Practitioner-centred research: an evaluation of the implementation of the bedside hand-over

Handover in Nursing: A Concept Analysis

BACKGROUND AND PURPOSE

The broad use of the term handover to describe any activity involving the transfer of professional responsibility from one person to another has led to an ambiguous understanding. Recently, handover has become a process central to the delivery of high-quality and safe patient care. The aim of this analysis was to clarify the concept of handover within the context of nursing practice.

METHODS

Rodgers's evolutionary approach was used as the analysis method along with some aspects of the dimensional analysis guided by Caron and Bowers, to understand the perspectives of senders and receivers.

RESULTS

The analysis revealed four attributes of handover: transfer of information, interaction for disambiguation, process, and strategy. Handover is defined as a process for transferring responsibility from sender to receiver through communication through the transfer of information, the interaction for disambiguation, and the context-sensitive strategy for accomplishing the continuity and safety of patient care. The salient dimension of handover was process, and the sub-dimensions were transfer of information, interaction for disambiguation, and strategy. From the sender's perspectives, it is the process of transferring information organized by the sender, and from the receiver's perspective, handover is the process establishing care plan through interactive strategy.

IMPLICATIONS FOR PRACTICE

The definition and identified attributes serve as a heuristic for designing strategies and further developing the construct of handover in nursing.

Patient, family and nurse experiences with patient presence during handovers in acute care hospital settings: a systematic review of qualitative evidence

OBJECTIVE

The objective of this systematic review was to synthesize the best available evidence on patients', family members' and nurses' experiences with bedside handovers in acute care settings.

INTRODUCTION

The transfer of patient information between nurses represents a critical component of safety within health care. Conducting handover at the bedside allows patients and families to participate in information exchanges. Studies that address bedside handover highlight benefits and concerns with their implementation. Insight into patients', families' and nurses' experiences with bedside handovers can help to identify the most appropriate and safest approach to handovers.

INCLUSION CRITERIA

The current review considered patients, family members and nurses in the acute care hospital setting. Nurses included licensed nurses, registered nurses, practical nurses, nursing assistants, nurse researchers, and advanced practice nurses.

METHODS

A three-step search strategy was used to identify English language qualitative primary research studies. Two reviewers independently appraised the included studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative studies that considered attitudes, beliefs and experiences of patients, families and nurses on patient presence during bedside handover were considered for this review. Papers included in the review were from 1998 to 2017.

RESULTS

The review included 12 qualitative publications. Key findings were extracted and classified as unequivocal (U) or credible (C). A total of 96 findings were extracted and aggregated into 14 categories. From the 14 categories, five synthesized findings were developed: i) becoming more informed; ii) upholding confidentiality and privacy; iii) varying desire and ability to participate; iv) individualizing patient care; and v) challenges in conducting bedside handovers can be overcome with adaptive practices.

CONCLUSIONS

This review captured the experiences of patients, families and nurses with patient presence during bedside handovers in a hospital setting. For the most part, patients and families describe bedside handover positively, reporting feeling more informed and engaged in care. This review highlights areas where patients' and nurses' views on bedside reporting may differ, particularly in the areas of desire to participate and the need for confidentiality. Although hospital environments can create challenges in sharing personal patient information at the bedside, these may be overcome through education and by the adoption of a flexible and individualized approach.

Patients' perceptions of bedside handoff: the need for a culture of always

Current literature on patients' perceptions of bedside handoff describes studies using qualitative, anecdotal, and/or indirect measurement. This study identifies patients' perceptions of the bedside handoff through direct and quantitative measurement. The statistically significant findings from a survey of 103 medical surgical adult patients demonstrate that registered nurse bedside handoff has a positive effect on patient perceptions of safety, understanding, and satisfaction. Bedside end-of-shift handoff is most effective when it is performed consistently.

Challenges of Nursing Handover

The aim of this study was to explore the challenges of nursing handover process during shift rotation in hospitals. The research had a descriptive exploratory design with a qualitative content analysis approach. To conduct the study, three pediatric wards were selected at first. Data were gathered through a 4-month observation of nursing handovers by recording the oral conversations of nurses during the process and semistructured interviews. Then, qualitative content analysis was used for data analysis. Two major themes and five subthemes emerged through the data analysis. The first and the second themes were a nonholistic approach and poor management, respectively. In general, applying a holistic approach and managing handover situations are recommended for nursing managers to overcome handover challenges. Future focus could be on addressing handover challenges through an action research study.

Bedside nursing handover: patients' opinions

Within the context of contemporary nursing practice, bedside handover has been advocated as a potentially more suitable mode for achieving patient-centred care. Given that patients can play an important role in the process, better understanding of patients' perspectives of bedside handover could be a critical determinate for successful implementation of the practice. Using a phenomenological approach, this study attempted to explore patients' perceptions of bedside nursing handover. Four key themes emerged from the patient interviews: 'a more effective and personalised approach', 'being empowered and contributing to error minimization', 'privacy, confidentiality and sensitive topics', and 'training need and avoidance of using technical jargon'. Patients welcome bedside handover as they can be empowered through participation in the process. Nevertheless, attention is needed to ensure that adequate training is provided to nurses and to minimize the use of technical jargon so that handover is delivered with a professional and consistent approach.

Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: Insights from interviews and observations

Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses’ use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor’s electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer “at a glance” information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.

Patients' perspectives of bedside nursing handover

BACKGROUND

Patient participation in handover is one aspect of patient-centred care, where patients are considered partners in care. Understanding the patient perspective provides a foundation for nurses to tailor their bedside handovers to reflect patients' thoughts and beliefs and encourage their active involvement in decision-making.

AIM

This study examined patients' perspectives of participation in shift-to-shift bedside nursing handover.

METHODS

A descriptive case study was conducted with 10 patients in one Queensland hospital who had experienced bedside handover during their hospitalisation in 2009. Participants were asked their views about bedside handover including its benefits and limitations, their existing and potential role in handover, the role of family members, and issues related to confidentiality. Data were analysed using thematic content analysis.

FINDINGS

Four themes emerged from the analysis. First, patients appreciated being acknowledged as partners in their care. Second, they viewed bedside handover as an opportunity to amend any inaccuracies in the information being communicated. Third, some preferred passive engagement rather than being fully engaged in the handover. Fourth, most patients appreciated the inclusive approach of handover as nurse-patient interaction.

CONCLUSIONS

Bedside handover provides an opportunity for patients to be involved as active participants in their care. They value having access to information on an ongoing basis, and although not all choose the same level of interaction, they see their role as important in maintaining accuracy, which promotes safe, high quality care.

The Use of Resources during Shift Hand-offs in a Pediatric Intensive Care Unit

The nursing handoff is a fundamental aspect of continued patient care that involves the transfer of vital medical information through various means. This project qualitatively examined nursing dyads to determine the types of resources used during handoffs and their frequency through the theoretical framework of distributed cognition. Forty handoffs between nurses, with experience ranging from 3 to 40 or more years, were observed within the intensive care unit of a pediatric hospital. The findings revealed that a variety of resources were referred to and appear mildly correlated with handoff durations, where more experienced individuals displayed a greater frequency of resource use in prolonged handoffs.

Handoffs in care--can we make them safer?

In today's complex and rapidly changing health care environments, patient harm may result if important patient information is not communicated from one health care provider to another during handoffs in care. Issues involving communication, continuity of care, and care planning are cited as a root cause in more than 80% of reported sentinel events. In light of the inherent risks associated with handoffs in care, the use of strategies that reduce the impact of human factors on effective communication and standardize the communication process is essential to ensure appropriate communication patient information and that a plan of care is continued through the process.

Can Technology Improve Intershift Report? What the Research Reveals

Shift report is a multifaceted process that serves to provide nurses with vital patient information to facilitate clinical decisions and patient care planning. A shift report also provides nurses with a forum for functions, such as patient problem solving and collaboration. The authors conducted a literature review, which indicates that current methodologies used to collect and convey patient information are ineffective and may contribute to negative patient outcomes. Data incongruence, legal implications, time constraints augmented by the nursing shortage, and the financial impact of shift report are also addressed. The literature reveals significant rationale for pioneering new and innovative methods of shift-to-shift communication. In the report To Err is Human: Building a Safe Health System, the Institute of Medicine attributes the deaths of up to 98,000 hospitalized Americans to medical errors, including communication failures [Institute of Medicine. (1999). To err is human: Building a safe health system. Report by the Committee on Quality of Health Care in America. Washington, DC: National Academy Press]. As a result, government policy makers and health care agencies have focused their attention on determining the root cause of errors to identify preventative measures, including the use of information technology [Institute of Medicine. (2004). Keeping patients safe: Transforming the work environment of nurses. Report by the Committee on Quality of Health Care in America. Washington, DC: National Academy Press]. Under these premises, the authors examined the process of nursing shift report and how it impacts patient outcomes. The use of computer technology and wireless modes of communication is explored as a means of improving the shift report process and, subsequently, health care outcomes and patient safety.

Managing change in the nursing handover from traditional to bedside handover - a case study from Mauritius

Background

The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system.

Methods

A force field analysis in terms of the driving forces had shown that there was dissatisfaction with the traditional method of handover which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The restraining forces identified were a fear of accountability, lack of confidence and that this change would lead to more work. A 3 – step planned change model consisting of unfreezing, moving and refreezing was used to guide us through the change process. Resistance to change was managed by creating a climate of open communication where stakeholders were allowed to voice opinions, share concerns, insights, and ideas thereby actively participating in decision making.

Results

An evaluation had shown that this process was successfully implemented to the satisfaction of patients, and staff in general.

Conclusion

This successful change should encourage other nurses to become more proactive in identifying areas for change management in order to improve our health care system.

The hidden benefit: the supportive function of the nursing handover for qualified nurses caring for dying people in hospital

1. The nursing handover is a key activity for nurses working in acute hospital wards in the NHS. Little scholarly attention has been paid to the use nurses make of the information exchanged during nursing handover or how certain features of the nursing handover might impact positively or negatively on patient outcomes. 2. This paper draws on data from a phenomenological study of 28 qualified diplomate nurses. 3. During the course of non-directive semi-structured interviews, some of the participants in this study expressed the opinion that nursing handover was helpful in enabling them to work with dying people in the acute hospital medical wards in which they worked. 4. The nurses identified two important functions of the nursing handover. The first was as a forum for discussing opinions and expressing feelings. The second was as a source of information on which to base their nursing decisions and actions. 5. It is proposed that some qualified nurses need help with the emotional labour of caring for dying people and that the nursing handover can assist in emotional adaptation, so enabling the management of troubling thoughts or feelings experienced in the course of caring for someone who is dying. 6. The role of the nursing handover in providing emotional support for nurses has been little studied and is a potentially useful area of future research, especially if it can be related to patient experiences and outcomes.

Challenging the handover ritual

Communicating nursing care during the patient's total hospital stay is a difficult task to achieve within the context of high patient turnover, a lack of overlap time between shifts, and time constraints. Clear and accurate communication is pivotal to delivering high quality care and should be the gold standard in any clinical setting. Handover is a commonly used communication medium that requires review and critique. This study was conducted in five acute care settings at a major teaching hospital. Using a grounded theory approach, it explored the use of three types of handover techniques (verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semistructured interviews with nurses and participant field observations. Textual data were managed using NUD*IST. Transcripts were critically reviewed and major themes identified from the three types of handovers that illustrated their strengths and weaknesses. The findings of this study revealed that handover is more than just a forum for communicating patient care. It is also used as a place where nurses can debrief, clarify information and update knowledge. Overall, each type of handover had particular strengths and limitations; however, no one type of handover was appraised as being more effective. Achieving the multiple goals of handover presents researchers and clinicians with a challenging task. It is necessary to explore more creative ways of conducting the handover of patient care, so that an important aspect of nursing practice does not get classified as just another ritual.