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

Improving the Accuracy of the Gynaecology Handover Process: An Effective Quality Improvement Project at a University Hospital in the United Kingdom

Objectives The objective of this study was to introduce a new system of handover in the gynaecology department and ensure its effectiveness with dynamic improvement measures. This was launched as a quality improvement project in a district general hospital in the United Kingdom. The primary aim was to start and consolidate a new system of a separate gynaecology handover in the presence of consultants, registrars (incoming and outgoing), senior house officers (incoming and outgoing) and gynaecology nurses. Design The strategy for consolidation included a daily quality review on the basis of a fixed proforma, identifying the obstacles faced, and improvising dynamic solutions. A new quality check proforma was introduced which took into account: (i) Presence of team members, (ii) Following of proper SBAR (Situation, Background, Assessment, Recommendation) format in the handover, (iii) Updating of patients awaiting surgeries with every detail on the list, (iv) Proper handing over of pending referrals, (v) Mention of sick patients with proper importance, and (vi) Proper handing over of new admissions. A pilot study was done to evaluate the baseline performance of the unit regarding the gynaecology team handover on the basis of the same proforma. The result of the baseline study was noted as the reference. Each day the team receiving the handover was interviewed for the next five months about the quality of each of the parameters on the predesigned proforma and the responses were noted. The answers were designed in binary form (Yes/No). These results were compiled at the end of each month. The result from each individual month was reviewed and the problems were identified and practical solutions were applied. These changes were noted and plotted graphically as a bar diagram. The monthly audit results were tabulated in an Excel sheet (Microsoft Corporation, Redmond, Washington, United States). Results Pilot study results and final month results were compared with the help of the Mcnemar test and statistically significant improvement was noticed in seven out of eleven parameters. There was a steady and gradual improvement in the responses. The possible limitations of the study were also noted at the same time. Conclusion The quality improvement project was highly effective in improving the quality of handover and increased patient safety to a large extent.

The Turkish version of the Handover Evaluation Scale: A validity and reliability study

AIM

The purpose of this study is to adapt the English version of the Handover Evaluation Scale to a Turkish nursing sample.

METHODS

This is a methodological and cross-sectional study. This study was conducted with 192 nurses working in different units in a public hospital between September 2016 and January 2017. A descriptive information form and the Handover Evaluation Scale were used to collect data. First, language validity and content validity were determined regarding the adaptation of the scale.

RESULTS

As a result of the adaptation process, it was determined that the scale's structure, which consisted of 10 items and two factors explaining 68.96% of the total variance, was valid and reliable for the Turkish nursing sample. A Kaiser-Meyer-Olkin test and Bartlett's test of sphericity indicated that the sample met the criteria required for factor analysis. The reliability coefficient for the overall scale was 0.92. The test-retest reliability results were 0.87 for the overall intraclass correlation coefficient, and the t-test result was P > .05.

CONCLUSION

This adaptation study revealed that the scale is a valid and reliable tool for evaluation of the handover of Turkish nurses.

Using focused ethnography to explore and describe the process of nurses' shift reports in a psychiatric intensive care unit

AIMS AND OBJECTIVES

To explore and describe the cultural routine of shift reports among nursing staff in a psychiatric intensive care unit and further to develop a taxonomic, thematic and theoretical understanding of the process.

BACKGROUND

Lack of communication among healthcare staff is associated with risks for medical errors. Thus, handovers and shift reports are an essential and integral routine among nurses to pass on information about the patients' health status. Previous studies within the field have highlighted the benefits of structured reporting tools. However, shift reports as a cultural activity within the nursing tradition have been given less attention, not the least in psychiatric care.

METHODS

Focused ethnography was used. The data comprised 20 observational sessions. The observations ranged over a time span of 5 months and were conducted in a psychiatric intensive care unit in Sweden.

RESULTS

The process of shift reports encompassed the following three phases: (a) getting settled, (b) giving the report and (c) engaging in the aftermath. The results demonstrate that the phases entail different cultural activities, which take place in different areas of the ward and that the level of formality varied.

CONCLUSIONS

Shift reports are not an isolated event with clear boundaries. The study enriches the understanding of shift reports as a "fuzzy process". The individual phases were found to be tied to cultural connotations, such as activities, places and roles with certain meanings for staff members.

RELEVANCE TO CLINICAL PRACTICE

The new insights are useful for nurses in overcoming an uncritical adoption of the biomedical tradition regarding pace and tone during shift reports. The reporting nurse has the potential to transform shift reports from a monologue with a foreclosed style to a more dialogical interaction with colleagues that focuses on the patients' needs rather than the needs of staff.

The 'switch on-switch off model': Strategies used by nurses to mentally prepare and disengage from work

There is considerable research on the experience of nurses during both their work and non-work time. However, we know relatively little about the strategies nurses use immediately before and immediately after their shift. This crossover period, from one shift to another, has critical impact for patient outcomes. The aim of this qualitative study was to explore strategies nurses employ to mentally prepare for their shift (switch on), and mentally disengage after the end of it (switch off). Eleven Greek hospital nurses were recruited for the study. Interviews were audio-taped and analysed using a content analysis approach. Five themes were identified as strategies nurses use to mentally prepare and disengage from their shift: (i) personal care/grooming; (ii) religious rituals; (iii) nicotine/caffeine; (iv) social interaction; and (v) listening to music. Nurses reported using the same strategies before and after their shift, but for different purposes. The authors propose a 'switch on-switch off' model to describe the process of mental preparation and mental disengagement from work. The switch-on/off approach represents an opportunity to increase nurses' resilience and identify individual and organizational factors that contribute to patient outcomes.

User participation in district psychiatry. The social construction of 'users' in handovers and meetings

An ideal in mental health care is user participation. This implies inclusion and facilitation by clinicians to enable users to participate in decisions about themselves and in the design of suitable treatment. However, much of the work of clinicians consists of handovers and other meetings where patients are not present. It is therefore interesting to study how the patient perspective is handled in such meetings and whether it forms a basis for user participation. We conducted fieldwork in three different inpatient wards in Norwegian District Psychiatric Centres. We used an interactional perspective in our analysis, where speech acts, framing and footing were key concepts. The findings show that the talk in the handovers and meetings contained five main themes and that there was a clear correlation between what was said and how it was said, and whether clinicians related to the content in a decisive, person-centred or indecisive manner. We discuss potential participation statuses for patients and their limited opportunity to influence the talk and possible decisions about themselves. Our conclusion is that handover meetings primarily function as an aid in organising clinicians' work and could ultimately be seen as counteracting user participation.

Learning, support and communication for staff in care homes: outcomes of reflective debriefing groups in two care homes to enhance end-of-life care

BACKGROUND

Nursing care homes are increasingly the place where frail older people die. However, training in end-of-life care is not statutory.

AIMS AND OBJECTIVES

To develop strategies to promote quality end-of-life care in nursing care homes.

DESIGN

Action research was used to work collaboratively with the managers and staff in two nursing care homes to develop end-of-life care.

METHODS

There were three overarching phases: an exploratory phase, feedback/planning of actions and a summative evaluation. Two main actions were inductively derived. One of the actions, reflective debriefing groups following a resident's death, is reported.

RESULTS

Ten reflective debriefing groups, led by the researcher (a specialist palliative care nurse), were undertaken. The groups facilitated learning at three different levels (being taught, developing understanding and critical thinking) and enabled staff to feel supported and valued.

IMPLICATIONS FOR PRACTICE

The use of reflective debriefing groups is a useful mechanism to support experience-based learning about death/dying in care homes.

Bedside shift reports: what does the evidence say?

Bedside shift reports are viewed as an opportunity to reduce errors and important to ensure communication between nurses and communication. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education. Nurse shift reports and nurse handovers are 2 of the most critical processes in patient care that can support patient safety and reduce medical errors in the United States. Nurses continue to not recognize the evidence supporting this practice and adopt bedside report into practice.

Shift change handovers and subsequent interruptions: potential impacts on quality of care

OBJECTIVES

Two statistical surveys in France revealed both widespread dissatisfaction about shift change handovers and the feeling of being frequently disturbed by interruptions. Shift change handovers (SCHs) are being reduced or eliminated in France to reduce staff costs. The objective of our study is to clarify the consequences of short SCHs on efficiency, team function, and quality of care.

METHODS

Real-time task ergonomic analysis of 29 state-registered nurses (RNs), 18 nursing aides (NAs), and 14 full-time physicians was conducted in various departments of general and university hospitals.

RESULTS

The average time available to RNs for sharing information during SCHs was 15 minutes at the beginning of the work session and 13 minutes at the end. There were, on average, 50 interruptions of activity, and these interruptions occupied 16% of the working time. Consequently, less time was available for direct care, although the number of such acts was increased. Periods for preparation of care, writing, seeking information, or equipment were very numerous. The mean number of changes of activity was very large: 260 per work session. For NAs, SCHs were similar to those for RNs at the beginning of the work session (mean = 18 minutes) but shorter at the end (10 minutes). The mean number of interruptions was 30 and caused 10.3% of the working time to be lost with 164 changes of activity. For physicians, SCHs were even shorter and, in many cases, nonexistent. The mean number of interruptions was 30 (11.4% of their working time, 153 changes of activity). Shift change handovers were mostly conducted separately for RNs, NAs, and physicians.

DISCUSSION

A better sharing of knowledge between the different health-care workers, and especially at the beginning of the work session, could reduce interruptions and potentially improve quality of care.

A systematic review on the transfer of information during nurse transitions in care

AIMS AND OBJECTIVES

To examine the qualitative evidence on dynamics of knowledge transfer during transitions in care in acute care hospitals.

BACKGROUND

The most common transition between nurse care providers is the intershift handoff. As these handoffs tend to be time-consuming and costly, it is important to understand the dynamics of the transfer of information at this time and, by extension, improve quality and safety.

DESIGN

Systematic Review.

METHODS

Qualitative studies conducted between 1988 and 2012 were sought. A comprehensive four-stage search strategy identified 125 qualitative studies that met the inclusion criteria. Of these, 50 were retrieved for appraisal. Retrieved papers were assessed by two independent reviewers for methodological quality prior to inclusion in the review using a standardised critical appraisal instrument.

RESULTS

The final sample consisted of 29 qualitative studies. This represented more than 800 nursing handoffs and 300 nurse interviews. Sixteen categories were identified, which were then subjected to a meta-synthesis to produce a single comprehensive set of synthesised findings.

CONCLUSION

The evidence shows the handoff to be a complex, social interaction highly sensitive to context and cultural norms, an activity essential to multiple functions that extend beyond quality and safety. They are subject to wide variability in both the methods used and the kind of information that is handed off. Notably, the elucidation of the different ways in which individual nurses act as gatekeepers and influence patient care is a major finding of this review.

RELEVANCE TO CLINICAL PRACTICE

The results of this systemic review provide evidence that a consistent guideline may provide an optimal shift report given the findings of this review that information transferred may be random and variable, inconsistent and incongruent, inaccurate or absent.

Measurement of the frequency and source of interruptions occurring during bedside nursing handover in the intensive care unit: An observational study

BACKGROUND

Effective clinical handover involves the communication of relevant patient information from one care provider to another and is critical in ensuring patient safety. Interruptions may contribute to errors and are potentially a significant barrier to the delivery of effective handovers.

OBJECTIVES

The study objective was to measure the frequency and source of interruptions during intensive care (ICU) bedside nursing handover.

METHODS

Twenty observations of bedside handover in an ICU were performed and the frequency and source of interruptions were recorded by the observer for each handover. Observations occurred Monday to Friday during shift change; night to day shift and day to evening shift. Interruptions were defined as a break in performance of an activity.

RESULTS

The mean handover time was 11 (± 4)min with a range of 5-22 min. The mean number of interruptions was 2 (± 2) per handover with a range of 0-7. The most frequent number of interruptions was seven, occurring during a 15 min handover. Doctors, nurses and alarming intravenous pumps were the most frequent source of interruptions, with administration staff and wards people also disrupting handovers.

CONCLUSION

Nurses, doctors and alarming intravenous pumps frequently interrupt ICU bedside handovers, which may lead to loss of critical information and result in adverse patient events. Increased knowledge in this area will ensure appropriate strategies are developed and implemented in healthcare areas to manage interruptions effectively and improve patient safety.

Understanding current intensive care unit nursing handover practices

Clinical handover is critical to clinical decision-making and the provision of safe, high quality, continuing care. Incomplete and inaccurate transfer of information can result in poor outcomes. To assess the content and completeness of the intensive care unit nursing shift-to-shift handover, a prospective, observational study design was used. A semistructured observation sheet based on 10 key principles for handover was used to overtly observe 20 bedside nursing handovers. Descriptive statistics were used to analyse the data. Overall, the content handed over was consistent with the key principles of clinical handover. However, there were some key principles that were minimally addressed or absent from clinical handovers. Development and implementation of a handover tool specific to intensive care will assist in ensuring that all key principles are adhered to so that adverse events associated with miscommunication during clinical handover are reduced and a high standard of care is maintained.

Construct validity and reliability of the Handover Evaluation Scale

AIMS AND OBJECTIVES

To examine the psychometric properties of the Handover Evaluation Scale using exploratory and confirmatory factor analysis.

BACKGROUND

Handover is a fundamental component of clinical practice and is essential to ensure safe patient care. Research indicates a number of problems with this process, with high variability in the type of information provided. Despite the reported deficits with handover practices internationally, guidelines and standardised tools for its conduct and evaluation are scarce. Further work is required to develop an instrument that measures the effectiveness of handover in a valid and reliable way.

DESIGN

Secondary analysis of data collected between 2006-2008 from nurses working on 24 wards across a large Australian healthcare service.

METHODS

A sample of 299 nurses completed the survey that included 20 self-report items which evaluated the effectiveness of handover. Data were analysed using exploratory factor analysis and confirmatory factor analysis supported by structural equation modelling.

RESULTS

Analyses resulted in a 14-item Handover Evaluation Scale with three subscales: (1) quality of information (six items), (2) interaction and support (five items) and (3) efficiency (three items). A fourth subscale, patient involvement (three items), was removed from the scale as it was not a good measure of handover.

CONCLUSIONS

The scale is a self-report, valid and reliable measure of the handover process. It provides a useful tool for monitoring and evaluating handover processes in health organisations, and it is recommended for use and further development.

RELEVANCE TO CLINICAL PRACTICE

Monitoring handover is an important quality assurance process that is required to meet healthcare standards. This reliable and valid scale can be used in practice to monitor the quality of handover and provide information that can form the basis of education and training packages and guidelines to improve handover policies and processes.

Stereotyping stigma: undergraduate health students' perceptions at handover

The World Health Organization (WHO) has recognized that errors in communication are one of the leading causes of adverse patient outcomes. Consequently, the WHO developed the High 5s Project to review, among other variables, handover of patients between shifts, professionals, and organizations. Seven countries were involved in the initial project. Australia responded by using the ISOBAR (Identify, Situation, Observations, Background, Agreed plan, and Read-back) tool as a template. However, none of the countries involved considered the social and emotional effects of handover on the staff or patients, although research has demonstrated that attitudes and values can be handed over from one nurse to another during this process. This article shows how the nurse who hands over care from one shift to the next can transfer stigma and labeling and offers suggestions for nurse educators and clinicians to apply national standards and core values to clinical practice and education.

Bedside review of patient care in an emergency department: The Cow Round

OBJECTIVE

Clinical handover is a critical point in medical care in the ED, which can contribute to adverse effects for patient care and staff workloads. Over a 4 and a half months in a tertiary referral hospital ED, a centralized whiteboard handover was performed followed by a multidisciplinary review of each patient. This round was referred to as the 'Cow Round'.

METHODOLOGY

This observational study used a standardized feedback survey of clinicians leading each Cow Round. The survey asked participants in the round to report issues found, which were not handed over during the centralized whiteboard handover. Data were analysed for the number of issues identified, the type of issue identified, and to determine if there was a relationship between the number of issues reported and patients in the department.

RESULTS

204 surveys met inclusion criteria. Clinical issues not handed over at the standard whiteboard round were found in 64% of Cow Rounds. Of the 2411 patients reviewed on Cow Rounds, 14.1% had at least one clinical issue not handed over during the whiteboard round. A mean of 2.2 issues per round (95% CI 1.9-2.5) were found. Pearson correlation found a relationship between the number of issues identified and the total number of patients in the department (r= 0.246 P= 0.005).

CONCLUSION

Review of patients led by a senior member of medical staff, at the patient bedside enables the timely identification and management of issues not communicated during the whiteboard handover process. This review is important when more patients are receiving treatment in the department.

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.

A systematic review of nurses' inter-shift handoff reports in acute care hospitals

OBJECTIVE

An inter-shift nursing handoff report is the exchange of patient care information for evidence-based nursing and midwifery from one nurse to another, and is a universal procedure used in hospitals to promote continuity of care. The objective of this review was to appraise and synthesize the best available qualitative evidence pertaining to the nursing handoff report at the time of shift change and make recommendations that can enhance the transfer of information between and among nurses, and by extension, improve patient care.

INCLUSION CRITERIA

The review considered qualitative studies that drew on the experiences of nurses at the time of inter-shift nursing handoff in acute care hospitals, and included designs such as phenomenology, grounded theory, narrative analysis, action research, ethnographic or cultural studies.

SEARCH STRATEGY

The search strategy sought to find both published and unpublished research papers. An initial search of the Joanna Briggs Institute for Evidence-Based Nursing and Midwifery, the Cochrane Library, and PubMed's Clinical Inquiry/Find Systematic Review database was conducted. Following this, an extensive three stage search was conducted using PubMed, CINAHL, HealthStar, ScienceDirect, Dissertation Abstracts International, DARE, PsycINFO, BioMedCentral, TRIP, Pre-CINAHL, PsycARTICLES, Psychology and Behavioural Sciences Collection, ISI Current Contents, Science.gov, Web of Science/Web of Knowledge, Scirus.com website. Included was a hand search of reference lists of identified papers to capture all pertinent material as well as a search of relevant world wide websites and search engines, such as Google Scholar and the Virginia Henderson Library of Sigma Theta Tau International.

METHODOLOGICAL QUALITY

Each paper was assessed independently, by two reviewers for methodological quality prior to inclusion in the review using the critical appraisal instrument QARI (Qualitative Assessment and Review Instrument) developed by the Joanna Briggs Institute for Evidence Based Nursing and Midwifery.

RESULTS

A total of 21 qualitative papers were included in the review of the 42 papers retrieved. Twenty-one were excluded as they did not meet the inclusion criteria. Findings were extracted and a meta-synthesis conducted using JBI-QARI. Three syntheses about the process of handoffs at the time of inter-shift nurses' reports in acute care hospitals were derived: 1) An embedded hierarchy exists that influences the conduct of inter-shift nursing handoffs; 2) Participating in inter-shift nursing handoffs are a way of becoming acculturated into the nursing unit's norms, expectations and rituals; 3) The nurse is the gatekeeper of information handed off that is used for subsequent care decisions.

CONCLUSION

There is evidence to support that the current process of inter-shift nurses' reports serves several purposes in addition to transfer of information, including the development of group solidarity. It is apparent from this review that the nurse is the gatekeeper for the flow of information regarding patient care and chooses what information to impart and act upon. Multiple ways of transferring information are recommended for the inter-shift nursing handoff as a way to manage information decay or funneling and to address potential communication gaps due to in congruencies between the medical record, verbal handoff report and actual clinical condition.

IMPLICATIONS FOR PRACTICE

A consistent guideline is a prerequisite to formulating an optimal shift report given the findings of this review that the quality of information transferred is unpredictable. The guideline needs to take into consideration, not only the exchange of information, but that nurses handle patient information in personal ways. To that end, a one-page report pre-populated with patient demographics, recent vital signs, laboratory results, and other information which can be accessed and printed at point-of-care at the time of change of shift is recommended.

IMPLICATIONS FOR RESEARCH

As external agencies continue to call for hand-off standardization that may not, in and of itself, reduce risk, further research is needed to determine the associations between inter-shift nursing reports and patient outcomes. Practice model initiatives, such as SBAR (situation-background-assessment-results) need to be investigated to determine if these methods can prevent information loss, particularly in those areas where information decays quickly, such as the Intensive Care Unit. As well, the current shortage of nurses make the composition of the nursing team less stable with more temporary and part-time workers resulting in a decrease in the cohesiveness and social interaction necessary to becoming acculturated in a nursing unit This could present a barrier to communication of important information and contribute to information loss that needs to be investigated.

Nursing handover within mental health rehabilitation: an exploratory study of practice and perception

Nursing handover is an established practice that involves an interchange of information between nurses to inform of the condition of patients. It is essential to nursing practice in terms of continuity and quality of patient care. However, there is a lack of agreement about the quality, content, and process of handover and, in particular, a lack of information specific to mental health contexts. This paper reports the results of exploratory research of the practice and beliefs about verbal nursing handover within an inpatient mental health rehabilitation setting. Qualitative data were obtained from audiotaped handovers and interviews with nurses and analysed using content analysis. Handovers were found to lack structure and content, be retrospective, problem-focused and inconsistent. The findings were fairly consistent with the literature and would likely be applicable across nursing settings; however, the need to appraise nursing handover in unique contexts was also revealed. The study raised questions about how nursing handover reflects the goals and philosophies of mental health rehabilitation and whether nursing handover is an activity fully integrated with the focus of mental health rehabilitation.

Information Environments for Supporting Consistent Registrar Medical Handover

This study was two-fold in nature. Initially, it examined the information environment and the use of customary information tools to support medical handovers in a large metropolitan teaching hospital on four weekends (i.e. Friday night to Monday morning). Weekend medical handovers were found to involve sequences of handovers where patients were discussed at the discretion of the doctor handing over; no reliable discussion of all patients of concern occurred at any one handover, with few information tools being used; and after a set of weekend handovers, there was no complete picture on a Monday morning without an analysis of all patient progress notes. In a subsequent case study, three information tools specifically designed as intervention that attempted to enrich the information environment were evaluated. Results indicate that these tools did support greater continuity in who was discussed but not in what was discussed at handover. After the intervention, if a doctor discussed a patient at handover, that patient was more likely to be discussed at subsequent handovers. However, the picture at Monday morning remained fragmentary. The results are discussed in terms of the complexities inherent in the handover process

Competence Development Among Nurses: The Process of Constant Interaction

BACKGROUND

The importance of competence to nursing practice was the motivation for this study, which explored nurses' experience in developing their competence as they progress through their careers.

METHODS

In accordance with grounded theory method, data collection and data analysis were performed simultaneously using the constant comparative method.

RESULTS

Data revealed that nurses developed competence through an iterative process called "the process of constant interaction." This five-stage process was found to be a complex, ongoing interpersonal dynamic between the nurse and the surrounding world.

CONCLUSIONS

Although the nurse is the key player in the process of his or her own competence development, employers have a pivotal responsibility in facilitating the nurse's progress toward ongoing professional competence, which is a key element of the quality of care.

Nurses' perception of shift handovers in Europe ? results from the European Nurses' Early Exit Study

AIM

This paper reports a study exploring nurses' perceptions of the shift handover and the possible reasons for reported dissatisfaction in 10 European countries.

BACKGROUND

The nursing handover fulfils a number of purposes and has important consequences for the continuity of patient care and nurses' satisfaction with the quality of care they are able to provide. However, the performance and function of shift handovers in health care is a widely neglected topic in practice and research.

METHOD

The Nurses' Early Exit Study (http://www.next-study.net) investigates the working conditions of nurses and variables influencing nursing retention. The data for this analysis were collected between 2002 and 2003 by self-report questionnaires in 10 European countries.

FINDINGS

The percentage of nurses dissatisfied with shift handovers ranged from 22% in England to 61% in France. In most countries the main reason for dissatisfaction with shift handovers was 'too many disturbances', followed by 'lack of time'. Most countries showed similar associations of dissatisfaction with qualification level and occupational seniority, but not with position and type of shift. 'Poor quality of leadership' and 'poor support from colleagues', were strongly associated with dissatisfaction.

CONCLUSIONS

In several (but not all) European countries, shift handovers may be a frequent cause for nurses' irritation. The underlying causes appear to be of an organizational nature. The findings have implications for solutions. Further debate and research should clarify the different purposes of shift handovers and relate them to handover style and to the quality of patient care.

Facteurs liés aux épisodes violents dans les soins

INTRODUCTION

The respective roles of medical specialties and work organization on violent events against healthcare workers (HCW) in different countries was examined.

METHODS

Using the results of the Presst-Next study, we analyzed data from 27134 HCW in 7 European countries. Multivariate logistic analyses were conducted with SPSS 12 software.

RESULTS

After adjustment for age, gender and other occupational risk factors, the factors indicating insufficient team work were highly associated with an increased risk of violent events. Dissatisfaction with shift change (OR=1.35; 95%CI 1.23-1.47), uncertainty about treatment (OR=1.57; 95%CI 1 .44-1.71), and frequent interruptions (OR=2.04; 95%CI 1.81-2.31) were linked to violent events, up to twice the number among HCW reporting better team work. Contradictory orders, dissatisfaction with psychological support, and harassment by superiors were all significantly associated with increased reporting of frequent violent events. We observed a positive gradient between violent events and job demand (time pressure) (OR=1.25 for an intermediate score and OR=1.55 for a high score, compared with a low score). Loneliness at work, certain work schedules, and physical load increased the risk. Nurses' aides were exposed to violent events more often (OR=1.57; 95%CI 1.38-1.79) than head nurses. Older HCW and those with more experience were less exposed. The highest risks were associated with working in psychiatric (OR=4.89; 95%CI 3.82-6.25) and emergency (OR=2.68; 95%CI 2.10-3.44) departments, compared with home care and day care. The excess risk was an additional 30% in geriatrics and long-stay departments. Significantly less risk was observed in pediatrics, obstetrics and gynecology departments (OR=0.70; 95%CI 0.56-0.88).

CONCLUSION

Team building requires time, and shift change is a key period. This time is far from nonproductive. Rather, its effective use reduces treatment errors, enhances quality of care, and reduces the frequency of violent events. It is crucial in every department.

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.

Some benefits experienced by hospice nurses from group clinical supervision

A small clinical supervision group consisting of five hospice nurses met together in their workplace 1 h weekly for 12 weeks. Issues concerning professional practice were examined with the help of a researcher (A.J.) who acted as facilitator. At the end of the group's life A.J. asked all nurses to complete a questionnaire related to the workplace and 12 identified helpful factors. Two weeks later the hospice nurses were interviewed in group format and asked to consider the reasons for their choice of answers. The data revealed that collectively--interpersonal learning (output), identification, catharsis, family re-enactment, group cohesiveness and self-understanding were experienced by the hospice nurses as the most helpful factors to the group. Existential factors, guidance, universality, interpersonal learning (input), instillation of hope and altruism were identified as less important. Variations in individual responses showed different ways in which a group might meet the needs of its members. The study concludes with the suggestion that work discussion groups can offer nurses the means to calm, regulate and plan their interactions with themselves and others. Clinical supervision is an effective format for exploring issues concerning professional practice, allowing nurses to: learn from each other, offer support, recognize how others see and esteem them as fellow workers, and moderate concerns and anxiety related to their work. Group work is likely to raise anxiety in all participants, however, and preparation and support are required for the group facilitator. Carefully chosen membership is also considered important to the safety of members and successes of the group.