Patient participation in nursing bedside handover: A systematic mixed-methods review

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study

AIM

To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention.

DESIGN

A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions.

METHODS

We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact.

RESULTS

Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information.

CONCLUSION

Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists.

RELEVANCE TO CLINICAL PRACTICE

Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change.

REPORTING METHOD

We adhered to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

We interviewed patients on study wards pre and post intervention.

Patients involvement in the discharge process from hospital to home: A patient's journey

AIMS

The aims of the study were to gain insight in the transfer process from hospital to homecare or rehabilitation centre from a patient's perspectives and to describe the experienced involvement, information provision and information needs patients.

DESIGN

A multiple case study with a phenomenological approach.

METHODS

Observations and interviews were employed, between May 2019 and August 2019, to capture the patient's perspectives and experiences on involvement, information provision and needs. Observations were executed during the discharge process from hospital to homecare (n = 6) or revalidation centre (n = 1) and during admission interviews with community nurses (n = 6). Interviews were conducted at the patient's home and the revalidation centre.

RESULTS

Eight themes were identified within three phases of the transfer process. The Sign-up phase contained two themes: 'organizing follow-up care' and 'planning the moment of discharge from the hospital'. The two themes in the Transfer phase were, 'verbal information provision' and 'written information provision'. Four themes were identified in the End phase: 'nursing supplies', 'medication', 'the electronic patient portal' and 'continuation of (para)medical care'.

CONCLUSIONS

Patient participation in the transition process from the hospital to follow-up care can be improved. This study indicates that unsafe situations could be prevented by patient involvement and clear perceptions of the role and responsibilities of patients, family and healthcare professionals.

IMPLICATIONS TO PATIENT CARE

Patient and family involvement has the potential to improve transition of care and techniques for shared decision-making can be applied to a greater extent.

IMPACT

This paper highlights that patients and families should be acknowledged as key figures in the transfer process and gives direction to healthcare professionals on how to increase involvement in the transfer process by actively inviting patients to participate in the transfer process.

REPORTING METHOD

COREQ guidelines for qualitative reporting. No patient or public contribution.

CONTRIBUTION TO GLOBAL CLINICAL COMMUNITY

This paper gives insights in patients' and families' perspectives on transition of nursing care and their involvement during the whole transfer process. This paper gives direction how to improve patient participation during the discharge process from hospital to follow-up care.

The Nursing Inter Shift Handover: A Moment of Care for Patients and Their Family Caregivers

Precedents: The transfer between nursing shifts must guarantee the quality of care for patients and their families in the hospital. This study aimed to transform the handover between nursing shifts to strengthen the care capacity of patients and their family caregivers, and improve the care capacity of nursing staff, in a Latin American university hospital. Methods: This is a Nursing Methodology Research developed in the following phases: (a) identification of the best handover practices between nursing shifts to apply them within the institutional culture; (2) diagnosis of the transfer between shifts in the hospital; (3) design and validation of the transformation proposal; (4) measurement of transfer indicators; and (5) definition of a path to improve this transfer. Results: The proposal developed focuses on the patient and their family caregiver. The proposed protocol considered the perspective of the care recipients, the nursing staff, and the best available evidence. The overall transfer rating over 10 months went from 65% to 84%. Conclusions: The adjustment to the transfer process made it possible to strengthen the care capacity of patients and their family caregivers and improve the care capacity of the nursing staff.

Decision-making about changing medications across transitions of care: Opportunities for enhanced patient and family engagement

BACKGROUND

Older patients often have complex medication regimens, which change as they move across transitions of care. Engagement of older patients and families in making medication decisions across transitions of care is important for safe and high-quality medication management.

AIMS

To explore decision-making between health professionals, older patients and families about medication changes across transitions of care, and to examine how patient and family engagement is enacted in the process of decision-making in relation to these medication changes.

METHODS

A focused ethnographic design was undertaken with semi-structured interviews, observations, and reflective focus groups or interviews. Reflexive thematic analysis was conducted on transcribed data. The study was undertaken at a public teaching acute care hospital and a public teaching community hospital in Australia.

RESULTS

In all, 182 older patients, 44 family members and 94 health professionals participated. Four themes were conceptualised from the data: different customs and routines, medication challenges, health professional interactions, and patient and family involvement. Environments had differences in their customs and routines, which increased the potential for medication delays or the substitution of unintended medications. Medication challenges included health professionals assuming that patients and families did not need information about regularly prescribed medications. Patients and families were informed about new medications after health professionals had already made decisions to prescribe these medications. Health professionals tended to work in disciplinary silos, and they had views about their role in interacting with patients and families. Patients and families were expected to take the initiative to participate in decision-making about medication changes.

CONCLUSIONS

Patient movements across transitions of care can create complex and chaotic medication management situations, which lacks transparency, especially for older patients and their families. A greater focus on pre-emptive and planned discussions about medication changes will contribute to improving patient and family involvement in medication decision-making.

What can nurses learn from patient's needs and wishes when developing an evidence-based quality improvement learning culture? A qualitative study

BACKGROUND

Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence-based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence-based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence-based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences.

OBJECTIVE

To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence-based quality improvement learning culture.

METHODS

A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi-structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used.

RESULTS

Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision-making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse-patient relationship was found to be time-consuming and challenging to restore.

CONCLUSIONS

Results confirmed the importance of a durable nurse-patient relationship and showed the consequences of nurses' communication on shared decision-making. Insights into patients' care preferences are essential to stimulate the development of an evidence-based quality improvement learning culture within nursing teams and for successful implementation processes.

Implementing bedside handovers in mental health care: Insights from an experience-based co-design

OBJECTIVES

Bedside handovers have the potential to provide opportunities to increase patient involvement in mental health care. However, limited research has been conducted on this subject.

METHODS

In this study, we investigate the suitability of experience-based co-design as a method for designing bedside handover in mental health care.

RESULTS

The article discusses the goals of bedside handover, the preferred structure and content of the handover, its location and frequency, and the familiarization involved in it.

CONCLUSIONS

EBCD proved to be a suitable method of making recommendations for involving patients in nursing handover in a mental healthcare unit of a general hospital.

PRACTICE IMPLICATIONS

Nurses and mental health care patients agreed on the ISBARRT model to structure bedside handovers.

Don't interrupt me! development of a handoff education bundle to simulate the real world

OBJECTIVES

Ineffective nurse-to-nurse handoff communication is associated with information omissions, diagnostic errors, treatment errors, and delays. New nurses report a lack of confidence and ability in handoff communication, which may stem from inadequate training in prelicensure nursing programs. Our objective was to introduce prelicensure nursing students to a standardized, theory-based method for handoff, including behavioral strategies employed by nurses during interrupted handoff.

METHODS

A handoff education bundle (HEB) was developed. Kern's six-step curriculum model was utilized to design, implement, and evaluate the handoff curriculum.

RESULTS

Student feedback highlighted the importance of integrating multiple, varying distractors during learning cycles and recognition of the impact of distractors on handoff.

CONCLUSIONS

Implementing a HEB at the prelicensure nursing level could promote competency in handoff communication for new graduate nurses.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Handoff is an international patient safety priority, as inadequate communication has been linked to adverse patient events.

Educational interventions for improving nursing shift handovers: A systematic review

AIM

This study analyzed the components of educational interventions for handovers among nursing students and nurses.

BACKGROUND

A handover is a communication process that occurs when patient care responsibilities and rights are transferred from one nurse to another. This process is important in nursing to ensure the continuity of nursing care and patient safety.

DESIGN

A systematic literature review of Korean and international studies was conducted to identify the components of handover educational programs for nursing students and nurses and analyze their effects, thereby providing a basis for the further development of these programs.

METHODS

Studies published in English or Korean no later than June 30, 2022, were found via an electronic database search using the MEDLINE, Embase, and CINAHL databases. Three reviewers independently evaluated all the studies. These studies focused on educational interventions for nursing students and nurses regarding covering shift-to-shift nursing handovers. After reviewing 1971 extracted articles, 18 satisfied the inclusion criteria.

RESULTS

Nine articles involved nursing students and nine involved nurses. Four articles covered bedside handovers as educational topics. Educational methods included lectures and active practice. Active practice comprised demonstrations, role-play, and feedback. The main content areas of the educational programs were an introduction to handovers; training regarding how to extract important information for handovers; and strategies using informatic and thematic structures, such as mnemonics, and concept mapping. The patient cases for role-play were provided in forms of written scenarios, virtual electronic charts, videos, scenario-based simulated situations, and actual patient cases assigned in clinical practice. The effects of the educational interventions were evaluated regarding knowledge, performance, and self-efficacy. Performance and self-efficacy were significantly higher in a study in which the intervention group was provided additional individual feedback compared to the control group and in a study in which the intervention group received multiple additional practice opportunities.

CONCLUSIONS

Handover education for nursing students and nurses should include individual feedback, demonstrations, and opportunities to practice to improve their performance and self-efficacy. Feedback methods should be further developed to increase the effectiveness of educational programs. Sample cases involving patients should be devised to increase these opportunities, and methods for improving educator efficiency should be identified.

Evaluating the efficacy of a digital App to enhance patient-centred nursing handover: A simulation study

AIM

The study aim was to evaluate the feasibility and efficacy of a digital App developed to enhance patient communication with nurses during bedside nursing handover at shift change.

METHODS

Six nurses and 11 patient actors/volunteers participated in 12 simulated nursing handovers across six simulation workshops. Over half the patients were aged 70+ years (55%); majority were female (82%). Handover video recordings were analysed using a structured observation tool and a revised Four Habits Coding Scheme to assess nurses' handover communication skills. Patient and nurse feedback was also sought. The STROBE checklist (Data S1) guided preparation of the study.

RESULTS

For all simulated handovers (n = 12): Nurses greeted the patient at commencement; nurses made eye contact with the patient; patients were given opportunity to ask questions; and all patient questions were answered. Nurses explained the handover process for less than half the handovers (42%). Familiarity with the patient's history was evident in every handover. Communication behaviours identified in most handovers included: good nonverbal behaviour; allowing time for the patient to absorb information; giving clear explanations; involving the patient in decisions; and exploring acceptability of the care plan. Patient and nurse feedback on the App included: The App was easy to navigate, features were well-liked, with some improvements suggested.

CONCLUSION

Patients and nurses provided positive feedback for the App during hospital stay and at handover. The App has the potential to enhance existing handover processes and increase safety of hospital care by using technology to educate and empower patients/carers to be active partners in communication with nurses during change-of-shift handover.

RELEVANCE TO CLINICAL PRACTICE

The App empowers and enables patients/carers to actively participate in nursing handover and allows patients to communicate concerns and provide information to their nursing team, facilitating a new approach.

PATIENT OR PUBLIC CONTRIBUTION

Patients and carers were involved in the research from the original co-design workshops that guided the development of the handover App. The research aims and outcome measures were informed by the experiences and preferences of patients/carers. Two patient representatives were involved in writing and submission of the grant application for the study to evaluate the efficacy of the App and were listed as co-authors on this paper. Patient volunteers were involved in the current study to pilot test the handover App. Patient volunteers were recruited through a consumer representative and volunteer registry at the health service. They participated in simulated nursing handovers with two nurses to assess the feasibility and acceptability of the handover App and then provided feedback and suggestions for improvement.

Patient participation in end-stage kidney disease care: variation over time and effects of staff-directed interventions - a quasi-experimental study

BACKGROUND

Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one's individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation.

METHODS

A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15-19 ml/min) or V (eGRF < 15 mL/min) entered the study. Of these, 245 patients (with kidney replacement therapy or intermittent outpatient visits only) completed a survey on patient participation at four time points: every six months from August 2019 to May 2021, patients reported their preferences for and experiences of participation using the validated Patient Preferences for Patient Participation tool, the 4Ps. Between the first and second data collection points, interventions were provided for designated staff to facilitate person-centred participation, using two strategies for two subgroups at three sites each: the managers receiving a bundle of information via e-mail on patient participation in a standard dissemination procedure (three sites), or an additional half-year support program for implementation offered to 1-2 staff per site (three sites), with no intervention for a control group (three sites). The differences in 4Ps data between groups were analysed using multilevel ordinal regression.

RESULTS

Over time and across all sites, most patients' experiences of participation fully or almost fully matched their engagement preferences (57%-90%). Still, up to 12% of patient reports indicated that their preferences and experiences were insufficiently matched: in these cases, the patients had preferred to be more involved than they had experienced, for example, in making healthcare plans and setting health-related goals. The interventions did not affect the levels of preference-based participation, but patients in the control group sites had slightly more consistent matches.

CONCLUSIONS

Living with kidney failure necessitates patient engagement, but opportunities to participate in accordance with one's preferences are not fully provided for all patients. Additional efforts to support a common understanding and to ensure person-centred patient participation is still needed.

Evaluation of patient participation in relation to the implementation of a person-centered nursing shift handover

BACKGROUND

It has been suggested that nursing shift-to-shift handover should be a more team-based dialogue with and for the patient rather than about a patient.

AIM

The aim of this study was to evaluate patient participation in relation to the implementation of the person-centered handover (PCH).

METHOD

A pretest-posttest design was used without a comparison group, including patients from nine units in a university hospital at pretest (n = 228) and after implementing PCH (posttest, n = 253) per the framework integrated-Promoting Action on Research Implementation in Health Services. The PCH is inspired by an Australian bedside handover model. The Patient Preferences for the Patient Participation tool was used to rate the preference for and experience of participation on 12 items, combined into three levels of preference-based participation (insufficient-fair-sufficient).

RESULTS

There were no differences regarding experience or preference-based participation between patients at pretest-posttest; however, posttest patients experienced participation in the item Reciprocal communication to a lesser extent than the pretest patients. Only 49% of the posttest group received PCH; of those not receiving PCH, some would have wanted PCH (27%), while some would have declined (24%). Patients receiving PCH had sufficient participation (82%), to a greater extent, regarding the item Sharing one's symptoms with staff than patients at pretest (72%). Patients receiving PCH also had sufficient participation, to a greater extent, than patients at posttest who did not receive, but would have wanted PCH, regarding four items: (1) sharing one's symptoms with staff, (2) reciprocal communication, (3) being told what was done, and (4) taking part in planning.

LINKING EVIDENCE TO ACTION

Most patients want to be present at PCH. Therefore, nurses should ask for the patients' preferences regarding PCH and act accordingly. Not inviting patients who want PCH could contribute to insufficient patient participation. Further studies are needed to capture what assistance nurses would want in identifying and acting in alignment with patient preferences.

Exploring the Knowledge Structure of Patient Safety in Nursing Using a Keyword Network Analysis

Patient safety is a critical and long-standing issue in nursing research. The purposes of this study were to explore the knowledge structure of patient safety and to provide a direction for future research by offering new perspectives and a theoretical clarification of patient safety in nursing. Keyword network analysis was performed by extracting keywords from abstracts of 6072 published articles. To reflect nursing perspectives, focus group interviews were conducted and Kim's typology consisting of four domains was used as the framework of analysis. Visualized knowledge structure showed avoiding medication error and preventing pressure ulcers or falls remain important topics within this research field. The distribution of core keywords as per four domains was in the following order: practice, client, environment, and client-nurse domain. Within the client domain, patients' harm-related core keywords were limited to physical harm. The detailed knowledge structure consisted of five themes: patient, preventable patient harm, practice, error, and environment. It comprised risk assessment for patients' characteristics and environmental elements surrounding patient and nursing practice, and risk management using information as knowledge-based nursing practice. Regarding further research, we suggest a multidimensional approach to patient harm, and the utilization of the client-nurse relationship and information systems as strategies for patient safety.

Influencing Factors of Nurses' Practice during the Bedside Handover: A Qualitative Evidence Synthesis Protocol

Nursing Bedside Handover (NBH) is acknowledged as a nursing practice implemented at the patient's bedside to improve communication safety during the shift change, but it is vulnerable due to inconsistent application among nurses. This synthesis of qualitative evidence aims to review and synthesize the perceptions and experiences of nurses regarding the factors that, in their perspective, influence NBH practice. We will follow the thematic synthesis methodology of Thomas and Harden and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement guidelines. A search will be conducted through the databases of MEDLINE, CINAHL, Web of Science, and Scopus, and we will follow the three-step search process to identify primary studies with qualitative or mixed-method research designs and projects of quality improvement. The screening and selection of the studies will be carried out by two independent reviewers. We will use the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to report the screening, search, and selection of studies. To assess its methodological quality, two reviewers will independently use the CASM Tool. The extracted data will be reviewed, categorized, and summarized in tabular and narrative formats. The findings obtained will allow us to inform future research and change management led by nurse managers.

Patient engagement, involvement, or participation - entrapping concepts in nurse-patient interactions: A critical discussion

The importance of patients taking an active role in their healthcare is recognized internationally, to improve safety and effectiveness in practice. There is still, however, some ambiguity about the conceptualization of that patient role; it is referred to interchangeably in the literature as engagement, involvement, and participation. The aim of this discussion paper is to examine and conceptualize the concepts of patient engagement, involvement, and participation within healthcare, particularly nursing. The concepts were found to have semantic differences and similarities, although, from a nursing perspective, they can be summoned to illustrate the establishment of a mutual partnership between a patient and a nurse. The individualization of such processes requires the joint effort of engagement, involvement, or participation, represented by interactive actions of both the patient (asking questions, telling/speaking up, knowledge acquisition, learning, and decision-making) and the nurse (recognizing, responding, information sharing, teaching, and collaborating). Suggesting that the concepts can be used interchangeably comes with some caution, requiring that nurses embrace patients playing a role in their health and healthcare. Further research and practice development should focus on how patients and nurses receive and respond to each other to establish patient engagement, involvement, and participation.

Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care

Background

Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses' contribution remains 'invisible'. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus.

Aims and objectives

Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study.

Design

A modified four-round Delphi study.

Methods

The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians.

Results

There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of 'critical' in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: 'patient experience', 'patient engagement' and 'professional and ethical approach to care' based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice.

Conclusion

This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses' contribution to patient-centred care is tangible in acute care.

Effective communication and patient safety among nurses in perioperative settings: a best practice implementation project

OBJECTIVES

The aim of this implementation project was to promote evidence-based best practice regarding effective communication and patient safety amongst nurses in perioperative settings.

INTRODUCTION

One of the main causes of surgical errors is inadequate communication. To address this issue, published research has shown that effective communication among healthcare professionals (HCPs) within and between all phases of perioperative care, as well as the proper transfer of all patient information at all transition points, are essential for ensuring patient safety and quality of care.

METHODS

This best practice implementation project was conducted based on the JBI implementation model and included three phases of activity: a baseline audit, a strategies implementation stage and a follow-up audit. The audit criteria used were based on a JBI evidence summary and referred to: education, interdisciplinary team, conflict resolution, team communication, transfer of patient information and safety intraoperative processes. The project was carried out in the perioperative environment of a university hospital, and the sample included 52 nurses.

RESULTS

Eleven audit criteria were used in the baseline audit. For four of these criteria (on education and information transfer) the compliance was zero, for five criteria (on intraoperative processes) the compliance had values between 31 and 66% and for two criteria (on interdisciplinary team/conflict resolution documentation and team communication monitoring), the identified compliance was maximum (100%). Following the identification of four barriers to compliance and the implementation of targeted strategies, the follow-up audit showed complete compliance (100%) for all criteria except three, for which the identified compliance values were 96, 95 and 25%.

CONCLUSION

The implementation of appropriate strategies in this project has led to a significant improvement in nurses' compliance with all audit criteria except one, regarding the verbal transfer of patient information. However, future audits and strategies are needed not only to support the improvements obtained but also to significantly increase the compliance rate for the audit criterion for which only a slight increase in compliance was recorded.

Development and psychometric testing of the patient participation in bedside handover survey

Introduction

When handover is conducted at the patient's bedside, active patient participation can be encouraged, which may improve the safety and quality of care. There is a need for valid and reliable tools to measure patient perceptions of participation in bedside handover, to ensure the rising number of implementation and improvement efforts are consistently and effectively evaluated. The aim of this study is to systematically develop and evaluate the psychometric properties of a self‐report survey to measure patients' perceptions of participation in bedside handover.

Methods

In Phase 1, our team developed a conceptual framework and item pool (n = 130). In Phase 2, content validity was assessed with four health consumers, four nurses and four researchers. Next, 10 current hospital inpatients tested the survey for end‐user satisfaction. In Phase 3, 326 inpatients completed the survey, allowing exploratory factor analysis, reliability analyses and convergent/divergent validity analyses to occur.

Results

Phase 1 and 2 resulted in a 42‐item survey. In Phase 3, 321 surveys were available for analysis. Exploratory factor analysis revealed a three‐factor solution, with 24 items, which matched our conceptual framework. The three factors were: ‘Conditions for patient participation in bedside handover’, ‘Level of patient participation in bedside handover’ and ‘Evaluation of patient participation in bedside handover’. There was strong evidence for factor reliability and validity. Additionally, the correlation between factors was strong.

Conclusion

This study furthers our conceptual understanding by showing that nurse facilitating behaviours are a strong precursor for patient participation and perceived handover outcomes, justifying the need for nursing training. A robust survey has been developed to measure patient perceptions of participation in bedside handover, which can effectively evaluate this approach to care. Engaging consumers and nurses as research team members was invaluable in ensuring that the survey is acceptable for end‐users.

Patient or Public Contribution

A health consumer and nurse partnered as members of the research team from study inception to dissemination.

Experiences of cancer patients about seeking health information: a qualitative study

OBJECTIVE

Searching for health information is an important strategy in dealing with cancer that contributed to the improved management of cancer. This qualitative study aimed to explore the experiences of cancer patients seeking health information using the conventional content analysis approach.

METHODS

The 18 participants were selected by purposive sampling and data were collected through semi-structured in-depth interviews. Data were analyzed by software MaxQDA 10 based on conventional content analysis.

RESULTS

Data analysis led to the emergence of three central categories, including "optimal cancer management," "poor information dissemination system," and "perceived health literacy."

CONCLUSION

Knowing how cancer patients obtain health information can form the basis to promote patients' health literacy and design a health information dissemination system tailored to the patients' needs.

Transformational Leadership Meets Innovative Strategy: How Nurse Leaders and Clinical Nurses Redesigned Bedside Handover to Improve Nursing Practice

In 2000, the Institute of Medicine (IOM) published To Err Is Human: Building a Safer Health System, highlighting medical errors resulting from failure in perception, assumption, and communication. The handover process is a high-risk activity prone to the communication vulnerabilities described in the IOM report. The handover project started as a 3-month pilot with plans to expand to the entire facility. The handover education had 4 elements: questionnaire, presentation, video, and simulation. Compliance with the new process was measured using audits completed by the unit managers. Sixty-four registered nurses on 2 acute units were educated by nurse champions. After a successful implementation, the surge of COVID-19 patients in spring of 2020 required us to adjust expectations regarding bedside handover. As the number of hospitalized COVID patients began to decrease, we reinvigorated the project and re-established the expectation that handover be performed at the bedside. A post-questionnaire was completed after implementation and revealed more favorable responses toward bedside handover. We also saw improvements in our patient satisfaction scores (Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]). With direct observation and a checklist, we were able to return to the practice of bedside handover following the surge of COVID-19 patients. As a direct result of the bedside RN involvement, we created and implemented a handover process that prioritized nursing needs and concerns. Our implementation of this evidence-based practice enhanced patient experience and improved safety. Through education, observational audits, and use of a checklist, we were able to re-establish the expectation and practice of handover being completed at the bedside.

Patient participation in electronic nursing documentation: An interview study among home-care patients

Background

Patients are increasingly expected to take an active role in their own care. Participation in nursing documentation can support patients to take this active role since it provides opportunities to express care needs and preferences. Yet, patient participation in electronic nursing documentation is not self‐evident.

Objective

To explore how home‐care patients perceive their participation in electronic nursing documentation.

Methods

Semi‐structured interviews were conducted with 21 home‐care patients. Interview transcripts were analysed in an iterative process based on the principles of reflexive inductive thematic analysis.

Results

We identified a typology with four patient types: ‘high need, high ability’, ‘high need, low ability’, ‘low need, high ability’ and ‘low need, low ability’. Several patients felt a need for participation because of their personal interest in health information. Others did not feel such a need since they trusted nurses to document the information that is important. Patients' ability to participate increased when they could read the documentation and when nurses helped them by talking about the documentation. Barriers to patients' ability to participate were having no electronic devices or lacking digital skills, a lack of support from nurses and the poor usability of electronic patient portals.

Conclusion

Patient participation in electronic nursing documentation varies between patients since home‐care patients differ in their need and ability to participate. Nurses should tailor their encouragement of patient participation to individual patients' needs and abilities. Furthermore, they should be aware of their own role and help patients to participate in the documentation.

Patient or Public Contribution

Home‐care patients were involved in the interviews.

Improving patient-centred care through a tailored intervention addressing nursing clinical handover communication in its organizational and cultural context

Aims

To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover.

Design

Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention.

Methods

Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data.

Results

Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications.

Conclusions

Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success.

Impact

Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals.

Systematic Review of Quality Improvement Projects Related to Intershift Nursing Handover

BACKGROUND

Nursing handover is a real-time process in which patient-specific information is passed between nurses to ensure the continuity and safety of patient care.

PURPOSE

The purpose of this study was to determine the effects of quality improvement (QI) projects in improving the intershift nursing handover process.

METHODS

A computerized search was performed of electronic databases for articles published during 2009-2019 in English or Korean for which the full texts were available. The included studies involved QI projects, handover between nurses, and intershift handover. The QI-MQCS (Quality Improvement Minimum Quality Criteria Set) was used to appraise the quality of QI strategies.

RESULTS

The handover methods used in the 22 QI projects could be broadly divided into 2 types: (1) using a standardized communication tool; and (2) involving patient-participation bedside handover.

CONCLUSIONS

The published research on intershift handover-related QI projects employed standardized communication tools and the patient-participation bedside handover method to reduce adverse events and handover times and increase the satisfaction of patients and nurses. Future studies should measure the changes in patient safety-related outcomes.

Nursing handover involving consumers on inpatient mental healthcare units: A qualitative exploration of the consumers' perspective

Handovers between nurses are a significant cause of communication problems and possible consumer safety issues. A potential solution for both problems is the nursing handover involving consumers, in which the consumer is present at the time of handover. This practice invites consumers to be more involved in their care process and supports a recovery-oriented practice. Research into nursing handovers involving consumers on inpatient mental health units is however very limited. A qualitative, phenomenological study was conducted. Semi-structured interviews with 13 consumers staying on an inpatient mental health unit of a general hospital were used. The interviews were transcribed verbatim and thematically analysed. Data saturation was reached after 11 interviews when no new themes or codes emerged from the data. Three themes were generated from the interviews: (i) the first moments on the inpatient mental health unit; (ii) the nurse as an ally; and (iii) informing each other. The COREQ-checklist was used. According to consumers, nursing handover involving consumers initiated a change in the relationship between consumers and nurses. Consumers and nurses got to know each other better during handover and built a relationship of trust. The introduction of nursing handover involving consumers created an accessible opportunity for consumers to exchange information with nurses and ask questions concerning their admission. Consumers felt jointly responsible for the continuity of the information about their healthcare process. Due to the use of nursing handover involving consumers, consumers experienced the opportunity to take more control in their health process and ensured that information is correct and complete.

Enhancing person-centred care in inpatient mental health settings through supported person-side handover: a multi method study

BACKGROUND

: Many nursing contexts have introduced bedside handover, where the person in care participates in the transfer of clinical information, with benefits for person, carers, and clinicians. This type of handover has been implemented across a number of mental health settings, but there is limited evidence regarding implementation approaches or of practice change. This study reports the development and evaluation of a co-produced education and support package.

AIM

: To evaluate changes in nurses' practice regarding bedside (person-side) handover following implementation of a structured education and support package.

DESIGN

: Multi-method design incorporating nurse surveys and chart audit.

METHODS

: The survey and audit were conducted in 2019-2020 on two inpatient mental health units in a metropolitan health service immediately prior to, and 6 months after, implementation, with 70 survey responses and 52 files audited. Non-parametric tests assessed change, and text comments were reported.

RESULTS

: Significant improvements were observed in nurses' reports of confidence, the ability to maintain privacy, identified benefits for the person and in information transfer. In contrast, the chart audit identified no change in documentation of this practice.

CONCLUSIONS

: The implementation of a co-produced education and support package demonstrated positive practice change in engaging people receiving care in handover. This approach to handover provides increased opportunity for nurses to work in partnership with people receiving mental healthcare, facilitating collaborative person-centred care and shared decision making.

Handover From the Emergency Department to Inpatient Units: A Quality Improvement Study

BACKGROUND

Intrahospital handovers are high risk. Standardization of content and process is recommended.

LOCAL PROBLEM

Emergency department to inpatient unit handovers were inefficient.

INTERVENTIONS

The intervention was a standardized operating protocol, including checklist and procedures.

METHODS

The intervention was coproduced and prototyped. Handovers were observed for intervention adherence, and the Handover Evaluation Scale was used to measure nurses' perceived quality of handover.

RESULTS

The handover had 3 steps. Step 1 had more content, prompting by the receiver, and family participation postintervention. Step 3 was shorter in duration, had less content, and occurred at the bedside more postintervention. Receiving nurses were able to ask questions and found that information provided was timely, current, and easy to follow. Sending nurses perceived that handover was less succinct postimplementation, despite decreases in handover duration and repetition of information.

CONCLUSIONS

This project has triggered ongoing improvement initiatives, necessary to keep accommodating the needs of nurses that work across boundaries.

Associations of person-related, environment-related and communication-related factors on medication errors in public and private hospitals: a retrospective clinical audit

BACKGROUND

Efforts to ensure safe and optimal medication management are crucial in reducing the prevalence of medication errors. The aim of this study was to determine the associations of person-related, environment-related and communication-related factors on the severity of medication errors occurring in two health services.

METHODS

A retrospective clinical audit of medication errors was undertaken over an 18-month period at two Australian health services comprising 16 hospitals. Descriptive statistical analysis, and univariate and multivariable regression analysis were undertaken.

RESULTS

There were 11,540 medication errors reported to the online facility of both health services. Medication errors caused by doctors (Odds Ratio (OR) 0.690, 95% CI 0.618-0.771), or by pharmacists (OR 0.327, 95% CI 0.267-0.401), or by patients or families (OR 0.641, 95% CI 0.472-0.870) compared to those caused by nurses or midwives were significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of double-checking of medication orders compared to single-checking (OR 0.905, 95% CI 0.826-0.991) was significantly associated with reduced odds of possibly or probably harmful medication errors. The presence of electronic systems for prescribing (OR 0.580, 95% CI 0.480-0.705) and dispensing (OR 0.350, 95% CI 0.199-0.618) were significantly associated with reduced odds of possibly or probably harmful medication errors compared to the absence of these systems. Conversely, insufficient counselling of patients (OR 3.511, 95% CI 2.512-4.908), movement across transitions of care (OR 1.461, 95% CI 1.190-1.793), presence of interruptions (OR 1.432, 95% CI 1.012-2.027), presence of covering personnel (OR 1.490, 95% 1.113-1.995), misread or unread orders (OR 2.411, 95% CI 2.162-2.690), informal bedside conversations (OR 1.221, 95% CI 1.085-1.373), and problems with clinical handovers (OR 1.559, 95% CI 1.136-2.139) were associated with increased odds of medication errors causing possible or probable harm. Patients or families were involved in the detection of 1100 (9.5%) medication errors.

CONCLUSIONS

Patients and families need to be engaged in discussions about medications, and health professionals need to provide teachable opportunities during bedside conversations, admission and discharge consultations, and medication administration activities. Patient counselling needs to be more targeted in effort to reduce medication errors associated with possible or probable harm.

Implementing and Sustaining Bedside Shift Report for Quality Patient-Centered Care

BACKGROUND

Two evidence-based practice projects and an innovative model provided best evidence and a framework for the implementation and sustainment of a bedside shift report (BSR) quality improvement project.

PROBLEM

Without a standardized BSR process, there was a lack of Veteran involvement in care planning decisions and nurse dissatisfaction related to missed communication of pertinent patient information.

APPROACH

Facilitators and barriers were identified and addressed during planning. Key elements of BSR were incorporated. After approval by shared governance, unit-based champions and leaders supported the change. Implementation began every 2 weeks on a different unit.

OUTCOMES

Implementation was completed in 4 months for 11 units. After 15 months, there was consistent BSR on 82% of the units and improved patient satisfaction with nurses taking time to listen.

CONCLUSIONS

Best evidence, unit-based champions, leadership support, project coordinators, and persistence are critical to implementing and sustaining practice change.

Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals' perspectives: A systematic review and meta-synthesis

AIMS

To explore patients' and healthcare professionals' (HCPs) perceived barriers and facilitators to patient engagement in patient safety.

METHODS

We conducted a systematic review and meta-synthesis from five computerized databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus and PsycINFO, as well as grey literature and reference lists of included studies. Data were last searched in December 2019 with no limitation on the year of publication. Qualitative and Mix-methods studies that explored HCPs' and patients' perceptions of barriers and facilitators to patient engagement in patient safety were included. Two authors independently screened the titles and the abstracts of studies. Next, the full texts of the screened studies were reviewed by two authors. Potential discrepancies were resolved by consensus with a third author. The Mixed Methods Appraisal Tool was used for quality appraisal. Thematic analysis was used to synthesize results.

RESULTS

Nineteen studies out of 2616 were included in this systematic review. Themes related to barriers included: patient unwillingness, HCPs' unwillingness, and inadequate infrastructures. Themes related to facilitators were: encouraging patients, sharing information with patients, establishing trustful relationship, establishing patient-centred care and improving organizational resources.

CONCLUSION

Patients have an active role in improving their safety. Strategies are required to address barriers that hinder or prevent patient engagement and create capacity and facilitate action.

Enhancing active patient participation in nursing handover: A mixed methods study

AIMS AND OBJECTIVES

To explore: i) the frequency and nature of patient participation in nursing handover and ii) patients' and nurses' perceived strategies to enhance patient involvement in nursing handover.

BACKGROUND

Patient participation in nursing handover is important for patient-centred care, shared decision-making, patient safety and a positive healthcare experience DESIGN: A multi-site prospective study using a mixed methods design.

METHODS

Between September and December 2019, nursing handovers were observed on ten randomly selected wards, followed by semi-structured interviews with patients (n = 33), and nurses (n = 20) from the observed handovers. Data were analysed using descriptive statistics for structured observations and thematic analysis of interviews, and triangulated to develop a greater understanding of patient participation in nursing handover. This study is reported using the Good Reporting of Mixed Methods Study guidelines.

RESULTS

The median patient age was 77 years and 47% (n = 55) patients were female. Of the 117 handovers, 76.9% (n = 90) were conducted in the patient's presence. Patients were active participants in 33.3% (n = 30) and passive participants in 46.7% (n = 42) of handovers; in 20% of handovers (n = 18), the patient had no input at all. Active participation was more likely in women (vs. men), surgical patients (vs. medical patients) and when nurses displayed engagement behaviours (eye contact, opportunity to ask questions, explanations). Three major themes were identified from the interviews: 'Being Involved', 'Layers of Influence' and 'Information Exchange'.

CONCLUSIONS

The main finding was that patient participation in handover was low and strongly influenced by a complex interplay of factors including patient and nurse preferences and perceptions.

RELEVANCE TO CLINICAL PRACTICE

Handover is an essential tool in the provision of safe patient care. Patients were able to actively participate in nursing handover when they understood the purpose and timing of handover and had rapport with nurses.

Patient participation in electronic nursing documentation: an interview study among community nurses

Background

Patient participation in nursing documentation has several benefits like including patients’ personal wishes in tailor-made care plans and facilitating shared decision-making. However, the rise of electronic health records may not automatically lead to greater patient participation in nursing documentation. This study aims to gain insight into community nurses’ experiences regarding patient participation in electronic nursing documentation, and to explore the challenges nurses face and the strategies they use for dealing with challenges regarding patient participation in electronic nursing documentation.

Methods

A qualitative descriptive design was used, based on the principles of reflexive thematic analysis. Nineteen community nurses working in home care and using electronic health records were recruited using purposive sampling. Interviews guided by an interview guide were conducted face-to-face or by phone in 2019. The interviews were inductively analysed in an iterative process of data collection–data analysis–more data collection until data saturation was achieved. The steps of thematic analysis were followed, namely familiarization with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and reporting.

Results

Community nurses believed patient participation in nursing documentation has to be tailored to each patient. Actual participation depended on the phase of the nursing process that was being documented and was facilitated by patients’ trust in the accuracy of the documentation. Nurses came across challenges in three domains: those related to electronic health records (i.e. technical problems), to work (e.g. time pressure) and to the patients (e.g. the medical condition). Because of these challenges, nurses frequently did the documentation outside the patient’s home. Nurses still tried to achieve patient participation by verbally discussing patients’ views on the nursing care provided and then documenting those views at a later moment.

Conclusions

Although community nurses consider patient participation in electronic nursing documentation important, they perceive various challenges relating to electronic health records, work and the patients to realize patient participation. In dealing with these challenges, nurses often fall back on verbal communication about the documentation. These insights can help nurses and policy makers improve electronic health records and develop efficient strategies for improving patient participation in electronic nursing documentation.

Nursing handover in the Indonesian hospital context: Structure, process, and barriers

Background

Nursing handover is an essential part of nursing practice to safe patient care, which occurs among nurses between shifts for transferring professional responsibility and accountability. However, there is limited information about the implementation and evaluation of nursing handover in Indonesian hospitals.

Objective

This study aimed to describe the structures, processes, and barriers of the nursing handover in the Indonesian hospital context.

Methods

This study employed a case study design in five inpatient units, especially in the medical-surgical wards of a referral hospital in Indonesia. The study was conducted from August to November 2018. A total of 100 handovers and 76 nurses were included. Focus group discussions were conducted in head nurses, nurse team leaders, and registered nurses. Observations were implemented to capture the handover process, including the number of the nurses in and out and the content of the information covered situation, background, assessment, and recommendations (SBAR). Data were analyzed using content analysis and fishbone analysis.

Results

The nursing handover consisted of three phases: before, during, and after. The handover barriers were divided into manpower, material, money, method, environment, and machine. The content of handover varied according to nurses' familiarity with the patients and their complexity. The nurses also actively participated during the handover process, although some nurses were absent in the handover time. About 75% of nurses had sufficient knowledge about the shift handover process using SBAR. The SBAR was adopted as a standard for handover, but no specific guideline or standard operating procedure.

Conclusion

The results of this study can be used as basic information to develop a guideline of nursing handover and supervision in the context of hospitals in Indonesia and beyond.

Comparing Perceptions of Patient Nonparticipation in Nursing Care: A Secondary Analysis

PURPOSE

Patient participation is characterized by dyadic patient-nurse interactions that enable patients to passively or actively participate in communicative and physical care activities. Less research has been conducted on nonparticipation. Examining this phenomenon may highlight issues to address and identify strategies that may ultimately promote patient participation and move the rhetoric of patient participation to a reality. The aim of this secondary analysis was to explore hospital patients' and nurses' perceptions of nonparticipation in nursing care specifically focused on communication and self-care.

DESIGN

Secondary supplementary analysis of qualitative data. We collated original transcripts from one dataset that included 20 patient and 20 nurse interviews conducted at two hospitals in Australia, in November 2013 to March 2014.

METHODS

Interviews were arranged into units of analysis dependent on group (patient/nurse) and setting (public/private hospital) and were reanalyzed using manifest, inductive content analysis.

FINDINGS

Two categories were found: (a) nurses impeding two-way clinical communication; and (b) patients and nurses disregarding patients' self-care efforts. These categories describe that nonparticipation occurred when nurses inhibited communication, and when patients were not involved in self-care while hospitalized or during discharge planning.

CONCLUSIONS

Perceptions of nonparticipation differ across settings, having implications for how patient participation recommendations are enacted in different contexts.

CLINICAL RELEVANCE

There is no one-size-fits-all approach; nurses need to identify common instances of nonparticipation within their setting and develop and implement strategies to promote patient participation that are suited to their context.

The quality of nursing care as perceived by nursing personnel: Critical incident technique

AIMS

To identify the determinants of the quality of nursing care from the perceptions of nursing personnel.

BACKGROUND

The quality of nursing care is often measured with standards, expectations, satisfaction and outcomes, but in developing countries, it relies mostly on negative indicators.

METHODS

A descriptive qualitative study was used. Semi-structured interviews based on the critical incident technique were conducted with a convenience sample of 136 nursing personnel who told 225 stories.

RESULTS

Seven quality determinants of nursing care were identified as follows: standard of care, triage and assessment, emergency care, communication with the patient or family, communication with colleagues, multidisciplinary teamwork and helping colleagues. The most important one was the standard of care.

CONCLUSION

Quality nursing care is based on the degree of excellence nursing personnel show with regard to their competences in technical care, communication and teamwork. A key attribute of quality nursing care is defined by the related standards, and the focus is mostly on the nursing care process.

IMPLICATIONS FOR NURSING MANAGEMENT

These findings can increase awareness of the determinants of nursing quality and the qualities of the nursing personnel involved and can help managers to evaluate nursing practice, select new employees and organise teams.

The benefits of consumer involvement in nursing handover on acute inpatient unit: Post-implementation views

The involvement of consumers in handover with nurses has been identified as reducing miscommunication between transitions in care and associated with reduction in adverse events in generalist nursing settings. The notion of having consumers present in nursing handover on acute mental health inpatient unit remains a relatively new concept. Central to recovery-focused mental health care is the consumer's active participation in the delivery of their care. The aim of this study was to explore the views of consumers with a mental illness about their experiences of being involved in nursing handover on acute mental health inpatient unit post-implementation of a new nursing handover involving consumers. Using an exploratory descriptive qualitative design, participants (N = 10) were recruited using purposive convenience sampling. Semi-structured interviews were undertaken, and the data were thematically analysed. Participants' principal diagnoses were schizophrenia (n = 2), schizoaffective disorder (n = 3), bipolar affective disorder (n = 2), borderline personality disorder (n = 1), and depression (n = 2). Three themes were generated from the interviews: (i) Knowing who, (ii) Shared decision-making, with subthemes: my voice was heard and not just a meet and greet, and (iii) Having time and space. The delivery of mental health care needs to put the consumer at the centre of such care regardless of the setting. In line with recovery-focused principles, the consumer's active involvement in the crucial activity of nursing handover on acute mental health inpatient unit is very important. The study has implications for ensuring consumer voices are heard in all aspects of their care delivery.

Feasibility and early effectiveness of the Tell-us Card communication tool to increase in-hospital patient participation: a cluster randomised controlled pilot study

BACKGROUND

Patient participation is fundamental to nursing care and has beneficial effects on patient outcomes. However, it is not well embedded yet and little is known on how nurses could effectively stimulate patient participation in hospital care. The Tell-us Card is a communication tool for inviting patients to talk about their preferences and needs, and to increase patient participation in daily care.

OBJECTIVES

To assess feasibility and early effectiveness of the Tell-us Card communication tool for enhanced patient participation during hospitalisation.

DESIGN AND METHOD

A pilot cluster randomised controlled study design was used including four nursing wards. Effectiveness was measured with the Individualized Care Scale (ICS) and the Quality from the Patients' Perspective (QPP) questionnaire. Linear mixed model analysis was used for analysis. Feasibility was assessed with an evaluative questionnaire for patients and nurses and by reviewing the content of Tell-us Cards using the Fundamentals of Care Framework (FOCF) for analysis. Ethical approval was attained.

RESULTS

Data of 265 patients showed a significant increase at one intervention ward on the ICS (effect size 0.61, p = 0.02) and most ICS subscales. No effect was visible on the QPP. The majority of patients regarded the intervention as beneficial; nurses however experienced barriers with incorporating the Tell-us Card into daily care. Analysis of the Tell-us Card content showed many elements of the FOCF being mentioned, with most patients indicating psychosocial needs like being involved and informed.

CONCLUSIONS

This pilot study showed a positive early effect of the Tell-us Card communication tool on patient participation, although integration in daily nursing care appeared to be complex and an optimal fit has not yet been reached. Patients were positive about the intervention and wrote meaningful issues on the Tell-us Cards. More research is needed on how to incorporate patient participation effectively in complex hospital care.

Engaging patients and families in communication across transitions of care: An integrative review

OBJECTIVE

To determine the current evidence about patient and family engagement in communication with health professionals during transitions of care to, within and from acute care settings.

METHODS

An integrative review using seven international databases was conducted for 2003-2017. Forty eligible studies were analysed and synthesised using framework synthesis.

RESULTS

Four themes: 1) Partnering in care: patients and families should be partners in decision-making and care; 2) Augmenting communication during transitions: intrinsic and extrinsic factors supported transition communication between patients, families and health professionals; 3) Impeding information exchange: the difficulties faced by patients and families taking an active role in transition; and 4) Outcomes of communication during transitions: reported experiences for patients, families and health professionals.

CONCLUSION

While attitudes towards engaging patients and family in transition communication in acute settings are generally positive, current practices are variable. Structural supports for practice are not always present.

PRACTICE IMPLICATIONS

Organisational strategies to improve communication must incorporate an understanding of patient needs. A structured approach which considers timing, privacy, location and appropriateness for patients and families is needed. Communication training is required for patients, families and health professionals. Health professionals must respect a patient's right to be informed by regularly communicating.

Usability and application of a data integration technique (following the thread) for multi- and mixed methods research: A systematic review

BACKGROUND

The scope of methodological development and innovation in multi- and mixed methods design is endless and, at times, challenging. The latter is especially true with regards to the integration of data generated through different methods. About a decade ago, Professor Jo Moran-Ellis and her colleagues at the University of Sussex suggested a framework for analytical integration known as "following a thread." Despite an increased focus within health services research on different perspectives and approaches to successful data integration, the framework's usability and application have not yet been well described.

OBJECTIVES

This systematic review aims to integrate and synthesise published accounts of the framework and its applications.

DESIGN AND DATA SOURCES

Seven electronic databases were utilised. Included were peer-reviewed scientific papers published in English from 2006 - 2018. The authors independently screened eligible publications by title and abstract.

RESULTS

Thirteen studies were included in our systematic review. One notable finding is that in almost half of the cases (n = 6), the framework had been applied as an analytical integration framework in single studies using multiple qualitative methods. Overall, the descriptions and accounts of the framework were sparse and lacked transparency. Accounts of the analytical integration framework could be said to fall within three overarching areas: (1) applications of the framework, (2) justifications for analytical integration, and (3) benefits and shortfalls of the framework.

CONCLUSION

Data integration is often one of the major method steps in multi- and mixed methods designs. To further the future development of methodologically sound frameworks for analytical integration, it is essential that they are sufficiently described so as to ensure validation of the framework's usability and replicability. "Following a thread" appears to be an promising analytical integration framework, particularly in that it can be applied with the same datatypes as well as between different types of data.

A systematic review on the structured handover interventions between nurses in improving patient safety outcomes

AIM

This review aimed to elucidate the effectiveness of structured handovers in improving patient outcomes in the wards.

BACKGROUND

Studies have reported that the lack of quality handovers is one of the main causes of adverse effects.

EVALUATION

A search over six electronic databases: MEDLINE; CINAHL; Web of Science; EMBASE; Scopus; and CENTRAL via Ovid concluded nine studies and synthesized by two independent reviewers based on the Cochrane Handbook for Systematic Reviews of Interventions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the undertaking of this review and meta-analysis. All studies published up to February 2019 were considered in this review.

KEY ISSUES

This review has demonstrated that structured handovers reduced the incidences of patient complications, medication errors and general adverse events. However, the results were not statistically significant.

CONCLUSION

Current structured handover formats were effective in reducing problematic handovers such as omission of information, inaccurate information and documentation errors.

IMPLICATIONS FOR NURSING MANAGEMENT

Although there is limited high-quality and rigorous research conducted to gain a clearer understanding of the impacts on patient-related outcomes in nursing care, structured handovers remained effective in reducing the number of mistakes in information transfer.

Exploring the barriers to patient engagement in the delivery of safe care in Iranian hospitals: A qualitative study

Aim

To investigate barriers to patient engagement in the delivery of safe hospital care.

Design

Qualitative exploratory study.

Methods

A qualitative study with 35 Iranian health professionals was conducted from February to April 2019 using semi-structured interviews to elicit their opinions. MAXQDA 11 software was used for data management, and the data were analysed using framework analysis.

Results

Barriers, which potentially have negative impact on patient engagement in the delivery of safer care, were categorized into four themes. The first category included patient-related barriers such as low levels of health literacy, ineffective education, patient unwillingness and cultural barriers. The second category included staff-related barriers such as the existence of negative attitudes towards engaging patients in matters relating to patient safety, ineffective communication, high workload and the reluctance on the part of physicians to engage with patients. Barriers created by limited resources and inadequate training provided by universities and in the workplace formed the third category and community-related barriers such as the inadequate dissemination of information via the mass media and a lack of community-based services formed the fourth category.

Conclusion

Results demonstrate the multilayered nature of the significant barriers to the engagement of patients in the delivery of safe care and reflect the need for a collaborative approach between the recipients of care, researchers, care providers and policy makers if these are to be overcome.

Developing an evidence-based and theory informed intervention to involve families in patients care after surgery: A quality improvement project

Objectives

In the post-surgical setting, active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care. This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients.

Methods

We used a quality improvement project following a multi-phase design. In Phase 1, an iterative method was used to combine evidence from a narrative review and professionals' preferences. In Phase 2, the logic model underlying the program was developed guided by four steps: (1) confirm situation, intervention aim, and target population; (2) documented expected outcomes, and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components.

Results

Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review. In Phase 2, the logic model was developed and includes (1) the inputs (e.g. educational- and environmental support), (2) the ultimate outcomes (e.g. reduction of postoperative complications), (3) the intermediate outcomes (e.g. behavioural changes), and (4) immediate outcomes (e.g. improved knowledge, skills and attitude).

Conclusions

We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards, and how we took different factors into account. The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.