Bedside nursing handover: A case study (original) (raw)
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Nurse handover: patient and staff experiences
British journal of nursing (Mark Allen Publishing), 2016
to understand the purpose, impact and experience of nurse handover from patient and staff perspectives. poor communication is increasingly recognised as a major factor in healthcare errors. Handover is a key risk point. Little consensus exists regarding the practice in nursing but the trend is towards bedside handover. Research on patient and staff experiences of handover is limited. a qualitative and observational study on two acute wards in a large urban hospital in the UK. interviews conducted with patients and staff and observation of handovers, ward rounds and patient-staff interactions. diverse forms of nurse handover were found, used in combination: office based (whole nursing team), nurse in charge (NIC) to NIC, and bedside. Patients' and nurses' views concurred on the purpose of bedside handover-transference of information about the patient between two nurses-and about the medical ward round, which was seen as a discussion with the patient. Views diverged regarding ...
Strategies to support continuity of care and improve patient safety during clinical handover have been developed. The aims of this study were to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross-sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part-time compared with full-time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation-Background-Assessment-Recommendation, active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care.
Nursing bedside clinical handover - an integrated review of issues and tools
2014
Aims and objectives This article reviews the available literature that supports implementing bedside clinical handover in nursing clinical practice and then seeks to identify key issues if any. Background Clinical handover practices are recognised as being an essential component in the effective transfer of clinical care between health practitioners. It is recognised that the point where a patient is ‘handed over’ from one clinician to another is significant in maintaining continuity of care and that doing this poorly can have significant safety issues for the patient. Design An integrated literature review. Method A literature review of 45 articles was undertaken to understand bedside clinical handover and the issues related to the implementation of this process. Results It was identified that there are a number of clinical handover mnemonics available that provide structure to the process and that areas such as confidentiality, inclusion of the patient/carer and involving the multidisciplinary team remain topical issues for practitioners in implementing good clinical handover practices. Conclusions This literature review identified a lack of literature available about the transfer of responsibility and accountability during clinical handover and auditing practices of the clinical handover process. The nurses were more concerned about confidentiality issues than were patients. The use of a structured tool was strongly supported; however, no one singular tool was considered suitable for all clinical areas. Relevance to clinical practice Nursing clinicians seeking to implement best practice within their professional speciality should consider some of the issues raised within this article and seek to address these issues by developing strategies to overcome them.
Bedside handover at the change of nursing shift: A mixed‐methods study
Journal of Clinical Nursing
Aim: To describe the structures, processes and content of bedside handover at the change of nursing shift in an acute care context. Background: The handover of patient information and care at the change of nursing shift is an essential, albeit risk laden, time consuming activity in clinical practice. Design: A convergent parallel mixed methods design was used. Methods: Thirty episodes of bedside handover were concurrently audio recorded and observed using a researcher developed tool modelled on the five domains of the British Medical Association's Safe Handover-Safe Patients framework. The audio recordings were analysed using content analysis. Quantitative and qualitative data generated, were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient's bedside during the change of nursing shift. This study followed Good Reporting of a Mixed Methods Study guidelines. Results: Bedside handover was observed to be mainly conducted at a fast pace. However, within this timeframe large volumes of complex information was shared and important nurse-patient interactions occurred. Analysis of the audio recordings provided evidence that the dialogue during handover was nurse dominated and the outgoing nurse appeared to influence the degree of patient participation. Conclusion: Bedside handover at the change of nursing shift involves three key stakeholders: outgoing nurse, incoming nurse and the patient. A combination of intricate communication skills both verbal and non-verbal facilitate the rapid sharing of large volumes of complex information which is necessary for the continuity and safety of patient care across nursing shifts.
Transitioning Nurse Handoff to the Bedside
Nursing Administration Quarterly, 2018
The emergency department is a complex environment in which reliable communication is vital for safe patient care. Communication during nurse shift report can be risky without an effective report process in practice. Reliability improves with the use of a standardized, patient-centered nurse handoff process. Quality improvement methods were used to promote reliable information exchange during nurse shift handoff through the implementation of a standardized, patient-centric bedside report process. Forty-six hospital-based emergency nurses participated in the project. Outcomes were measured through observation of bedside report process, nurse, and patient surveys. Of 13 handoffs observed, 92% occurred at the bedside and 54% of patients actively participated in the report process. The offgoing nurses adopted most elements of the handoff process, while the oncoming nurses were less successful. Nurses believed that the new process influenced their ability to respond to patient needs and patients were more satisfied with nurses. A structured, patient-centered bedside handoff process can reduce safety risk and promote satisfaction with care through reliable information exchange. This implementation template for bedside handoff engages staff and patients while translating best practice.
Improving clinical handover in a paediatric ward: implications for nursing management
Aim To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. Background ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. Method Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self administered Likert scales, observation and a focus group. Results After the intervention, there was a stronger relationship between the participants’ understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved and over practises, including family inclusion and safety checks. Implications for nursing management A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise.
Namibia as a country is not an exception to adverse events due to inadequately managed beside handover. The country has similar contributing factors which may cripple the inefficiency of patient handover, for instance high patient turnover in wards, lack of specific handover guidelines in public hospital settings. Bedside handover are overlooked in its importance as in the case of Namibia where it can be regarded as the possible cause of death (that is still under investigation). From this study support this phenomenon as 60% of the respondents indicated that they are neutral on such a high-risk matter where they were supposed to be highly alerted. Currently, bedside handover in public hospitals is a day-to-day communication event by the health professionals. However, in Namibia information conveyed is not structured and the patient participation is not stressed. There is a constant outcry of the implications of inadequate bedside handover in the public health facilities. A recent example which ended up in litigation is where a registered nurse was involved with a high risk pregnant woman who was admitted to a public hospital for an elective caesarean section for the following day, but since it was a public holiday (May 1), the operation was not performed. Subsequently the patient died (New Era, 29 April 2014). This case is possibly a result of miscommunication during the handover process and shows a lack of accountability. Bedside handover has become the most useful way of communication however, it does not happen in vacuum as it is bounded to a legal obligations as stated in American Medical Association (AMA) in its definition that handover is an action of transferring of responsibility and accountability for patient care from one provider or team of providers to another (AMA 2006). Therefore, all nurses are expected to be responsible as individuals, and to use their knowledge and skills to achieve high accountability levels at their health institutions. The goals of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), requires a standardized approach to handover communication that in-particular allows for the opportunity to ask and answer questions accurate, current information about a patients care, condition, and recent or anticipated changes (2006:37). Effective communication with a patient during total hospital stay is a difficult task due to high patient turnover and time constraints (Catchpole 2007.) Thus, in most cases handover information may be given in a hurried manner, which may compromise the care of patients involved. Nursing staff carries a heavy workload daily as wards are understaffed (Report of Commission of Enquiry into Health Industry 2014). In such situation it is evident to face challenges with various clinical responsibilities within the hospital setting. One of these responsibilities is to communicate effectively and to recognize the risks involved in bedside handover process in order to safeguard and ensure continuity of care. The respondents of this study are not sensitive enough towards bedside handovers and they are lacking knowledge of the significance of basic teamwork skills to allow the team to work in harmony and to coordinate bedside handover meetings successfully. Due to the fact that most respondents are neutral to disagree which is an indication that they are not fully aware that it can result in adverse events such as medical errors; prolonged patient stay in hospital and delay in treatment and care. Furthermore, it is internationally recognized that, with any patient handover there is a likelihood of risk involved and errors in handover can be fatal to the patient outcome (Manser 2013). Jones stated that cognitive errors occur; nurses’ clinical decisions may be inaccurate and associated with inappropriate interventions that can lead to increased and untimely patient mortality (Jones 2012). Furthermore, Thurgood stated, that patient reporting is a task that repeatedly testing nurse’s knowledge, skills and communication (Thurgood 1995). Given the fact that a constant movement of new nursing graduates entering hospital settings, it is imperative they bear adequate knowledge and skills to organize a seamless, error free bedside handover. Thus, this project focused of the knowledge about bedside handover elements such as preparation, introduction, information exchange, patient involvement and safety scan and some adverse event that may take place during the bedside handover process. Thus, this study aimed at assessing the knowledge regarding the importance of bedside handover procedure; the awareness of implications; and to verify the knowledge of the practical application amongst the final year Bachelor of Nursing Science students at the University of Namibia, Main Campus.
Reprint of: Patient participation in nursing bedside handover: A systematic mixed-methods review
International Journal of Nursing Studies, 2019
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' 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 patientcentred 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 $ This article is a corrected reprint of a previously published article. For citation purposes, please use the original publication details;
Review question / Objective: Nurses could have inconsistent practice during the Nursing Bedside Handover (NBH) implementation (Clari et al., 2021; Malfait et al., 2019; Whitty et al., 2017). During almost two decades, this inconsistency in nurses' practices has been explained by the strategy of implementation followed at the wards and the resistance behaviors of nurses (Burston et al., 2015; Evans et al., 2012; Kassean & Jagoo, 2005; Malfait et al., 2020; Sand-Jecklin & Sherman, 2013, 2014). Recently, this explanation has come to consider the possibility of nurses' practices be a practice individualized, flexible, and adaptive (McCloskey et al., 2019; Schirm et al., 2018; Tobiano et al., 2018). Based on these supplementary explanations, we formulated the following review question: - What are the factors perceived by nurses that influence inconsistency of practice during NBH? The purpose of this synthesis of the qualitative evidence is to review and synthesize nurses’ percept...