Handover in Nursing: A Concept Analysis

BACKGROUND AND PURPOSE

The broad use of the term handover to describe any activity involving the transfer of professional responsibility from one person to another has led to an ambiguous understanding. Recently, handover has become a process central to the delivery of high-quality and safe patient care. The aim of this analysis was to clarify the concept of handover within the context of nursing practice.

METHODS

Rodgers's evolutionary approach was used as the analysis method along with some aspects of the dimensional analysis guided by Caron and Bowers, to understand the perspectives of senders and receivers.

RESULTS

The analysis revealed four attributes of handover: transfer of information, interaction for disambiguation, process, and strategy. Handover is defined as a process for transferring responsibility from sender to receiver through communication through the transfer of information, the interaction for disambiguation, and the context-sensitive strategy for accomplishing the continuity and safety of patient care. The salient dimension of handover was process, and the sub-dimensions were transfer of information, interaction for disambiguation, and strategy. From the sender's perspectives, it is the process of transferring information organized by the sender, and from the receiver's perspective, handover is the process establishing care plan through interactive strategy.

IMPLICATIONS FOR PRACTICE

The definition and identified attributes serve as a heuristic for designing strategies and further developing the construct of handover in nursing.

The sum of us. Implementing a Person Centred Care Bundle - A narrative inquiry

AIM

This study is a narrative inquiry that aims to better understand the experience of nurses implementing a Person-Centred Care (PCC) bundle onto an acute care ward in a large hospital in Melbourne, Australia.

BACKGROUND

The PCC includes five key focus areas aimed at streamlining nursing practice 1) Nursing assessment and care planning, 2) bedside handover, 3) patient safety rounding, 4) patient whiteboards, and 5) safety huddles. The PCC bundle outlines a nursing care process that is interactional with the patient, focused on information sharing, safety and respect.

METHOD

A narrative inquiry was used to explore the nurse's experiences implementing the PCC. Surveys and focus groups were used to collect data and thematic analysis was used to identify any key themes.

RESULTS

The three themes were; Passing the baton; Keeping the cogs moving when time poor; and Deep interpersonal relating-The sum of us.

A systematic review on the structured handover interventions between nurses in improving patient safety outcomes

AIM

This review aimed to elucidate the effectiveness of structured handovers in improving patient outcomes in the wards.

BACKGROUND

Studies have reported that the lack of quality handovers is one of the main causes of adverse effects.

EVALUATION

A search over six electronic databases: MEDLINE; CINAHL; Web of Science; EMBASE; Scopus; and CENTRAL via Ovid concluded nine studies and synthesized by two independent reviewers based on the Cochrane Handbook for Systematic Reviews of Interventions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the undertaking of this review and meta-analysis. All studies published up to February 2019 were considered in this review.

KEY ISSUES

This review has demonstrated that structured handovers reduced the incidences of patient complications, medication errors and general adverse events. However, the results were not statistically significant.

CONCLUSION

Current structured handover formats were effective in reducing problematic handovers such as omission of information, inaccurate information and documentation errors.

IMPLICATIONS FOR NURSING MANAGEMENT

Although there is limited high-quality and rigorous research conducted to gain a clearer understanding of the impacts on patient-related outcomes in nursing care, structured handovers remained effective in reducing the number of mistakes in information transfer.

Handovers in care homes for older people – their type, timing and usefulness. Findings from a scoping review

There is a considerable body of literature on the importance of effective shift handovers in hospitals and other health-care settings but less is known about the transfer of information between staff starting and completing stints of paid work in care homes. In the first of two articles considering this under-explored topic, we report findings from a scoping review examining what is known about shift-to-shift handovers in care homes for older people and their equivalents. It is based on systematic searches of electronic databases of English-language journals on ageing and internet searches for material published between January 2005 and October 2016. Guidance from the regulatory body for health and social care in England, the Care Quality Commission, highlights the importance of handovers in care homes but the degree to which they are embedded into care home routines appears to be variable, influenced by factors such as workplace culture, shift patterns and the extent to which they involve all those on duty or just those with professional qualifications. Staffing shortages and whether or not members of staff are paid for their time attending handovers appear to be further constraints on their use. We conclude that there is considerable scope for further research in this field to identify and develop good practice.

Effectiveness of different nursing handover styles for ensuring continuity of information in hospitalised patients

BACKGROUND

An accurate handover of clinical information is of great importance to continuity and safety of care. If clinically relevant information is not shared accurately and in a timely manner it may lead to adverse events, delays in treatment and diagnosis, inappropriate treatment and omission of care. During the last decade the call for interventions to improve handovers has increased. These interventions aim to reduce the risk of miscommunication, misunderstanding and the omission of critical information.

OBJECTIVES

To determine the effectiveness of interventions designed to improve hospital nursing handover, specifically:to identify which nursing handover style(s) are associated with improved outcomes for patients in the hospital setting and which nursing handover style(s) are associated with improved nursing process outcomes.

SEARCH METHODS

We searched the following electronic databases for primary studies: Cochrane EPOC Group specialised register (to 19 September 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (to 1 March 2013), MEDLINE (1950 to 1 March 2013) OvidSP, EMBASE (1947 to 1 March 2013) OvidSP, CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1980 to 1 March 2013) EbscoHost and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index) (to 9 July 2012). The Database of Abstracts of Reviews (DARE) was searched for related reviews. We screened the reference lists of included studies and relevant reviews. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) http://www.who.int/ictrp/en/ and Current Controlled Trials www.controlled-trials.com/mrct and we conducted a search of grey literature web sites.

SELECTION CRITERIA

Randomised controlled trials (RCTs or cluster-RCTs) evaluating any nursing handover style between nurses in a hospital setting with the aim of preventing adverse events or optimising the transfer of accurate essential information required for continuity of care, or both.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data.

MAIN RESULTS

The search identified 2178 citations, 28 of which were considered potentially relevant. After independent review of the full text of these studies, no eligible studies were identified for inclusion in this review due to the absence of studies with a randomised controlled study design.

AUTHORS' CONCLUSIONS

There was no evidence available to support conclusions about the effectiveness of nursing handover styles for ensuring continuity of information in hospitalised patients because we found no studies that fulfilled the methodological criteria for this review. As a consequence, uncertainty about the most effective practice remains. Research efforts should focus on strengthening the evidence abut the effectiveness of nursing handover styles using well designed, rigorous studies. According to current knowledge, the following guiding principles can be applied when redesigning the nursing handover process: face-to-face communication, structured documentation, patient involvement and use of IT technology to support the process.

Stereotyping stigma: undergraduate health students' perceptions at handover

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

The lack of standard definitions in the supportive and palliative oncology literature

CONTEXT

Multiple organizations have raised concerns about the lack of standard definitions for terminology in the supportive and palliative oncology literature.

OBJECTIVES

We aimed to determine 1) the frequency of 10 commonly used terms in the supportive and palliative oncology literature, 2) the proportion of articles that provided definitions for each term, and 3) how each term was defined.

METHODS

We systematically searched MEDLINE, PubMed, PsycINFO, the Cochrane Library, Embase, ISI Web of Science, and Cumulative Index to Nursing and Allied Health Literature for original studies, review articles, and systematic reviews related to palliative care and cancer in the first six months of 2004 and 2009. We counted the number of occurrences for "palliative care," "supportive care," "best supportive care," "hospice care," "terminal care," "end-of-life," "terminally ill," "goals of care," "actively dying," and "transition of care" in each article, reviewed them for the presence of definitions, and documented the journal characteristics.

RESULTS

Among the 1213 articles found, 678 (56%) were from 2009. "Palliative care" and "end-of-life" were the most frequently used terms. "Palliative care," "end-of-life," and "terminally ill" appeared more frequently in palliative care journals, whereas "supportive care" and "best supportive care" were used more often in oncology journals (P<0.001). Among 35 of 601 (6%) articles with a definition for "palliative care," there were 16 different variations (21 of 35 articles used the World Health Organization definition). "Hospice care" had 13 definitions among 13 of 151 (9%) articles. "Supportive care" and other terms were rarely defined (less than 5% of articles that used the term).

CONCLUSION

Our findings highlight the lack of definitional clarity for many important terms in the supportive and palliative oncology literature. Standard definitions are needed to improve administrative, clinical, and research operations.

Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: Insights from interviews and observations

Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses’ use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor’s electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer “at a glance” information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.