An observational study of patient care outcomes sensitive to handover quality in the Post-Anaesthetic Care Unit

An Examination of Nurses' Empowerment and Speaking Up During Postanesthesia Clinical Hand Overs

Hierarchical relationships can negatively affect nurses' psychological empowerment and interprofessional hand overs. We explored nurses' perceptions of their psychological empowerment, teamwork, and work engagement; relationships between these concepts during interprofessional clinical hand overs; and observed interactive communication behaviors during hand overs. We used surveys and observations of interprofessional clinical hand overs to collect data from 39 nurses in a postanesthesia care unit in Australia. Nurses reported high scores for psychological empowerment and work engagement. Relationships between empowerment and teamwork (r = 0.41, P = .01) and empowerment and work engagement (r = 0.65, P < .001) were positive and significant. Relationships between nurses' observed communication behaviors and perceptions of empowerment, teamwork, and work engagement were nonsignificant. Additional research is needed to better understand how empowerment, teamwork, and work engagement affect nurses' interactive communication behaviors during interprofessional clinical hand overs in the postanesthesia care unit.

Exploring postoperative handover quality in relation to patient condition: A mixed methods study

AIMS AND OBJECTIVES

To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices.

BACKGROUND

High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors.

DESIGN

Observational mixed methods convergent design.

METHODS

Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research.

RESULTS

Information omissions in the handovers observed ranged from 1-13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team.

CONCLUSIONS

The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality.

RELEVANCE TO CLINICAL PRACTICE

It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.

A brief intervention to standardize postanesthetic clinical handoff

This naturalistic, pre- and post-design study explored the feasibility and acceptability of a brief patient safety intervention to introduce a tool to standardize interdisciplinary communication processes at patient handoff between anesthetists and postanesthesia nurses in the postanesthetic care unit. Observation and interview data were collected pre- and post-intervention from a convenience sample of 27 nurses and 23 anesthetists in a large tertiary hospital in Melbourne, Australia. Following the intervention, significant improvement was observed in nurses' performance of several patient safety behaviors, but trends in nurses' interdisciplinary communication behaviors such as asking questions and escalation of care were nonsignificant. This research provides evidence that tools to standardize clinical handoff communication may empower nurses to perform desired patient safety behaviors during interprofessional handoff. It underpins future research to explore strategies to empower nurses to advocate for patient safety during interdisciplinary communication, and provides a foundation for patient handoff improvement, education, and further research.

Effects of a stepwise handovers ISBARQ programme among nursing college students

Background

Due to a lack of standardized guidelines, it is necessary to verify the effectiveness of educational programmes for nursing students' systematic handover training.

Aims

This study aimed to develop a stepwise nursing handover programme and to examine its effects on awareness of handover Situation, Background, Assessment, Recommendation, communication self-efficacy and satisfaction with handover education.

Design

This was a single-group repeated measures ANOVA study.

Methods

This study was conducted in a nursing department, using a convenience sample of 25 senior nursing students from April 2 to June 22, 2018. The programme was divided into lectures, scenario role-playing and nursing case role-playing. The research questions were analysed using repeated measures ANOVA.

Results

Awareness of handover Situation, Background, Assessment, Recommendation, communication self-efficacy and satisfaction with handover education gradually increased after each step of the programme. The stepwise nursing handover programme, progressing from low to high levels of learning, can be used to improve the nursing handover system and handover communication ability.