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Webster K, Hlebichuk J, Jensen L, Zastrow R. COASTing Through Bedside Report: An Innovative Approach to Safe Transitions of Care. J Nurs Care Qual 2024:00001786-990000000-00159. [PMID: 39151044 DOI: 10.1097/ncq.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND Bedside shift report improves patient satisfaction, peer accountability, communication, and decreases safety events. LOCAL PROBLEM Clinical practice of bedside report varied prior to the pandemic. Due to limited personal protective equipment and exposure risk, bedside report was halted during the pandemic. APPROACH The Iowa Model of Evidence-Based Practice was used to guide this project. To standardize communication during bedside report, safety data and literature were reviewed and grouped by themes. The acronym COAST was developed, consisting of code status, oxygen, access, safety, and tubes/drains. These elements were to be discussed at the bedside during handoff. RESULTS Compliance with completing elements of COAST increased during the pilot, 9- and 12-month sustainment periods. Additional safety-related outcomes of cardiopulmonary resuscitation wristband application, falls, and good catches improved. Notably, overtime declined. CONCLUSIONS A bedside report with standardized communication focusing on safety elements can improve compliance with adoption and patient safety outcomes.
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Affiliation(s)
- Kristi Webster
- Author Affiliations: Advocate Health System-Chair-Midwest Nursing Practice Council, Clinical Nurse-Medical Respiratory Intensive Care Unit, Aurora St. Luke's Medical Center (Mrs Webster), Milwaukee, WI; Magnet Department, Aurora St. Luke's Medical Center (Dr Hlebichuk), Milwaukee, WI; Strategy and Innovation, Advocate Health (Mrs Jensen), Milwaukee, WI; and Patient Safety, Advocate Health (Dr Zastrow), Oak Brook, IL
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Van de Velde E, Vandewiele H, Van Hecke A, Eeckloo K, Malfait S. Bedside handovers in mental health care: An explorative review. Arch Psychiatr Nurs 2024; 51:10-16. [PMID: 39034063 DOI: 10.1016/j.apnu.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/15/2023] [Accepted: 04/25/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Involving mental healthcare patients in nursing handover practices seems a promising method for increasing patient participation, empowerment, and shared decision-making but is hardly found in practice. METHOD An explorative review on bedside handovers in mental health care was conducted. Searched databases included CINHAHL, Web of Science, PubMed, and Embase. The search strategy yielded 3126 articles. Nine articles met the inclusion criteria and were included in this review. RESULTS Pre- and post-implementation perspectives were described, as well as strategies for implementation. After the implementation of bedside handover, nurses and patients experienced more time spent together and a greater sense of involvement with the care plans could be noticed. DISCUSSION Being involved in bedside handovers facilitates active participation and open dialogue between nurses and patients. This accelerates the opportunities for patients to take part in shared decision-making and feel recognised as experts in their illness experience. More research on possible differences in effectiveness across different patient diagnoses is recommended. CONCLUSION Involving patients in mental health care in handover practices seems a promising method but limited research has been done to explore the meaning it has to mental healthcare nurses and patients.
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Affiliation(s)
| | - Hanne Vandewiele
- Clinical Nurse Specialist Psychiatry, University Hospital Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Head of Strategic Policy Cell, Ghent University Hospital, Belgium.
| | - Simon Malfait
- Strategic Unit & Nursing Department, Ghent University Hospital, Belgium.
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Sun C, Burke C. Assessing the Potential of Technology to Describe Resident and Staff Interactions in Assisted Living Facilities. J Gerontol Nurs 2024; 50:7-11. [PMID: 38959512 DOI: 10.3928/00989134-20240618-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE Falls are a significant financial burden and health hazard for residents in assisted living facilities (ALFs). However, limited capacity to observe residents has hindered understanding of resident-staff interactions within rooms. The current study aimed to describe nurse-resident interactions using data from a remote technology combining computer vision and staff location tracking. METHOD Eighty-three staff working at an urban ALF with 215 residents were trained at the initiation of the study. Remote surveillance devices were installed in 32 residences and staff and resident interactions were tracked over 170 days. RESULTS Staff visited residents an average of 20.7 times per day for short durations (mean = 1.08 minutes). Urgent alert response times averaged 3.0 minutes, with faster response times through the mobile application (mean = 2.7 minutes) compared to in-person (mean = 3.3 minutes) response. CONCLUSION By better understanding staff activity patterns in ALFs, this study has the potential to improve fall prevention and care for residents in ALFs. [Journal of Gerontological Nursing, 50(7), 7-11.].
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Chien LJ, Slade D, Goncharov L, Taylor J, Dahm MR, Brady B, McMahon J, Raine SE, Thornton A. Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study. J Clin Nurs 2024; 33:2688-2706. [PMID: 38528438 DOI: 10.1111/jocn.17107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/08/2023] [Accepted: 01/19/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Laura J Chien
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Liza Goncharov
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, Sydney, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia
| | - Maria R Dahm
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Bernadette Brady
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, Australia
- St Vincent's Hospital Melbourne, Melbourne, Australia
- Australian Catholic University, Australia
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, Sydney, Australia
- Australian Catholic University, Australia
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Mora Capín A, Jové Blanco A, Oujo Álamo E, Muñoz Cutillas A, Barrera Brito V, Vázquez López P. Involving the Patient and Family in the Transfer of Information at Shift Change in a Pediatric Emergency Department. Jt Comm J Qual Patient Saf 2024; 50:357-362. [PMID: 38307780 DOI: 10.1016/j.jcjq.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND The transfer of information at the change of shift is a critical point for patient experience during the care process. The aim of this study was to evaluate caregivers' perceptions before and after the implementation of a multidisciplinary bedside handoff in a pediatric emergency department (PED). METHODS This was a quality improvement pre-post intervention, single-center study. The authors included caregivers of patients allocated in the observation unit of a PED during health care provider shift change. The study was made up of the following phases: (1) preintervention survey distribution, (2) implementation of the bedside handoff, involving all health care professionals (including nurses, nursing assistants, and pediatricians) and caregivers, and (3) postintervention survey distribution. The survey explored the three dimensions of patient experience defined as main study outcomes: information received and communication with professionals, participation, and continuity of care. RESULTS A total of 102 surveys were collected (51 each in the preintervention and postintervention phases). In the preintervention phase, 94.1% of caregivers would have wished to be actively involved in the change of shift. In the postintervention phase, more caregivers felt that professionals had proper introductions (49.0% vs. 84.3%; p < 0.01), had kept them informed of the plan to be followed (58.8% vs. 84.3%; p = 0.02), and encouraged questions (45.1% vs. 82.4%; p < 0.01). Caregivers of the postintervention phase perceived less disorganization during the change of shift (25.5% vs. 5.9%; p = 0.01) and a greater sense of continuity (64.7% vs. 86.3%; p = 0.02). CONCLUSION The bedside handoff is a useful strategy to improve patient and family perceptions of communication with professionals, information received, and continuity of care at health care providers shift change. Future lines of research and improvement include ensuring equity in participation in the bedside handoff for all caregivers, monitoring the handoffs to determine how often patients/caregivers participate and correct mistakes in information transfer. and exploring professionals' perceptions.
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Cho IY, Yun JY, Moon SH. Development and effectiveness of a metaverse reality-based family-centered handoff education program in nursing students. J Pediatr Nurs 2024; 76:176-191. [PMID: 38412709 DOI: 10.1016/j.pedn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/21/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Effective patient handoffs are vital in pediatric populations. This study aimed to develop and identify the impact of a metaverse-based handoff program using ZEPETO on nursing students' handoff competence, handoff self-efficacy, learning realism, and satisfaction. DESIGN AND METHODS This study used a non-randomized, pre-post nonequivalent group design to develop, implement, and verify a metaverse-based handoff simulation program in a nursing school in South Korea. We assigned 69 senior nursing students from a university to an experimental group or a control group. We developed a metaverse-based, handoff simulation program of family-centered care by building a pediatric intensive care unit (PICU) using ZEPETO. The program included an online lecture, a metaverse rounding discussion, and a metaverse-based handoff simulation of postoperative care for infants with congenital heart disease. We measured handoff competence, handoff self-efficacy, learning realism, and learning satisfaction pre- and post-program. RESULT(S) The experimental group showed significantly higher handoff self-efficacy than the control group (t = 3.17, p = 0.002). No significant differences were found in handoff competency, learning realism, or learning satisfaction between the groups. CONCLUSION(S) This study confirmed that a family-centered care-based handoff metaverse simulation program based on the experiential learning theory enhanced nursing students' handoff self-efficacy. The program equipped students to conduct safe and effective handoffs in real-world clinical settings by providing an immersive learning experience and emphasizing patient-centered communication. PRACTICAL IMPLICATIONS Based on these results, family-centered, handoff education programs are recommended to be developed that focus on learning realism and learning satisfaction to enhance nursing students' handoff competence.
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Affiliation(s)
- In Young Cho
- College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, South Korea
| | - Ji Yeong Yun
- Department of Nursing, Jesus University, 383 Seowon-ro, Wansangu, Jeonju-si, Jeollabukdo 54989, South Korea
| | - Sun-Hee Moon
- College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, South Korea.
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Van de Velde E, Van Hecke A, Eeckloo K, Malfait S. Implementing bedside handovers in mental health care: Insights from an experience-based co-design. PATIENT EDUCATION AND COUNSELING 2024; 119:108051. [PMID: 37952401 DOI: 10.1016/j.pec.2023.108051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/15/2023] [Accepted: 11/01/2023] [Indexed: 11/14/2023]
Abstract
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.
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Affiliation(s)
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Strategic Policy Cell, Ghent University Hospital, Belgium
| | - Simon Malfait
- Clinical Support Unit, Nursing Department, Ghent University Hospital, Belgium; Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
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Yuen EYN, Street M, Abdelrazek M, Blencowe P, Etienne G, Liskaser R, Choudhary N, Considine J. Evaluating the efficacy of a digital App to enhance patient-centred nursing handover: A simulation study. J Clin Nurs 2023; 32:7626-7637. [PMID: 37439324 DOI: 10.1111/jocn.16782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/27/2023] [Accepted: 05/29/2023] [Indexed: 07/14/2023]
Abstract
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.
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Affiliation(s)
- Eva Y N Yuen
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
| | - Maryann Street
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- Centre for Quality and Patient Safety Research-Eastern Health Partnership, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Burwood, VIC, Australia
| | - Phillipa Blencowe
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- Eastern Health, Box Hill, VIC, Australia
| | | | | | - Navit Choudhary
- School of Information Technology, Deakin University, Burwood, VIC, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Burwood, VIC, Australia
- Centre for Quality and Patient Safety Research-Eastern Health Partnership, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
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Cruchinho P, Teixeira G, Lucas P, Gaspar F. Evaluating the Methodological Approaches of Cross-Cultural Adaptation of the Bedside Handover Attitudes and Behaviours Questionnaire into Portuguese. J Healthc Leadersh 2023; 15:193-208. [PMID: 37674524 PMCID: PMC10478977 DOI: 10.2147/jhl.s422122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023] Open
Abstract
Nurse managers need culturally adapted assessment instruments to support the implementation of change to Nursing Bedside Handover (NBH) in healthcare institutions. This study aimed to cross-culturally adapt the Bedside Handover Attitudes and Behaviours (BHAB) questionnaire to the Portuguese context and evaluate the methodological approaches used for this purpose. To guide this study, we followed a guideline for cross-cultural translation and adaptation measurement instruments in healthcare. The results of the content validity testing suggested that the BHAB questionnaire is a valid instrument for use in the Portuguese context. To obtain these results we showed 1) using of a new methodological approach, the dual focus, to resolve the divergences and ambiguities in the translators' committee and the multi-professional committee; 2) the lack of a conceptual definition of the construct of the instrument as a requirement to retain items with I-CVI <0.70 after validity relevance pretesting and 3) the cognitive debriefing and relevance pretesting as methodological approaches which can be used alone or together to reinforce the evaluation of cultural relevance of the items. We concluded there is a need for guidelines to support the decision-making process of healthcare researchers with comprehensive information about the different methodological approaches they can follow.
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Affiliation(s)
- Paulo Cruchinho
- Nursing Research, Innovation and Development Centre (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, 1600-190, Portugal
| | - Gisela Teixeira
- Nursing Research, Innovation and Development Centre (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, 1600-190, Portugal
| | - Pedro Lucas
- Nursing Research, Innovation and Development Centre (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, 1600-190, Portugal
| | - Filomena Gaspar
- Nursing Research, Innovation and Development Centre (CIDNUR) of Lisbon, Nursing School of Lisbon, Lisboa, 1600-190, Portugal
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Pun J. Using a simulation-based approach to promote structured and interactive nursing clinical handover: a pre- and post-evaluation pilot study in bilingual Hong Kong. BMC Nurs 2023; 22:38. [PMID: 36765330 PMCID: PMC9921344 DOI: 10.1186/s12912-023-01189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
Effective clinical nursing handover involves the transfer of responsibility and accountability for patient care between nurses, leading to better patient safety and continuity of care. Nurses in bilingual contexts, such as Hong Kong - where nurses are trained in English but communicate in Cantonese - may find it challenging to deliver a safe clinical handover. This article reports a pilot study in which a simulation-based approach is being developed to enhance nursing handover with structured and interactive interactions, using handover protocols such as ISBAR (introduction, situation, background, assessment, recommendation and readback) and CARE-team (connect, ask, respond, empathise) protocols in a bilingual context. The study has a pre- and post-evaluation design involving a questionnaire survey before and after a 4-hour workshop. Fourteen selected bilingual nurses in Hong Kong were trained according to the ISBAR and CARE-team protocols, and their perceptions of complete and structured handovers were evaluated before and after training using the questionnaire. The nurses reported that they were more self-confident in their handover experiences, with a deeper understanding of ISBAR and CARE-team protocols after the simulation-based training intervention, leading to better (i.e., more structured and interactive) clinical handover between nurses. Overall, the staff perceived their handover communication to have improved using simulation-based training.
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Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, 83 Tat Hong Avenue, Kowloon Tong, Hong Kong.
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Influencing Factors of Nurses' Practice during the Bedside Handover: A Qualitative Evidence Synthesis Protocol. J Pers Med 2023; 13:jpm13020267. [PMID: 36836500 PMCID: PMC9965971 DOI: 10.3390/jpm13020267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
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.
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Siegel EO, Kolanowski AM, Bowers BJ. A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models. Res Gerontol Nurs 2023; 16:5-13. [PMID: 36692436 DOI: 10.3928/19404921-20230104-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].
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Abo Seada AI, Abo Habieb ETE, Salameh BS, El-Wkeel NS, Abdelkader Reshia FA. Developing Nursing Standards for Maintaining Shift Handover in the Intensive Care Unit: A Methodological and Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221144078. [PMID: 36546669 PMCID: PMC9793009 DOI: 10.1177/00469580221144078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patient handover, which is a method of moving the clinical data of patients to another individual or professional community, is a high-risk area for the safety of patients due to errors which can happen during staff break time, changeover shifts, and when patients are moved in and out of units. Standards for critical care nurses will improve bedside handover due to the presence of clear plans implemented by nurses who are well informed about them. To develop nursing standards for maintaining handover in the intensive care unit. A methodological and cross-sectional study was conducted at Mansoura University Hospital and included 15 experts and 150 staff nurses. Twelve items were excluded from the tool because their CVR ratio was less than 0.7. Therefore, after eliminating 12 items, the number of tool items produced was 66. The Kaiser-Meyer-Olkin value = 0.713, with the recommended value being 0.6 or above. The cut-off score for the analysis model was 0.3, and the KMO value criterion was greater than 1, which defined eight-factor loadings as the best fit for the results, accounting for 69.5% of the variance. The aim of this study was satisfactorily achieved, with 0.9055 validity and reliability for the handover instrument, which consisted of 60 items with a total reliability score.
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Affiliation(s)
| | | | - Basma Salim Salameh
- Faculty of Nursing, Arab American
University, Jenin, Occupied Palestinian Territory,Basma Salim Salameh, Arab American
University, Jenin 240, Occupied Palestinian Territory, 13 Zababdeh.
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Zhou J, Zhang F, Wang H, Yin Y, Wang Q, Yang L, Dong B, Yuan J, Liu S, Zhao L, Luo W. Quality and efficiency of a standardized e-handover system for pediatric nursing: A prospective interventional study. J Nurs Manag 2022; 30:3714-3725. [PMID: 35066952 DOI: 10.1111/jonm.13549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/24/2021] [Accepted: 01/13/2022] [Indexed: 12/30/2022]
Abstract
AIM This study examined the effect on pediatric nursing handover quality and efficiency when a standardized e-handover system was implemented. BACKGROUND Handover quality is an important aspect of nursing quality management; however, handover quality among nursing staff is poor. METHODS A prospective interventional study was carried out in a general pediatrics ward from December 2019 to November 2020. The tools included a standardized e-handover system. The intervention strategies included workflow remodeling and employee training on oral handover using the standardized e-handover system. RESULTS The omission frequency of critical handover elements decreased from 47.32% to 2.94% (p < .01), among which the omission frequencies of nine out of 16 key elements significantly decreased. Integrity also showed improvement. Specifically, the integrity of five types of critical information was significantly improved, including vital signs, signs and symptoms, laboratory test results, radiologic examination results, and treatment regimen (2.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 3.00 vs. 5.00, p < .01; 5.00 vs. 5.00, p = .009; 3.00 vs. 4.00, p < .01, respectively). Information accuracy was 100%. Workflow and efficiency significantly improved, communication duration with patient/family during work hours significantly increased (24.00 vs. 56.00, p < .01), and prehandover preparation duration significantly decreased (32.00 vs. 2.50, p < .01). Nurse handover satisfaction showed improvement (56.88 ± 15.08 vs. 74.31 ± 9.22, p < .01). CONCLUSION The standardized e-handover system effectively improved nurse handover quality, optimized workflow, increased work efficiency, and promoted teamwork. IMPLICATIONS FOR NURSING MANAGEMENT Standardized e-handover systems have great potential for ensuring the safety of pediatric patients and improving the quality of handover.
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Affiliation(s)
- Jiali Zhou
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Fen Zhang
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Hansong Wang
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China.,Child Health Advocacy Institute, China Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Qian Wang
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Lihua Yang
- Department of Pediatric Pulmonology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Bin Dong
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Jiajun Yuan
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Shijian Liu
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Liebin Zhao
- Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
| | - Wenyi Luo
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School Of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai, China
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15
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Paredes-Garza F, Lázaro E, Vázquez N. Nursing bedside handover in an intensive care unit with a mixed structure: Nursing professionals' perception. J Nurs Manag 2022; 30:4314-4321. [PMID: 36193037 DOI: 10.1111/jonm.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/17/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
AIM The main objective is to determine if the infrastructure of critical care units influences the perception of professionals using this handover method. BACKGROUND Nursing bedside handover is considered a safe information transfer method that can help reduce communication errors; however, it has some disadvantages expressed by health professionals and patients, related to confidentiality, stress and less rest. METHODS Qualitative descriptive study. The perception of nursing professionals who work in a critical care unit with a mixed structure (open and closed boxes) in a tertiary care hospital was evaluated through a semi-structured interview with a battery of common questions (prepared after literature review) and spontaneous questions according to the objectives of the study. RESULTS Five thematic areas related to the study objectives were observed: patient safety, message content, confidentiality/privacy, intimacy/rest/noise, and patient participation. CONCLUSIONS Nursing bedside handover improves safe communication between professionals, because it avoids errors or distractions by double or triple checking (if we include the patient) as well as empowering the patient and including him in his recovery. Carrying it out in closed boxes increases confidentiality and improves intimacy as there are no other patients or relatives nearby who can hear the message. However, the place or shift where the handover is performed does not interfere with the effectiveness of the communication of the message. The morning shift is the busiest, which could affect the patient's rest, a fact that could be solved if it is carried out in a closed box. IMPLICATIONS FOR NURSING MANAGEMENT Carrying out the handover in individual boxes in intensive care units would provide greater privacy to the patient and reduce the perception of external noise, contributing to the reduction of interruptions and the increase of the patient's rest. It is also a key element in patient safety through verification by double or triple check-up, the structuring of the message and the visualization of devices presented by the patient. In addition, it will allow the professional to start a process of early humanization and participation of the patient in the health process.
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Affiliation(s)
| | - Esther Lázaro
- Universidad Internacional de Valencia, Valencia, Spain
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16
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Tobiano G, Marshall AP, Gardiner T, Jenkinson K, Shapiro M, Ireland M. Development and psychometric testing of the patient participation in bedside handover survey. Health Expect 2022; 25:2492-2502. [PMID: 35898173 PMCID: PMC9615084 DOI: 10.1111/hex.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/19/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.,NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Andrea P Marshall
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Therese Gardiner
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Kim Jenkinson
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Margaret Shapiro
- Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
| | - Michael Ireland
- School of Psychology and Wellbeing, University of Southern Queensland, Toowoomba, Queensland, Australia
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17
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Webster KL, Keebler JR, Lazzara EH, Chaparro A, Greilich P, Fagerlund A. Handoffs & Teamwork: A Framework for Care Transition Communication. Jt Comm J Qual Patient Saf 2022; 48:343-353. [DOI: 10.1016/j.jcjq.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
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18
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Chien LJ, Slade D, Dahm MR, Brady B, Roberts E, Goncharov L, Taylor J, Eggins S, Thornton A. Improving patient-centred care through a tailored intervention addressing nursing clinical handover communication in its organizational and cultural context. J Adv Nurs 2022; 78:1413-1430. [PMID: 35038346 PMCID: PMC9304151 DOI: 10.1111/jan.15110] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 12/05/2022]
Abstract
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.
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Affiliation(s)
- Laura J Chien
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Diana Slade
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Maria R Dahm
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bernadette Brady
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Liza Goncharov
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia.,Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, New South Wales, Australia
| | - Suzanne Eggins
- Institute for Communication in Health Care, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia.,Australian Catholic University, Sydney, New South Wales, Australia
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19
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Cho S, Lee JL, Kim KS, Kim EM. Systematic Review of Quality Improvement Projects Related to Intershift Nursing Handover. J Nurs Care Qual 2022; 37:E8-E14. [PMID: 34231504 DOI: 10.1097/ncq.0000000000000576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Sumi Cho
- Department of Nursing, Korea Nazarene University, Cheonan, South Korea (Dr Cho); Department of Nursing, Daejeon University, Daejeon, South Korea (Dr Lee); Department of Nursing, Samsung Medical Center, Seoul, South Korea (Dr K. S. Kim); and Department of Nursing Science, SunMoon University, Chungnam, South Korea (Dr E. M. Kim)
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20
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Van de Velde E, Van Hecke A, Van Cleemput N, Eeckloo K, Malfait S. Nursing handover involving consumers on inpatient mental healthcare units: A qualitative exploration of the consumers' perspective. Int J Ment Health Nurs 2021; 30:1713-1725. [PMID: 34495574 DOI: 10.1111/inm.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | | | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - Simon Malfait
- Strategic Unit & Nursing Department, Ghent University Hospital, Gent, Belgium
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21
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Paul D, Glover S, Roche MA, Klarnett K, Chen X, Wall J, Joyce M. Enhancing person-centred care in inpatient mental health settings through supported person-side handover: a multi method study. Contemp Nurse 2021; 57:290-301. [PMID: 34709985 DOI: 10.1080/10376178.2021.1999837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Diane Paul
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, Wicks Road, North Ryde, NSW 2113, Australia
| | - Suzanne Glover
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, Wicks Road, North Ryde, NSW 2113, Australia
| | - Michael Anthony Roche
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia.,Faculty of Health, University of Canberra, 11 Kirinari Street, Bruce, ACT 2617, Australia
| | - Karen Klarnett
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, Wicks Road, North Ryde, NSW 2113, Australia
| | - Xiaomeng Chen
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, Wicks Road, North Ryde, NSW 2113, Australia
| | - James Wall
- Hornsby and Kuringai Hospital, Mental Health Intensive Care Unit, Northern Sydney Local Health District, Palmerston Road, Hornsby, NSW 2077, Australia
| | - Mark Joyce
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, Wicks Road, North Ryde, NSW 2113, Australia
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22
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Olasoji M, Plummer V, Cross W. Strategies for Implementing Consumer Involvement in Nursing Handover on Acute Mental Health In-Patient Units. Issues Ment Health Nurs 2021; 42:951-959. [PMID: 33325756 DOI: 10.1080/01612840.2020.1852460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Consumer participation in the process of care delivery is crucial to recovery-oriented care. Nursing handover is an important process during the delivery of care on acute in-patient units. Despite the importance of involving consumers in this process, it remains a relatively new concept within mental health. This is due to the complexities involved in the provision of care within the mental health setting. There is a paucity of research on how to successfully implement consumer involvement in nursing handover within mental health settings even though this practice has been occurring within generalist settings for some time now. This paper reports on the findings on the implementation of consumer involvement on an acute in-patient unit. The views of consumers and mental health nurses about the process have already being reported. This current paper describes how a new handover system was implemented using a modified version of the model for successful change to bedside handover by McMurray et al. which was based on Lewin's force-field model of unfreezing, moving and refreezing and Kotter's model of change. The key elements of successful implementation are discussed. There is a need to carefully design and implement consumer involvement in nursing handover within acute in-patient units. There are lessons to be learnt in the process adopted and described in this paper.
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Affiliation(s)
- Michael Olasoji
- Faculty of Health, Arts and Design, Swinburne University of Technology, Wantirna, Australia.,School of Health, Federation University Australia, Berwick, Australia
| | - Virginia Plummer
- School of Health, Federation University Australia, Berwick, Australia
| | - Wendy Cross
- School of Health, Federation University Australia, Berwick, Australia
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23
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Clari M, Conti A, Chiarini D, Martin B, Dimonte V, Campagna S. Barriers to and Facilitators of Bedside Nursing Handover: A Systematic Review and Meta-synthesis. J Nurs Care Qual 2021; 36:E51-E58. [PMID: 33852530 DOI: 10.1097/ncq.0000000000000564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bedside nursing handover (BNH) has been recognized as a contributor to patient-centered care. However, concerns about its effectiveness suggest that contextual factors should be considered before and after BNH implementation. PURPOSE This review aimed to identify, evaluate, and synthetize the qualitative literature on the barriers to and facilitators of BNH as experienced by nurses and patients. METHODS The Joanna Briggs Institute meta-aggregation method was applied. A systematic search was performed to identify qualitative studies published from inception to June 30, 2020. Two independent researchers assessed methodological quality and extracted data. RESULTS Twenty-four articles were included, comprising 161 findings, and 5 synthesized findings emerged with a moderate level of confidence. CONCLUSIONS BNH ensures patient safety and increases satisfaction and recognition among patients and nurses. This evidence on the barriers to and facilitators of BNH could help health care providers who have implemented or plan to implement this practice.
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Affiliation(s)
- Marco Clari
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy (Drs Clari, Conti, and Campagna and Ms Martin and Mr Dimonte); and Department of Surgery, Città della Salute e della Scienza University Hospital, Torino, Italy (Ms Chiarini)
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24
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Alshyyab MA, FitzGerald G, Albsoul RA, Ting J, Kinnear FB, Borkoles E. Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study. Int J Health Plann Manage 2021; 36:2392-2410. [PMID: 34476834 DOI: 10.1002/hpm.3314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/15/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment. METHODS A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale. RESULTS Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility. CONCLUSIONS This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- Department of Public Health, School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Gerard FitzGerald
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia
| | - Rania Ali Albsoul
- Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joseph Ting
- Department of Public Health and Social Work, School of Health, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Emergency Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Erika Borkoles
- Department of Public Health, School of Medicine, Public Health, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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25
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Desmedt M, Ulenaers D, Grosemans J, Hellings J, Bergs J. Clinical handover and handoff in healthcare: a systematic review of systematic reviews. Int J Qual Health Care 2021; 33:6039082. [PMID: 33325520 DOI: 10.1093/intqhc/mzaa170] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 11/03/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this systematic review is to appraise and summarize existing literature on clinical handover. DATA SOURCES We searched EMBASE, MEDLINE, Database of Abstracts of Reviews of Effects and Cochrane Database of Systematic Reviews. STUDY SELECTION Included articles were reviewed independently by the review team. DATA EXTRACTION The review team extracted data under the following headers: author(s), year of publication, journal, scope, search strategy, number of studies included, type of studies included, study quality assessment, used definition of handover, healthcare setting, outcomes measured, findings and finally some comments or remarks. RESULTS OF DATA SYNTHESIS First, research indicates that poor handover is associated with multiple potential hazards such as lack of availability of required equipment for patients, information omissions, diagnosis errors, treatment errors, disposition errors and treatment delays. Second, our systematic review indicates that no single tool arises as best for any particular specialty or use to evaluate the handover process. Third, there is little evidence delineating what constitutes best handoff practices. Most efforts facilitated the coordination of care and communication between healthcare professionals using electronic tools or a standardized form. Fourth, our review indicates that the principal teaching methods are role-playing and simulation, which may result in better knowledge transfer to the work environment, better health and patients' well-being. CONCLUSIONS This review emphasizes the importance of staff education (including simulation-based and team training), non-technical skills and the implementation process of clinical handover in healthcare settings.
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Affiliation(s)
- Melissa Desmedt
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium
| | - Dorien Ulenaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium
| | - Joep Grosemans
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium.,Faculty of Healthcare, PXL University of Applied Sciences and Arts, Elfde-Liniestraat 24, Hasselt, Province of Limburg 3500 Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium
| | - Jochen Bergs
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Gebouw D, Diepenbeek, Province of Limburg 3500 Belgium.,Faculty of Healthcare, PXL University of Applied Sciences and Arts, Elfde-Liniestraat 24, Hasselt, Province of Limburg 3500 Belgium
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Street M, Dempster J, Berry D, Gray E, Mapes J, Liskaser R, Papageorgiou S, Considine J. Enhancing active patient participation in nursing handover: A mixed methods study. J Clin Nurs 2021; 31:1016-1029. [PMID: 34268829 DOI: 10.1111/jocn.15961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Maryann Street
- Deakin University, Geelong, Vic., Australia.,School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in The Institute for Health Transformation, Geelong, Vic., Australia.,Deakin University Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Vic., Australia
| | | | - Debra Berry
- Deakin University, Geelong, Vic., Australia.,School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in The Institute for Health Transformation, Geelong, Vic., Australia.,Deakin University Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Vic., Australia
| | - Erika Gray
- Eastern Health, Box Hill, Vic., Australia
| | - Joanne Mapes
- Eastern Health, Box Hill, Vic., Australia.,Western Health, Footscray, Vic, Australia
| | | | | | - Julie Considine
- Deakin University, Geelong, Vic., Australia.,School of Nursing and Midwifery; Centre for Quality and Patient Safety Research in The Institute for Health Transformation, Geelong, Vic., Australia.,Deakin University Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Vic., Australia
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Pollack AH, Mishra SR, Apodaca C, Khelifi M, Haldar S, Pratt W. Different roles with different goals: Designing to support shared situational awareness between patients and clinicians in the hospital. J Am Med Inform Assoc 2021; 28:222-231. [PMID: 33150394 PMCID: PMC7883969 DOI: 10.1093/jamia/ocaa198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Team situational awareness helps to ensure high-quality care and prevent errors in the complex hospital environment. Although extensive work has examined factors that contribute to breakdowns in situational awareness among clinicians, patients’ and caregivers’ roles have been neglected. To address this gap, we studied team-based situational awareness from the perspective of patients and their caregivers. Materials and Methods We utilized a mixed-methods approach, including card sorting and semi-structured interviews with hospitalized patients and their caregivers at a pediatric hospital and an adult hospital. We analyzed the results utilizing the situational awareness (SA) theoretical framework, which identifies 3 distinct stages: (1) perception of a signal, (2) comprehension of what the signal means, and (3) projection of what will happen as a result of the signal. Results A total of 28 patients and 19 caregivers across the 2 sites participated in the study. Our analysis uncovered how team SA helps patients and caregivers ensure that their values are heard, their autonomy is supported, and their clinical outcomes are the best possible. In addition, our participants described both barriers—such as challenges with communication—and enablers to facilitating shared SA in the hospital. Discussion Patients and caregivers possess critical knowledge, expertise, and values required to ensure successful and accurate team SA. Therefore, hospitals need to incorporate tools that facilitate patients and caregivers as key team members for effective SA. Conclusions Elevating patients and caregivers from passive recipients to equal contributors and members of the healthcare team will improve SA and ensure the best possible outcomes.
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Affiliation(s)
- Ari H Pollack
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sonali R Mishra
- Information School, University of Washington, Seattle, Washington, USA
| | - Calvin Apodaca
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Maher Khelifi
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Shefali Haldar
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
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Abstract
BACKGROUND Communication failures, including clinical handoff or clinical handover errors, contribute to 80% of all serious preventable adverse events each year. The N-PAS, N = Nurse, P = Patient Summary, A = Action Plan, and S = Synthesis, is a flexible standardized clinical handoff tool for nurses. PURPOSE The purpose of this study was to determine the proportion of N-PAS core components present in real-world patient handoffs. METHODS A mixed-methods design was used to analyze secondary data. Patient handoffs (n = 138) were transcribed into statements and then independently coded by 2 research assistants. RESULTS Of all handoff statements, 63.2% were coded as Patient Summary and 13.6% were coded as Action Plan, whereas Synthesis was not coded in any handoffs. Three new Patient Summary elements and 1 new Action Plan element were identified. CONCLUSION Patient Summary and Action Plan are critical data reported during clinical handoff. A handoff synthesis is a critical step to include in handoff training.
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29
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Trotta RL, Rao AD, McHugh MD, Yoho M, Cunningham RS. Moving beyond the measure: Understanding patients' experiences of communication with nurses. Res Nurs Health 2020; 43:568-578. [PMID: 33141484 DOI: 10.1002/nur.22087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/12/2022]
Abstract
Under Medicare's Value-Based Purchasing Program, scores derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are used in the determination of incentive payments and financial penalties for healthcare organizations. Organizations, therefore, invest in approaches to improve the likelihood of positive patient responses. Evidence suggests that nurse communication as measured by HCAHPS influences overall patient satisfaction, yet little is known regarding what patients believe constitutes effective communication with nurses. In this qualitative descriptive study, we conducted phone interviews with 49 recently hospitalized patients to better understand patients' perceptions of their communication with nurses. Our findings indicate that patients perceived their communication with nurses to unfold via nurses' behaviors. Namely, nurses' engagement with patients, anticipation of patients' needs, responsiveness to patients' concerns, and teaching practices positively influence patient satisfaction with communication with nurses. These behaviors resonated most strongly with patients during particularly memorable moments of uncertainty and vulnerability over the course of a hospital stay. These findings suggest that focusing on the development of nurses' behaviors, ensuring processes are in place to support positive behaviors and creating organizational environments that position nurses to consistently apply these behaviors, can improve patients' perceptions of their communication with nurses. These findings also provide a foundation for further research focused on developing and testing specific behavioral interventions and their effect on communication perception.
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Affiliation(s)
- Rebecca L Trotta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Aditi D Rao
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Matthew D McHugh
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Margaret Yoho
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Regina S Cunningham
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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30
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Olasoji M, Plummer V, Shanti M, Reed F, Cross W. The benefits of consumer involvement in nursing handover on acute inpatient unit: Post-implementation views. Int J Ment Health Nurs 2020; 29:786-795. [PMID: 32100448 DOI: 10.1111/inm.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Michael Olasoji
- School of Health Professions, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Virginia Plummer
- School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia.,Peninsula Health, Frankston, Victoria, Australia
| | | | - Fiona Reed
- Peninsula Health, Frankston, Victoria, Australia
| | - Wendy Cross
- School of Nursing and Healthcare Professions, Federation University, Berwick, Victoria, Australia
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31
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Campbell AR, Layne D, Scott E, Wei H. Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review. J Nurs Manag 2020; 28:1465-1472. [DOI: 10.1111/jonm.13083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Diana Layne
- College of Nursing Medical University of South Carolina Charleston SC USA
| | - Elaine Scott
- College of Nursing East Carolina University Greenville NC USA
| | - Holly Wei
- College of Nursing East Carolina University Greenville NC USA
- College of Nursing East Carolina University Greenville NC USA
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32
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Norrie C, Moriarty J, Lipman V, Elaswarapu R, Manthorpe J. A qualitative study of handovers at shift changeovers in five care homes for older people in England. Int J Older People Nurs 2020; 15:e12339. [DOI: 10.1111/opn.12339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/06/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Caroline Norrie
- Policy Research Unit on Health and Social Care Workforce The Policy Institute at King's King’s College London London UK
| | - Jo Moriarty
- Policy Research Unit on Health and Social Care Workforce The Policy Institute at King's King’s College London London UK
| | - Valerie Lipman
- Policy Research Unit on Health and Social Care Workforce The Policy Institute at King's King’s College London London UK
| | - Rekha Elaswarapu
- Policy Research Unit on Health and Social Care Workforce The Policy Institute at King's King’s College London London UK
| | - Jill Manthorpe
- Policy Research Unit on Health and Social Care Workforce The Policy Institute at King's King’s College London London UK
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33
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Forde MF, Coffey A, Hegarty J. Bedside handover at the change of nursing shift: A mixed‐methods study. J Clin Nurs 2020; 29:3731-3742. [DOI: 10.1111/jocn.15403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/21/2020] [Accepted: 06/27/2020] [Indexed: 12/26/2022]
Affiliation(s)
| | - Alice Coffey
- Catherine McAuley School of Nursing and Midwifery University College Cork Cork Ireland
- Department of Nursing & Midwifery Health Science Building Northbank Campus University of Limerick Limerick Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery University College Cork Cork Ireland
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34
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Exploring Practices of Bedside Shift Report and Hourly Rounding. Is There an Impact on Patient Falls? ACTA ACUST UNITED AC 2020; 50:355-362. [DOI: 10.1097/nna.0000000000000897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Malfait S, Eeckloo K, Van Opdorp L, Van Biesen W, Van Hecke A. The impact of bedside handovers on relevant clinical indicators: A matched‐controlled multicentre longitudinal study. J Adv Nurs 2020. [DOI: 10.1111/jan.14406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/29/2020] [Accepted: 04/20/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Simon Malfait
- Ghent University Hospital Ghent Belgium
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care – University Center for Nursing and Midwifery Ghent University Ghent Belgium
| | - Kristof Eeckloo
- Ghent University Hospital Ghent Belgium
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care Ghent University Ghent Belgium
| | - Lara Van Opdorp
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care Ghent University Ghent Belgium
| | - Wim Van Biesen
- Ghent University Hospital Ghent Belgium
- Faculty of Medicine and Health Sciences Department of Internal Medicine Ghent University Ghent Belgium
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences Department of Public Health and Primary Care – University Center for Nursing and Midwifery Ghent University Ghent Belgium
- Nursing Department Ghent University Hospital Ghent Belgium
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36
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Patients prefer clinical handover at the bedside; nurses do not: Evidence from a discrete choice experiment. Int J Nurs Stud 2020; 105:103444. [DOI: 10.1016/j.ijnurstu.2019.103444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023]
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37
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Bourgault AM. Are Patients and Family Members an Essential Aspect of Bedside Handoff? Crit Care Nurse 2020; 39:10-12. [PMID: 31154323 DOI: 10.4037/ccn2019481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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38
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Bressan V, Mio M, Palese A. Nursing handovers and patient safety: Findings from an umbrella review. J Adv Nurs 2019; 76:927-938. [DOI: 10.1111/jan.14288] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 01/18/2023]
Affiliation(s)
| | - Moreno Mio
- School of Nursing Department of Medical Sciences University of Udine Udine Italy
| | - Alvisa Palese
- Department of Medical Sciences University of Udine Udine Italy
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39
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Hu J. Patients prefer bedside handover and wish to be active partners in it. Evid Based Nurs 2019; 24:21. [PMID: 31871038 DOI: 10.1136/ebnurs-2019-103221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Jiale Hu
- Department of Nurse Anesthesia, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
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40
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Gettis MA, Dye B, Williams C, Frankish B, Alvarez B. Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations. Worldviews Evid Based Nurs 2019; 16:495-497. [PMID: 31638303 DOI: 10.1111/wvn.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Betsy Dye
- Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
| | - Calvin Williams
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Brenna Frankish
- Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
| | - Beverly Alvarez
- Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
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Abstract
This literature review looks at articles on bedside shift report initiatives and offers strategies that may lead to sustained practice.
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Abstract
OBJECTIVE To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. DESIGN Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. SETTING Tertiary PICU within an academic children's hospital. PARTICIPANTS PICU nurses who received a patient handoff between October 2017 and July 2018. INTERVENTIONS None. MAIN RESULTS AND MEASUREMENTS Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). CONCLUSIONS Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.
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Rhudy LM, Johnson MR, Krecke CA, Keigley DS, Schnell SJ, Maxson PM, McGill SM, Warfield KT. Change-of-Shift Nursing Handoff Interruptions: Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2019; 16:362-370. [PMID: 31328379 DOI: 10.1111/wvn.12390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The importance of change-of-shift handoffs in maintaining patient safety has been well demonstrated. Change-of-shift handoff is an important source of data used in surveillance, a nursing intervention aimed at identifying and preventing complications. Surveillance requires the nurse to acquire, process, and synthesize information (cues) encountered during patient care. Interruptions in handoff have been observed but there is a gap in the evidence concerning how interruptions during nurse-to-nurse handoff impact the change-of-shift handoff process. AIMS To describe registered nurses' perceptions of interruptions experienced during change-of-shift handoff at the bedside in critical care units and analyze the number, type, and source of interruptions during change-of-shift handoff at the bedside. METHODS An exploratory descriptive design was used. One hundred nurse-to-nurse handoffs were observed, and four focus groups were conducted. Observation data were analyzed with descriptive statistics and quantitative content analysis. Focus group data were analyzed with qualitative content analysis. RESULTS AND FINDINGS Of the 1,196 interruptions observed, 800 occurred in the communication between the two nurses involved in the handoff. Over 80% (645) of these interruptions were from the nurse receiving handoff and included questions or clarification of information received. About half of the nurses reported that interruptions occurred during handoff. Focus group findings revealed that whether or not something is an interruption is determined by the individual nurse's appraisal of value added to their knowledge of the patient and/or plan of care at the time of handoff. LINKING EVIDENCE TO ACTION Interruptions during handoff are evaluated as useful or disruptive based on the value to the nurse at the time. Strict structuring or mandating of handoff elements may limit nurses' ability to communicate information deemed most relevant to the care of a specific unique patient.
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Affiliation(s)
- Lori M Rhudy
- Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Sharon M McGill
- University of Minnesota School of Nursing, Minneapolis, MN, USA
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Malfait S, Eeckloo K, Van Biesen W, Van Hecke A. Barriers and Facilitators for the Use of NURSING Bedside Handovers: Implications for Evidence‐Based Practice. Worldviews Evid Based Nurs 2019; 16:289-298. [DOI: 10.1111/wvn.12386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Simon Malfait
- Ghent University Hospital Ghent Belgium
- Department of Public Health, University Center for Nursing and Midwifery, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Kristof Eeckloo
- Ghent University Hospital Ghent Belgium
- Department of Public Health, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Wim Van Biesen
- Ghent University Hospital Ghent Belgium
- Department of Internal Medicine, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Ann Van Hecke
- Ghent University Hospital Ghent Belgium
- Department of Public Health, University Center for Nursing and Midwifery, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
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45
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Morelock SG, Kirk JD. An urban medical system's exploratory study of medication errors. Nurs Open 2019; 6:1197-1204. [PMID: 31367446 PMCID: PMC6650646 DOI: 10.1002/nop2.319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/21/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022] Open
Abstract
AIMS This study sought to identify patterns of medication errors with respect to shifts, day of week, unit involved, severity, medication class and cause of errors and to propose possible solutions. DESIGN This was a retrospective explorative study using a database containing 605 medication events from two medical centres. Variables assessed include medication type, the error severity, and time the medication was ordered, the unit that the error occurred on and the day of the week of the errors. METHODS Simple percentages were used to report the results, and point-biserial correlation was employed to test for significant differences between the day and night shifts. RESULTS There were no statistically significant findings when comparing event severity against the a.m. or p.m. shifts. The medication classes with the most errors were antibiotics, and the most common reason cited for errors was dose omission. The most commonly reported severity level was a 2 which requires increased patient monitoring.
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Reprint of: Patient participation in nursing bedside handover: A systematic mixed-methods review. Int J Nurs Stud 2019; 97:63-77. [PMID: 31181413 DOI: 10.1016/j.ijnurstu.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 08/30/2017] [Accepted: 10/22/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous reviews of nursing handover have been undertaken, but none have focused on the patient's role. OBJECTIVES To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. DESIGN Systematic mixed- methods review. DATA SOURCES Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. REVIEW METHODS Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. RESULTS Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barriers to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' discomfort encouraging patient participation and worries for sharing confidential and sensitive information. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and increasing the interpersonal approach during handover. CONCLUSIONS Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses to achieve this and prepare patients to do this. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
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Malfait S, Van Hecke A, Van Biesen W, Eeckloo K. A systematic review of patient participation during bedside handovers on wards with older patients indicates evidence is urgently needed. Int J Older People Nurs 2019; 14:e12226. [PMID: 30768854 DOI: 10.1111/opn.12226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/19/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Simon Malfait
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Faculty of Medicine and Health Sciences, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health, Faculty of Medicine and Health Sciences, University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Renal Department, Ghent University Hospital, Ghent, Belgium
- European Renal Best Pratice, Ghent, Belgium
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Ayaad O, Haroun A, Yaseen R, Thiab F, Al-Rawashdeh K, Mohammad I, Aqtash M, Qadumi S, Altantawi Y, Nairat A. Improving Nurses’ Hand-off Process on Oncology Setting Using Lean Management Principles. Asian Pac J Cancer Prev 2019; 20:1563-1570. [PMID: 31128063 PMCID: PMC6857860 DOI: 10.31557/apjcp.2019.20.5.1563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/11/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Patients in oncology setting are struggling with the complexed disease, and long and intensive treatment options. This increase the need of patients for more coordination and effective hand-off between health providers including nurses. Aims: The main aim of this project is to improve the effectiveness of hand-off between nurses in the oncology setting using lean management principles. Methods: One group pretest-posttest quasi-experimental design was conducted at King Hussain Cancer Center during quarter two to quarter four in 2017. The project was conducted using the lean tools including root cause analysis, redesigning the hand-off process; using structured tools, and standardization of the hand-off process. Results: The finding of this project showed a significant decreasing in the hand-off duration and the incidence of events related to nursing practice deviation in post-intervention. Moreover, the results showed that the nurse satisfaction score was improved. However, there is a little difference in patient satisfaction results between two quarters for overall satisfaction and per each domain. Conclusion: The project approved that the use of structured tools, safety briefing, and standardized hand-off process play important role in improving the effectiveness of the hand-off process.
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Affiliation(s)
- Omar Ayaad
- Nurse Supervisor, Quality and Patient Safety, Department of Nursing, King Hussein Cancer Center, Amman, Jordan.
| | - Anas Haroun
- Nurse Supervisor, Quality and Patient Safety, Department of Nursing, King Hussein Cancer Center, Amman, Jordan.
| | - Rawya Yaseen
- Nurse Supervisor, Quality and Patient Safety, Department of Nursing, King Hussein Cancer Center, Amman, Jordan.
| | - Fouad Thiab
- Nurse Manager, King Hussein Cancer Center, Amman, Jordan
| | | | - Iqbal Mohammad
- Nurse Manager, King Hussein Cancer Center, Amman, Jordan
| | | | - Saleh Qadumi
- Charge Nurse, King Hussein Cancer Center, Amman, Jordan
| | | | - Ahmad Nairat
- Nurse Supervisor, Quality and Patient Safety, Department of Nursing, King Hussein Cancer Center, Amman, Jordan.
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Bressan V, Cadorin L, Stevanin S, Palese A. Patients experiences of bedside handover: findings from a meta-synthesis. Scand J Caring Sci 2019; 33:556-568. [PMID: 30866081 DOI: 10.1111/scs.12673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bedside shift reports have been recently recommended to ensure handovers. However, no evidence summarising studies designed to determine the qualitative approaches capable of better understanding patient experience have been published to date. AIM The aim of this study was to acquire a deeper understanding of the experiences of patients regarding bedside shift reports. DATA SOURCES AND REVIEW METHODS A systematic review of qualitative studies followed by a meta-synthesis method based upon Sandelowski's and Barroso's guidelines was performed. Four databases were systematically explored (PubMed, CINAHL, Scopus and PsycINFO) without any limitation in time and up to the 31 August 2018. A total of 10 studies were included and evaluated in their methodological quality; then, a thematic synthesis was developed to synthetize the findings. RESULTS Three major themes reflect patients' experience regarding the bedside shift reports: (i) 'Being involved'; (ii) 'Being the centre of nursing care processes'; and (iii) 'Experiencing critical issues'. Patients are supportive of bedside shift reports as a right, as an opportunity to be involved, and of being in the centre of the nursing care process. By designing and implementing bedside shift reports, nurses also have an opportunity to increase patient safety and to provide concrete proof of the advancements achieved by the nursing profession in recent years. CONCLUSIONS The bedside shift reports experience has been little studied to date from the perspective of patients. According to the findings, implementation of the bedside shift reports should include providing education to nurses with regard to the preferences and expectations of patients, as well as the critical issues that they can experience during the bedside shift reports. Presenting the bedside shift reports method, asking patient consent, discussing potential critical issues and the degree of involvement preferred at hospital admission, is strongly recommended.
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Affiliation(s)
- Valentina Bressan
- School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy
| | - Lucia Cadorin
- Continuing Education Centre, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano - Pordenone, Italy
| | | | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy
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50
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Malfait S, Eeckloo K, Van Biesen W, Van Hecke A. The effectiveness of bedside handovers: A multilevel, longitudinal study of effects on nurses and patients. J Adv Nurs 2019; 75:1690-1701. [DOI: 10.1111/jan.13954] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/06/2018] [Accepted: 11/21/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Simon Malfait
- Ghent University Hospital; Ghent Belgium
- Faculty of Medicine and Health Sciences; Department of Public Health; University Center for Nursing and Midwifery; Ghent University; Ghent Belgium
| | - Kristof Eeckloo
- Ghent University Hospital; Ghent Belgium
- Faculty of Medicine and Health Sciences; Department of Public Health; Ghent University; Ghent Belgium
| | - Wim Van Biesen
- Ghent University Hospital; Ghent Belgium
- Faculty of Medicine and Health Sciences; Department of Internal Medicine; Ghent University Hospital; Ghent Belgium
| | - Ann Van Hecke
- Ghent University Hospital; Ghent Belgium
- Faculty of Medicine and Health Sciences; Department of Public Health; University Center for Nursing and Midwifery; Ghent University; Ghent Belgium
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