Abstract
Bedside handover during the change of shift allows nurses to visualize patients and facilitate patient participation, both purported to improve patient safety. But, bedside handover does not always occur and when it does, it may not involve the patient. To explore and understand barriers nurses perceive in undertaking bedside handover. A cross-sectional survey was administered to 200 nurses working on medical wards, recruited from two Australian hospitals, one private and one public. As part of the survey, there was one open-ended question asking about perceived barriers to bedside handover. Content analysis was used to analyze data. Barriers were assessed using a determinant framework. The open-ended question was answered by 176 (88%) participants. Three categories were identified. First, censoring the message showed nurses were concerned about patients and third-parties hearing sensitive information. In the second category, disrupting the communication flow, nurses perceived patients, family members, other nurses and external sources, interrupted the flow of handover and increased its duration. Finally, inhibiting characteristics demonstrated that individual patient and nurse views or capabilities hindered bedside handover. Barriers to bedside handover were determined to relate to individual nurse factors, patient factors, social, political and legal factors, and guideline factors. Suggestions for enhancing bedside handover include debunking nurses' misconceptions, reflecting on nurses' viewpoints, using active educational approaches, and promotion of legal requirements to heighten nurses' confidence dealing with sensitive information. Regular patient rounding, and standardized handover may enable patient involvement in handover. Finally, reviewing the local context to ensure organizational processes support bedside handover is recommended.
Highlights
Background and RationaleBedside handover during the change of shift allows nurses to visualise patients and facilitate patient participation, both purported to improve patient safety
Most participants were female, registered nurses, who had worked for approximately 6 years, and had similar characteristics to those who completed the rest of the survey (Table S1)
Our study showed nurses thought privacy issues, inefficient flow of communication and individual patient and nurse characteristics frequently hindered bedside handover
Summary
Background and RationaleBedside handover during the change of shift allows nurses to visualise patients and facilitate patient participation, both purported to improve patient safety. Nursing change of shift handover, known as handoff and end of shift report, is a risky activity, impacting on patient safety and continuity of care (Wong, Yee, & Turner, 2008). During transition of one shift of nurses to the the oncoming nurse receives a handover and is updated with patient information (Kitson, Muntlin Athlin, Elliott, & Cant, 2014). This activity can occur up to three times per day, involving different nurses on each shift (World Health Organization, 2007), with each handover presenting an opportunity for miscommunication (Wong et al, 2008). As found in a second review, nurses report improved efficiency, accountability and information accuracy while patients may experience improved satisfaction and feel better informed and engaged through bedside handover (Sherman et al, 2013)
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