice Nursing Handover Tool in Intensive Care Using the Knowledge-to-Action Framework

BACKGROUND

Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, standardized handover tools for nursing team leaders (TLs) in intensive care are limited.

AIMS

The study aim was to implement and evaluate an evidence-based electronic minimum data set for nursing TL shift-to-shift handover in the intensive care unit using the knowledge-to-action (KTA) framework.

METHODS

This study was conducted in a 21-bed medical-surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in TL handover were recruited. Three phases of the KTA framework (select, tailor, and implement interventions; monitor knowledge use; and evaluate outcomes) guided the implementation and evaluation process. A postimplementation practice audit and survey were carried out to determine nursing TL use and perceptions of the electronic minimum data set 3 months after implementation. Results are presented using descriptive statistics (median, IQR, frequency, and percentage).

RESULTS

Overall (86%, n = 49), TLs' use of the electronic minimum data set for handover and communication regarding patient plan increased. Key content items, however, were absent from handovers and additional documentation was required alongside the minimum data set to conduct handover. Of the TLs surveyed (n = 35), those receiving handover perceived the electronic minimum data set more positively than TLs giving handover (n = 35). Benefits to using the electronic minimum data set included the patient content (48%), suitability for short-stay patients (16%), decreased time updating (12%), and printing the tool (12%). Almost half of the participants, however, found the minimum data set contained irrelevant information, reported difficulties navigating and locating relevant information, and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface.

LINKING EVIDENCE TO ACTION

Prior to developing and implementing electronic handover tools, adequate infrastructure is required to support knowledge translation and ensure clinician and organizational needs are met.