Communication: Is There a Standard Handover Technique to Transfer Patient Care?

Pilot study to develop a pre-operative "Cardiothoracic Clinical Handover Tool" and its effect on handover quality

BACKGROUND

Clinical handover is an essential step in the surgical patient's hospital journey, but one that is not without risk. Within cardiothoracic surgery, endeavours to protocolise post-operative handover from cardiac theatre to cardiac intensive care units have resulted in enhanced patient safety, but little to no effort has focused on the pre-operative setting and the dissemination of information throughout the surgical team.

METHODS

We designed a pre-post study examining the quality of pre-operative cardiothoracic patient handovers before and after the introduction of an intra-departmentally designed "Cardiothoracic Clinical Handover Tool" based on the Royal College of Surgeons of England's guidelines for "Safe Handover".

RESULTS

Forty clinical handovers were assessed in each arm of the study. Handover quality improved from a score of 63.75% to 88.57% (p = < 0.001). This prolonged handover duration from a mean of 72.1 to 102.4 seconds per case (p = 0.003). Interruptions occurred in 27.5% of pre- and 25% of post-intervention handovers. Interruptions resulted in increased handover duration in both pre- and post-intervention groups (114.6 vs 77.7 seconds, p = 0.012) and poorer quality handovers in the pre-intervention group (51.28% vs 68.42%, p = 0.03) but failed to impact handover quality in the post-intervention group (88.57% vs 88.57%, p = 1).

CONCLUSIONS

Clinical handover tools have the potential to enhance the quality of pre-operative handover and protect against poor handover practices such as interruptions, safe-guarding patient welfare. We provide the first cardiothoracic specific pre-operative handover tool based on the RCSE guidelines.

Barriers and outcomes of therapeutic communication between nurses and patients in Africa: a scoping review

BACKGROUND

Therapeutic communication (TC) promotes effective patient care, emotional wellbeing, and improves patient outcomes. The purpose of this review was to synthesise evidence on barriers and outcomes of TC between nurses and patients in Africa and to inform future studies and systematic reviews.

METHODS

Search for the records was done in four major databases including PubMed, Science Direct, PubMed CENTRAL, and JSTOR. Additional searches were done in Google Scholar and Google. Results and findings from published studies and grey literature were included. A total of 16 articles met the eligibility criteria and were included in the review. This scoping review followed the guidelines by Askey and O'Malley.

RESULTS

Barriers associated with TC were grouped under five main themes: sociodemographic factors, patient-related factors, nurse-related factors, environmental and health service-related. Age, and religious beliefs were the main sociodemographic factors that hindered TC while stress and inadequate knowledge and skills were identified among the nurse-related barriers to TC. Extreme weather conditions and mosquito infestation were environmental factors while lack of access to TC educational programmes on TC was a health service-related factor that interfered with TC. Both positive and negative outcomes of TC were also identified.

CONCLUSION

Continuous professional development on TC is necessary to improve nurses' attitudes and update their skills to enable them to render culturally competent nursing care to patients.

Trauma Patient Transitions From Critical Care: A Survey of U.S. Trauma Centers

BACKGROUND

Transitions between clinical units are vulnerable periods for patients. A significant body of evidence describes the importance of structured transitions, but there is limited reporting of what happens. Describing transitions within a conceptual model will characterize the salient forces that interact during a patient transition and, perhaps, lead to improved outcomes.

OBJECTIVE

To describe the processes and resources that trauma centers use to transition patients from critical care to nonintensive care units.

METHODS

This cross-sectional study surveyed all Level I and II trauma centers listed in the American Trauma Society database from September 2020 to November 2020. Data were merged from the American Hospital Association 2018 Hospital Survey.

RESULTS

A total of 567 surveys were distributed, of which 152 responded for a (27%) response rate. Results were organized in categories: capital input, organizational facets, employee behavior, employee terms/scope, and labor inputs. Resources and processes varied; the most important opportunities for transition improvement included: (1) handoff instruments were only reported at 36% (n = 27) of trauma centers, (2) mandatory resident education about transitions was only reported at 70% (n = 16) of trauma centers, and (3) only 6% (n = 4) of trauma centers reported electronic medical record applications that enact features to influence employee behavior.

CONCLUSIONS

After years of focusing on transitions as a high-stake period, there remain many opportunities to develop resources and enact effective processes to address the variability in transition practice across trauma centers.

Improving Handoffs in the Perioperative Environment: A Conceptual Framework of Key Theories, System Factors, Methods, and Core Interventions to Ensure Success

BACKGROUND

Patient handoffs involve the transition of information and responsibility for care from one health care provider to another. They occur frequently during a patient's perioperative care continuum, potentially introducing communication errors that could result in harmful, even fatal consequences. The perioperative environment poses distinct challenges to team communication and patient safety, which in turn leaves the surgical patient uniquely vulnerable to adverse events.

CONCEPTUAL FRAMEWORK

The best way to achieve safe, coordinated handoffs throughout the perioperative continuum has yet to be established. However, a variety of theoretical principles, methods, and interventions have been used successfully in operative and nonoperative contexts among multiple disciplines. Informed by a literature review, the authors describe a conceptual framework for the development, implementation, and sustainment of a multimodal perioperative handoff improvement bundle. The conceptual framework presented here begins with overarching objectives for patient-centered handoff improvement efforts. The article outlines theoretical principles that could be used to guide and inform future multimodal interventions, as well as health care system factors to consider. Further, the authors propose employing data-driven quality improvement and research methodologies to conduct, measure, achieve, and sustain long-term success. Finally, this report describes essential evidence-based interventional components to employ.

IMPLICATIONS

Future efforts to improve handoff safety in the perioperative environment will require a comprehensive evidence-based approach. The authors believe the conceptual framework presented here outlines essential components for success. It integrates proven theoretical frameworks, consideration of system factors, data-driven iterative methods, and synergistic patient-centered interventions.

Relationship between emergency nurses' professional competencies and the Nursing care product

OBJECTIVE

(1) The professional competencies are related to the Nursing care product. (2) Staffing in APROCENF was related to six CSANE factors. (3) Care transfer in APROCENF was related to four CSANE factors. (4) Staffing and care transfer require competencies. to relate urgency and emergency nurses' professional competencies with the Nursing care product.

METHOD

a cross-sectional study conducted in the urgency and emergency units of two public hospitals. The participants were 91 nurses, 3 Nursing residents, 4 coordinators and 1 manager. Two validated instruments were used: 1) Competence Scale of Actions of Nurses in Emergencies and 2) Nursing Care Product Evaluation. Factors and domains were used, respectively. Descriptive statistics were applied, as well as Cronbach's alpha, Wilcoxon and Spearman's correlation tests (p<0.05).

RESULTS

in the professional competencies, higher values were verified for self-evaluation (p<0.001). In all 1,410 Nursing care product assessments, there was predominance of the "Good" score (n=1,034 - 73.33%). The "Nursing staffing" domain was related to the "Professional practice" (r=0.52719), "Relationships at work" (r=0.54319), "Positive challenge" (r=0.51199), "Targeted action" (r=0.43229), "Constructive behavior" (r=0.25601) and "Adaptation to change" (r=0.22095) factors; the "Care monitoring and transfer" domain, with "Professional practice" (r=0.47244), "Relationships at work" (r=0.46993), "Positive challenge" (r=0.41660) and "Adaptation to change" (r=0.31905) and the "Meeting care needs" domain, with "Professional practice" (r=0.32933), "Relationships at work" (r=0.31168), "Positive challenge" (r=0.29845) and "Adaptation to change" (r=0.28817).

CONCLUSION

there is a relationship between professional competencies and the Nursing care product domains.

Shift handover quality in Saudi critical care units: determinants from nurses' perspectives

BACKGROUND

Nurses' effective handover communication is vital for patient safety and quality of care. Few studies have empirically tested how certain factors influence the quality of handover in the Saudi context.

METHODS

A descriptive correlational design was used with a convenience sample of all nurses (N = 201) working in Saudi hospital CCUs in 2022. Demographics and handover quality instruments were used to collect the necessary data in addition to two open-ended questions that asked about perceived barriers and facilitators to handover. The analysis was conducted using descriptive statistics and regression analysis.

RESULTS

The majority of nurses reported good-quality handover. The regression analysis showed that staffing, cognitive capacity, the focus of attention, relationships, and safety climate factors contributed positively to the variance of handover quality. In contrast, intrusions, distractions, anxiety, time stress, and acute and chronic fatigue factors negatively affected the prediction of handover quality (p < 0.05). Nurses added types of shifts and languages as barriers to handover while emphasizing training and the use of standardized tools for handover as facilitators.

CONCLUSION AND RECOMMENDATIONS

Nursing handover is a multidimensional phenomenon. By understanding the determinants that contribute to or hinder handover quality, it is possible to develop targeted interventions aimed at improving communication and the quality of shift handover in CCUs. The current study's findings highlight the need for nurses to work in a more supportive environment, receive better training, and follow a standardized handover protocol. Additionally, nurse managers should pay more attention to nurses' well-being to control or mitigate the effect of psychological precursors on the quality of nurses' handover. Future research should investigate handover practices and outcomes on units that have both good and bad practice environments.

The relationships between patient safety culture and sentinel events among hospitals in Saudi Arabia: a national descriptive study

BACKGROUND

Sentinel events (SEs) can result in severe and unwanted outcomes. To minimize the fear of sentinel events reporting and the occurrence of sentinel events, patient safety culture improvements within healthcare organizations is needed. To our knowledge, limited studies explored the relationships between patient safety culture and sentinel events on a local level and no research has been conducted at the national level in Saudi Arabia.

OBJECTIVES

This study aimed to explore the relationships between the patient safety culture and the reported-SEs on a national level during the year 2020 in Saudi hospitals.

METHODS

This was a descriptive study. We utilized two data sources (the reported-SEs and the patient safety culture survey) that were linked using hospitals information. To explore the relationships between patient safety culture and reported-SEs rates, we performed descriptive statistics, a test of independence, post-hoc analysis, correlation analysis, and multivariate regression and stepwise analyses.

RESULTS

The highest positive domain scores in patient safety culture domains in the Saudi hospitals (n = 366) were "Teamwork Within Units" (80.65%) and "Organizational learning-continuous improvement" (80.33%), and the lowest were "Staffing" (32.10%) and "Nonpunitive Response to Error" (26.19%). The highest numbers of reported-SEs in 103 hospitals were related to the contributory factors of "Communication and Information" (63.20%) and "Staff Competency and Performance" (61.04%). The correlation analysis performed on 89 Saudi hospitals showed that higher positive patient safety culture scores were significantly associated with lower rates of reported-SEs in 3 out of the 12 domains, which are "Teamwork Within Units", "Communication Openness", and "Handoffs and Transitions". Multivariate analyses showed that "Handoffs and Transitions", "Nonpunitive Response to Error", and "Teamwork Within Units" domains were significant predictors of the number of SEs. The "Staff Competency and Performance" and "Environmental Factors" were the most contributory factors of SEs in the number of significant correlations with the patient safety culture domains.

CONCLUSION

This study identified patient safety culture areas of improvement where hospitals in Saudi Arabia need actions. Our study confirms that a more positive patient safety culture is associated with lower occurrence of sentinel events. To minimize the fear of sentinel events reporting and to improve overall patient safety a culture change is needed by promoting a blame-free culture and improving teamwork, handoffs, and communication openness.

Barriers to nurses' therapeutic communication practices in a district hospital in Ghana

BACKGROUND

Patients accessing health care enter the hospital environment with extreme anxiety, fear and distress which impacts their interactions with nurses and other health care professionals who are expected to help allay these anxieties in order to enhance patients care satisfaction. However, evidence suggests that there is a lack of effective therapeutic nurse-patient interaction in hospitals and the clinical environment globally, especially in sub-Saharan Africa.

METHODS

A qualitative research approach with an exploratory design was used to purposively select 30 participants who were engaged in face-face interactions. A semi-structured interview guide was used to conduct five audio-recorded FGDs with the 30 participants (6 in each group-2 males and 4 females) after which the discussions were transcribed verbatim, and content analyzed.

FINDINGS

Two (2) main themes and 10 sub-themes emerged from the analysis of the data. The two themes were: Therapeutic communication practices and Barriers to therapeutic communication. Some of the factors identified by patients to impede therapeutic nurse-patient interaction include family interference, negative attitude from patients, patient condition, a discriminatory attitude of nurses, increased workload, and stress.

CONCLUSION

Communication practices identified in this study include nurses' manner of communication, use of touch, positive reassurance, and nurses' demeanor. Several obstacles affect communication practices, hence the need to implement measures to improve nurse-patient interaction.

Nurses' perceptions of the ISBAR handover protocol and its relationship to the quality of handover: A case study of bilingual nurses

Introduction

Poor communication at handover may cause harm to the patient. Despite numerous studies promoting ISBAR as a communication tool for structured handover, nurses have varied levels of understanding of the ISBAR tool; this may lead to different perceptions. This paper aims to explore the structural relationships between factors relating to handover communication among nurses.

Method

A path analysis was conducted to analyse how 206 bilingual nurses' knowledge of the ISBAR affects the perceived quality of handover, using a validated Nursing Handover Perception Questionnaire.

Results

Nurses' knowledge of the ISBAR was not a statistically significant factor affecting the perceived quality of handover. Rather, nurses' understanding of patients' care plans and receiving updated information about patients determine the perceived quality of handover.

Discussion

Nurses' compliance with the ISBAR tool should be considered in order to further identify and develop effective communication skills. Nurses' understanding of patients' care plans and receiving updated patient information significantly corresponded to the perceived quality of handover.

SBAR Method for Improving Well-Being in the Internal Medicine Unit: Quasi-Experimental Research

SBAR (Situation, Background, Assessment, Recommendation) is a tool for standardizing and improving interprofessional communication. This study aims to explore the impact of SBAR in healthcare professionals' wellbeing, through concepts such as job satisfaction, engagement, resilience, and job performance, in the internal medicine unit of a university hospital in the province of León (Spain). This is an observational, descriptive, longitudinal case study with a pre- and post-intervention approach. Questionnaires were distributed to a group of doctors, nurses, and healthcare assistants before and after the implementation of the SBAR tool in the ward. The use of SBAR was monitored to ensure staff compliance. Data statistical analysis was performed using the SPSS program. Resilience levels increased significantly post-intervention. Job satisfaction and engagement levels remained neutral, slightly decreasing post-intervention. Besides' being a useful tool to improve communication, SBAR was effective in improving resilience among staff. Several aspects related to hospital management may have had an impact on job satisfaction and engagement results.

Nurses' Perceptions of Patient Safety Culture During the Pandemic in Covid-19 Referral Hospitals

Patient safety culture is essential in creating a safe and healthy hospital environment. This study aims to portray nurses' perceptions of patient safety culture during the Pandemic in COVID-19 Referral Hospitals. This paper was a descriptive study. The population was nurses working in inpatient, Covid-19 isolation, intensive, and emergency rooms. In addition, the sample was 268 nurses with a stratified random sampling. Data collection used a questionnaire using Google Forms. It consisted of the demographic characteristics of respondents (name, gender, age, marital status, working time, education, nurse position, levels of nursing, and patient safety training) also nurses' perception of patient safety culture. The Hospital Survey on Patient Safety Culture (HSOPC) was an instrument to assess patient safety culture. Data analysis used IBM SPSS Statistics version 22.0 to describe the mean, median, minimum, and maximum values and presentation. Results showed that the mean patient safety culture among nurses in COVID-19 referral hospitals was 147.09 (62.55%). In addition, the lowest dimension of patient safety culture was feedback and communication (31.75%), while the highest was an organizational improvement (73.16%). Thus, the patient safety culture in the COVID-19 referral hospital still needed improvement. A good patient safety culture can increase patient safety and the quality of health services. Therefore, hospital management should optimize all dimensions of patient safety culture to ensure patient safety. Future research could explore predisposing factors of patient safety culture

Navigating the Path to a Sustainable "PACU Pause" and Standardized Perioperative Handoff: A Quality Improvement Project

PURPOSE

The purpose of this project was to develop and implement a pause and standardized perioperative handoff to improve the quality of the handoff and the satisfaction of the perioperative team in the postanesthesia care unit (PACU) setting.

DESIGN

The Iowa Model for Evidence-Based Practice guided this evidence-based practice-quality improvement project.

METHODS

A team was formed of key nurses and other perioperative members to execute the project. The outcome of the evidence review, appraisal, and synthesis supported the change to a pause and standardized perioperative handoff. The project team educated perioperative staff on the practice change and new process. Baseline, 3-month and 1-year data were collected for adherence to the PACU PAUSE and handoff critical elements, and baseline and 3-months for satisfaction.

FINDINGS

PACU PAUSE adherence was 42.30% prepractice change, 92.3% postchange and 96.10% at 1-year. Adherence to the 17 critical elements in the standardized handoff was 40.16% prepractice change, 77.36% postchange and 71.78% at 1-year. Nurse satisfaction with the PACU PAUSE and handoff increased 59% and 50% respectively from pre to postpractice change. Operating room nurse and anesthesia provider satisfaction with PACU PAUSE and handoffs was greater than 85% at baseline and increased 14% and 8% respectively.

CONCLUSIONS

The PACU PAUSE allows for increased nurse concentration during the handoff and this can improve patient safety. Using a standardized handoff in situation, background, assessment, response format can decrease information loss and miscommunication, improve the quality of the handoff and the perioperative team members satisfaction with the handoff, and may mitigate patient safety events.

Factors associated with nurses' perceptions, their communication skills and the quality of clinical handover in the Hong Kong context

Background

Clinical handover is a pivotal, high-risk communicative event because it involves the transfer of responsibility and accountability for patients and their care. Nurses’ perceptions and their communication skills inevitably impact on their ability of clinical handover. Limited studies have explored nurses’ handover practice in the Hong Kong context. This study aimed to identify factors associated with and specific impact paths between the quality, communication skills and nurses’ perceptions on clinical handover.

Methods

A questionnaire survey was conducted immediately after the nurses’ training in effective handover communication. A convenience sample of 206 bilingual nursing staff from a local hospital in Hong Kong participated in this paper-and-pencil survey adopted from the Nurses Handover Perceptions Questionnaire survey.

Results

The path analysis revealed that except the opportunity to ask questions and high perceptions of the ISBAR communication protocol, other factors were significantly correlated with improved quality of handover. In addition, nurses who had updated information were likely to ask more questions and obtain a better understanding of the patient care plan during handover.

Conclusions

The quality of nursing handover depended on the degree of nurses’ grasp of the patient care plan. The ISBAR communication protocol was considered helping nurses to improve their communication skills with other colleagues and indirectly enhance patient’s safety. However, although ISBAR facilitated nurses to structure clearer handover communication, it was not the most important predictive factor for determining handover quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00624-0.

Developing and Implementing an Ambulatory Postanesthesia Care Unit Hand-Off Tool

PURPOSE

The purpose of this research study was to improve communication and reduce critical information loss between the ambulatory postanesthesia care unit (PACU) and ambulatory surgical center (ASC) nurses by developing, piloting, and evaluating a hand-off communication tool.

DESIGN

Descriptive study.

METHODS

This pilot study was conducted in an outpatient surgery unit located at a large Magnet university hospital in New Jersey. Twenty ASC registered nurses (RNs) evaluated the hand-off tool developed for this study. Descriptive statistics were used to analyze the data from the 20 ASC RNs using three Likert-scale questions.

FINDINGS

Three Likert-style questions guided the rating of this tool. Using correlation analysis, the results support that the tool may be perceived as an instrument that was simultaneously easy to use, helpful, and communicated relevant patient data. The calculation of the reliability coefficient was 0.89.

CONCLUSIONS

This standardized hand-off tool relayed the pertinent and relevant patient data needed to support handoff from the ambulatory PACU to the ASC. Only ASC RNs rated the tool in this study. A planned second phase will evaluate PACU nurse's perception of the tool.

Critical care nurses' communication challenges during handovers: A systematic review and qualitative meta-synthesis

AIMS

To review and synthesize qualitative studies to gain a deeper understanding of critical care nurses' inter-departmental and shift-to-shift handover challenges.

BACKGROUND

Good-quality nurse-to-nurse handover promotes patient safety, while poor handover has been associated with medical errors. However, systematic reviews of qualitative approaches for better understanding the handover experiences of critical care nurses are lacking.

EVALUATION

Systematic review methods incorporating meta-synthesis were used. A comprehensive search of seven databases was conducted. Two independent reviewers performed data extraction and evaluated ten studies using the Critical Appraisal Screening Program. Findings were analysed and synthesized using thematic analysis. The transactional model of communication was used to guide the analysis.

KEY ISSUES

A total of 10 qualitative studies were included. Seven major handover themes were identified: (a) expectations of perfection, (b) need for partnership, (c) unilateral communication, (d) obstacles to information acquisition, (e) lack of pertinent patient information, (f) need for a structured handover and (g) interruptions/distractions.

CONCLUSIONS

Handovers should be considered an essential part of patient-centred care for ensuring continuity of care.

IMPLICATIONS FOR NURSING MANAGEMENT

Poor communication during a handover could increase the nurse's burden or stress and adversely affect patient care. Therefore, training should be provided on explicit handover communication.