[Implementing bedside handover in neurological rehabilitation: An Action Research Approach in Practice Development]

Implementing bedside handover in neurological rehabilitation: An Action Research Approach in Practice Development Abstract. Background: Nursing handovers are considered high-risk tasks but are also an important resource for conveying pertinent insights in the patients' situation and engaging them in the care process. As part of a broader action research project, a participatory approach was used to implement bedside handovers. Aims: It seemed central to sustainable change to gain insights which underlying factors motivate nurses to change handover practices. Methods: A qualitative design was chosen, in which five exploratory interviews were conducted with nurses. Results: The biggest challenges are privacy concerns and dealing with cognitively impaired patients. The motivations for bedside handover are a less error-prone transfer of information and a more accurate impression of the patient, in addition to a patient contact which is experienced as valuable. Discussion: The change in handover structure is accompanied by changes in the ward culture. The challenges faced by the staff require high communication skills to bridge them. The main factor for the preference of the handover form is the effect on the patients. Limitations: Transferability is limited due to the high contextual relevance. Transfer: With the help of a structured implementation strategy, even rituals can be modified. The bedside handover has a beneficial influence on patient-centredness.

Nurses' Versus Physicians' Perceptions of the Bedside Handover Practice in the Intensive Care Unit: An Egyptian Prospective, Comparative Study

This article reports a prospective, comparative study using a semistructured interview technique, to compare the perceptions of nursing professionals and physicians about the bedside handover practice, in intensive care units (ICUs). Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Despite increasing demand for structured processes to guide clinical handovers, the perception may differ between nurses and physicians, particularly in the ICU. The results of the current study showed that the quality of the information provided during handovers was perceived by both the nurses and physicians as satisfactory and relevant to the patient's care. The findings of this study could have impacts on the daily medical practices in the ICU. The results of this study could be utilized to design programs that will improve nurses' and physicians' understanding and practices of the handover process as well as the information needed to be communicated.

Development of patient-centred care in acute hospital settings: A meta-narrative review

BACKGROUND

Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context.

AIM

To understand the development of patient-centred care in the context of acute hospital settings over the past decade.

METHODS

A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic.

RESULTS

One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care.

CONCLUSIONS

Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions.

TWEETABLE ABSTRACT

Patient-centred care in acute care settings - we have arrived! Is it sustainable?

The challenges of maintaining patient confidentiality in pediatric settings

PURPOSE

The study investigated challenges encountered by healthcare professionals in complying with the duty of confidentiality in a pediatric department.

DESIGN AND METHODS

In this qualitative study, we conducted two focus group interviews with healthcare professionals from two pediatric departments in Denmark using the methodology described by Kvale and Brinkmann.

RESULTS

We identified three challenges related to maintaining confidentiality. 1) Time pressure and physical surroundings in the clinical setting. 2) Communication challenges (where and with whom). 3) Navigation in the clinical setting to uphold privacy. In general, nurses and physicians struggle to maintain patient confidentiality in a setting where sensitive information is shared quickly.

CONCLUSION

Pediatric nurses and physicians experience challenges related to patient confidentiality that impact their clinical practice. These challenges relate to privacy and dignity and communicating with children and their parents.

PRACTICE IMPLICATIONS

Building design or renovation of pediatric departments should underpin confidentiality and privacy issues. Our study makes an important and novel contribution to existing knowledge regarding healthcare professionals' experiences in maintaining patient privacy and confidentiality.

Braided identities in acute care nurses' practices of work: professional, clinician, employee

Purpose

This paper aims to explore how dispositions of nursing habitus carry shift handover into practice in acute care.

Design/methodology/approach

Handover (the exchange of information by nurses between shifts) is more recently purported to be a procedure that transfers the responsibility of and accountability for care to maintain patient safety. Using Bourdieu's theory of practice as lens, this paper examines data from an ethnographic study of nurses' work in acute care to reveal what happens in and around nurses' practices of handover.

Findings

Exploring handover as a practice enables identification of nurses' responsibilities of work as professional, clinician and employee. These responsibilities are not practised separately, rather, as braided identities they are embodied into nurses' practices of work. Nurses' clinician and employee identities address the clinical and organisationally relevant material contained in handover, but it is in the ways that nurses embody their responses that their professional identity becomes evident.

Research limitations/implications

Viewing handover as a procedure suggests that nurses are rule followers and/or sole players and conceptualises nurses as individualised professionals only. This received knowledge as doxa misrecognises the centrality of connectedness between nurses in their work in the acute care setting.

Originality/value

Recognising nurses' braided workplace identities as being professional, clinician and employee upends the doxa of nurses work as tasks and roles in the delivery of healthcare in the acute care setting.

An integrative review of supportive relationships between child-bearing women and midwives

AIMS

To review and evaluate the literature on the factors related to developing supportive relationships between women and midwives, including facilitators and barriers.

DESIGN

An integrative review.

METHOD

The search used CINAHL, MEDLINE, Embase, EMcare, Maternity and Infant Care, PsycINFO, and Google Scholar from January 2009-June 2020. Two reviewers screened the eligible studies, and 2,399 records were identified. Quality was assessed with the mixed methods appraisal tool, and 14 articles were included.

RESULTS

The findings highlight that successful relationships require therapeutic communication, trust, respect, partnership, and shared decision-making. Supportive relationships improve women's satisfaction and birth outcomes, and continuity of care model is an enabling factor. Further research is required to understand supportive relationships in non-continuity of care models and when different cultural backgrounds exist.

Confidentiality breaches in hospital: the experiences of young people and parents

BACKGROUND

Healthcare professionals, including nurses, have a vital role in protecting patient confidentiality. However, evidence shows that breaches of confidentiality are common in hospitals for various reasons, including the ward design and issues related to healthcare staff's professionalism. The situation can be complicated further in paediatric care because of the age range of patients and their associated needs and rights about information sharing, confidentiality and consent.

AIM

To explore the views and experiences of young people admitted to hospital, and their parents and related caregivers, about the effects of confidentiality breaches.

METHOD

A descriptive questionnaire-based survey was conducted in 2018 in two regional hospitals in Denmark over two weeks. A total of 214 surveys were completed by parents and related caregivers (n=173) and by young people (n=41).

FINDINGS

Many parents and young people reported that they had overheard healthcare professionals discussing care, including information about named patients, test results, personal disclosures and various comments or opinions. In many cases these breaches of confidentiality affected patients' overall experience of hospital and led some to withhold important information.

CONCLUSION

This study demonstrates the challenges of preserving confidentiality in children's wards. Situations in which confidentiality breaches were reported appear to have been affected by the physical environment, such as ward design, as well as staff behaviour and attitudes. Therefore, nurses and other healthcare professionals need to enhance their understanding of issues related to confidentiality and pay attention to how and where information about patients is shared.

Barriers to and Facilitators of Bedside Nursing Handover: A Systematic Review and Meta-synthesis

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.

Bedside shift report: Nurses opinions based on their experiences

BACKGROUND

Nurse bedside shift report (BSR) improves satisfaction, quality and safety. Yet, postimplementation adoption rates remain low in hospitals where BSR has been introduced. Further research is needed to understand what content is most appropriate to discuss during BSR and what facilitators are from the clinical nurses' perspective.

AIMS

Identify and describe acute care clinical nurses' and nursing supervisors' experiences and opinions regarding: process of BSR, appropriate content for BSR and barriers and facilitators related to implementation of BSR.

DESIGN

A phenomenological qualitative study was conducted at an acute care 500 bed, not-for-profit academic medical centre located in the southern United States.

METHODS

Clinical nurses (N = 22) and nursing supervisors (N = 12) from every inpatient division were recruited and interviewed. The data were analysed for relationships, similarities and differences. Themes were then identified by two independent researchers.

RESULTS

Five themes were identified: (a) time constraints and clinical nurse's workflow must be taken into consideration; (b) a modified approach is necessary; (c) process and specific critical content should be individualized so that it is meaningful for all parties involved; (d) specific critical content that should be discussed outside the patient's room; and (e) specific critical content that should be discussed inside the patient's room.

CONCLUSIONS

One way to minimize interruptions is to conduct BSR using a modified approach, where a portion of the hand-off occurs inside and outside the patient's room. In addition, this study identified the nurses' preferred location where specific critical topics should be discussed.

RELEVANCE TO CLINICAL PRACTICE

Results from this study should be used to inform the practice BSR so the desired outcomes of patient and family satisfaction, nursing quality and patient safety can be realized. This study should influence future research aimed at identifying strategies for successful implementation and sustained use of BSR. The COREQ checklist was used to write manuscript.

Involving mental health consumers in nursing handover: A qualitative study of nursing views of the practice and its implementation

Nursing handover occurs between shifts and is an important means of communication and information exchange around consumer care. The involvement of consumers in nursing handover, known as 'bedside handover', is well established within general health settings and promotes a patient-centred approach to care. Bedside handover represents an opportunity for mental health settings to consolidate recovery-oriented principles, albeit with some unique challenges in the way that involving consumers in nursing handover is implemented. This qualitative descriptive study explores the views of nursing staff and nursing managers about involving consumers in nursing handover and the process of implementation across five mental health inpatient units in Australia. The study took place in a local health district covering regional and rural areas of New South Wales that had issued a directive to implement bedside handover. The consolidated criteria for reporting qualitative research (COREQ) checklist was applied to this study. Six focus groups were held with nursing staff (n = 22), and eleven individual interviews were undertaken with nursing managers to explore their perceptions of bedside handover and its implications for nursing practice. The data were analysed using thematic analysis. Data from focus groups and interviews were analysed separately and then combined to generate three themes: (i) the mental health context is different; (ii) protecting consumer privacy and confidentiality; and (iii) it might make things worse. The findings provide insights into both the challenges, and the process of involving consumers in nursing handover within mental health settings and provides guidance for future implementation.

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

OBJECTIVE

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

INTRODUCTION

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

INCLUSION CRITERIA

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Unplanned Admission to the ICU: A Qualitative Study Examining Family Member Experiences

BACKGROUND

Transfers to the ICU from acute care are common, and it is essential to understand how family members of critically ill patients experience these transitions of care.

RESEARCH QUESTION

Can we enhance our understanding of family members' experiences during hospital stays complicated by a patient's unplanned admission to the ICU?

STUDY DESIGN AND METHODS

Qualitative interviews were conducted with family members of patients were transferred from acute care to the ICU at a level I trauma center in Seattle, WA (n = 17). To organize data, we used thematic analysis, coupled with a validated conceptual model of clinician-surrogate communication.

RESULTS

Drawing from a validated conceptual model, we used two domains to frame our coding: "information processing" and "relationship building." Within information processing, we coded information disclosure, sensemaking, and expectations; within relationship building, we coded emotional support, trust, and consensus and conflict. Family members wanted timely, accurate information about the patient's condition both during and after transfer. An unplanned ICU admission was a stressful event for family members, who looked to clinicians for emotional support. Developing trust was challenging, because family members struggled to feel like integrated members of the medical team when patients transitioned from one setting to another.

INTERPRETATION

Family of patients who experience an unplanned ICU admission want high-quality communication both during and after a patient's transfer to the ICU. This communication should help family members make sense of the situation, address unmet expectations, and provide emotional support. In addition, interventions that foster family-clinician trust can help family members feel like integrated members of the care team as they face the challenge of navigating multiple different environments within the hospital.

The secrets to successful nurse bedside shift report implementation and sustainability

This literature review looks at articles on bedside shift report initiatives and offers strategies that may lead to sustained practice.

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

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.

Improving Nurses’ Hand-off Process on Oncology Setting Using Lean Management Principles

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.

Standardization of the duty shift in a General Adult Intensive Care Unit

ABSTRACT Objective: To standardize the duty shift in a General Adult Intensive Care Unit. Method: Multi-method research, which used action research, descriptive study and content validation. Participants included 11 care nurses and 4 intensive care nurses. For the data collection, a semi-structured questionnaire was used, meetings with participants and validation with specialists. In this step, the modified online Delphi Technique was used. For data treatment, the Discourse of the Collective Subject (DCS) was used, descriptive analysis and Content Validity Index. Results: Three DCS on duty change, a Standard Operating Procedure (SOP) and an information registration instrument, validated in appearance, clarity, suitability and content. Final considerations: The instrument assists in the transmission of information, strengthening patient safety and SOP will outline the shift, these tools can improve ICU shift, minimizing the risks of communication failure.

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

BACKGROUND

Numerous reviews of nursing handover have been undertaken, but none have focused on the patients' 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 barrier 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' concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. 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 involving both patients and nurses throughout the change process.

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 and patient views. 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.

Stories of change: the text analysis of handovers in an Italian psychiatric residential care home

WHAT IS KNOWN ON THE SUBJECT?: There is a growing emphasis on communication as a result of the move towards the more inclusive approach associated with the community-based rehabilitation model. Therefore, more importance is attached to handovers. Besides ensuring transfer of information, handovers enhance group cohesion, socialize staff members to the practices of the service and capture its organizational culture. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: While handovers are mainly used for information transfer and to manage the services' daily routine, this paper offers an insight on how handovers can be conceived as valuable instruments to document cultural and organizational change. Only a limited amount of studies has focused on handovers in mental healthcare settings, and most of them only consider the perspectives of psychiatric nurses, while embracing a broader perspective, this paper provides valuable insights into the perspectives of various service providers. The overcoming of the dichotomy deficit-based vs. recovery-oriented model is possible if professionals use handovers to reflect upon their practice and the ways in which their cultural models are affected by the environmental context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Handovers are valuable instruments to document organizational change. It would be important for psychiatric and rehabilitation facilities to keep track of the handover records over time as they may provide insightful information about cultural change and the transformations in the core values and beliefs held by professionals.

ABSTRACT

Handovers assure a timely and correct information transfer while socializing workers to the service's culture; however, no study describes them as instruments to document organizational change and only a few have focused on psychiatric settings. Aim To investigate the change in the culture of an Italian psychiatric residential care home as perceived by its mental health workers (MHWs) over the course of two decades. Method Emotional text analysis (ETA) was used to analyse the MHWs' handovers completed from 1990 to 2011. Results The analysis generated four clusters and three main factors illustrating the change in the MHWs' representations of the residential care home and its occupants. The factors showed: (1) the shift from an individualistic, problem-focused view to an inclusive, community-based approach; (2) the presence of a descriptive as well as a specialized language; and (3) the presence of a double focus: on patients and professionals. Conclusions Handovers transcripts document the following changes: (1) a shift from a symptom-based to a recovery-oriented approach; (2) a modification of the MHWs values towards an holistic view of the patient; (3) a growing importance assigned to accountability, services integration and teamwork. The paper shows that handovers can be used diachronically to document organizational change.

Nurses’ perceptions of bedside clinical handover in a medical-surgical unit: An interpretive descriptive study

Background:

Clinical handover is the transfer of relevant and important information and responsibility for patient care from one healthcare provider to another. An effective clinical handover is determined by the transition of critical information and the continuity of quality care for the patient. In the inpatient settings, bedside clinical handover mainly occurs during shift changes (morning to afternoon shift, afternoon to night shift and night to morning shift). Bedside clinical handover can take place in a cohort room of up to six patients or a single-bedded room with only one patient. Various nurses in the nursing hierarchy are involved in the handover, each contributing to ensure patients’ safety and continuity of quality care.

Aim:

To explore nurses’ perceptions of bedside clinical handover in an inpatient acute-care ward in Singapore.

Methodology:

An interpretive, descriptive, qualitative study was conducted using focus group interviews with semi-structured questions. The interviews were conducted with 20 nurses from an acute-care hospital in Singapore. The interviews were audiotaped and transcribed verbatim. Data collected were analyzed using thematic analysis.

Results:

Nurses described that bedside clinical handover could potentially compromise patient’s confidentiality and that the patient and/or their family members and the environment were sources of constant interruptions and distractions. Bedside clinical handover also acted as a platform for communication amongst nurses and between nurses and patients.

Conclusion:

This study provided an insight into nurses’ perceptions of bedside clinical handover and offered a foundation for nurses to improve the handover process.

Patient and nurse preferences for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment

Objective

To describe and compare patients' and nurses' preferences for the implementation of bedside handover.

Design

Discrete choice experiment describing handover choices using six characteristics: whether the patient is invited to participate; whether a family member/carer/friend is invited; the number of nurses present; the level of patient involvement; the information content; and privacy.

Setting

Two Australian hospitals.

Participants

Adult patients (n=401) and nurses (n=200) recruited from medical wards.

Main outcome measures

Mean importance scores for handover characteristics estimated using mixed multinomial logit regression of the choice data.

Results

Both patient and nurse participants preferred handover at the bedside rather than elsewhere (P<.05). Being invited to participate, supporting strong two‐way communication, having a family member/carer/friend present and having two nurses rather than the nursing team present were most important for patients. Patients being invited to participate and supporting strong two‐way communication were most important for nurses. However, contrary to patient preferences, having a family member/carer/friend present was not considered important by nurses. Further, while patients expressed a weak preference to have sensitive information handed over quietly at the bedside, nurses expressed a relatively strong preference for handover of sensitive information verbally away from the bedside.

Conclusions

All participants strongly support handover at the bedside and want patients to participate although patient and nurse preferences for various aspects of bedside handover differ. An understanding of these preferences is expected to support recommendations for improving the patient hospital experience and the consistent implementation of bedside handover as a safety initiative.

Patients' perceptions of the meaning of good care in surgical care: a grounded theory study

Background

Patients in surgical care have reported a fear of being discharged prior to sufficient recovery and a lack of control of their situation. Establishing the patient-nurse relationship is essential in the context of the care. The Swedish National Board of Health and Welfare has established indicators for good care for comparison, evaluation and improvement of the quality of the health care system. These indicators are knowledge-based, appropriate, safe, effective and equal health care, as well as care within a reasonable time and patient-centred care. Current core competence in nursing education include quality improvement, patient-centred care, teamwork and collaboration, using evidence-based practice, safety and informatics. This study investigates patients’ perceptions of the meaning of good care in inpatient surgical care.

Methods

Grounded theory according to Charmaz was chosen as the study design. Interviews were conducted with 13 patients from six surgical wards in the south of Sweden in 2014–2015.

Results

The results showed that patients in surgical care perceived good care as being safe, as they were vulnerable and anxious. This could be achieved through accessible care, reliable care, caring attitudes and participating in one’s own care. Patient participation was achieved by information and education and the possibility to affect their care.

Conclusion

Patients need safety to experience good care. Caring attitudes and patient participation can be attained through patient-centred care. Bedside handover can improve patients’ perceptions of accessible care and reliable care and can increase patient participation. Continuously maintaining competence and using evidence-based practice are needed to achieve reliable care.

Patient and nurse preferences for nurse handover-using preferences to inform policy: a discrete choice experiment protocol

INTRODUCTION

Nursing bedside handover in hospital has been identified as an opportunity to involve patients and promote patient-centred care. It is important to consider the preferences of both patients and nurses when implementing bedside handover to maximise the successful uptake of this policy. We outline a study which aims to (1) identify, compare and contrast the preferences for various aspects of handover common to nurses and patients while accounting for other factors, such as the time constraints of nurses that may influence these preferences.; (2) identify opportunities for nurses to better involve patients in bedside handover and (3) identify patient and nurse preferences that may challenge the full implementation of bedside handover in the acute medical setting.

METHODS AND ANALYSIS

We outline the protocol for a discrete choice experiment (DCE) which uses a survey design common to both patients and nurses. We describe the qualitative and pilot work undertaken to design the DCE. We use a D-efficient design which is informed by prior coefficients collected during the pilot phase. We also discuss the face-to-face administration of this survey in a population of acutely unwell, hospitalised patients and describe how data collection challenges have been informed by our pilot phase. Mixed multinomial logit regression analysis will be used to estimate the final results.

ETHICS AND DISSEMINATION

This study has been approved by a university ethics committee as well as two participating hospital ethics committees. Results will be used within a knowledge translation framework to inform any strategies that can be used by nursing staff to improve the uptake of bedside handover. Results will also be disseminated via peer-reviewed journal articles and will be presented at national and international conferences.