Bedside Handover Research Articles

Cardio-thoracic surgical patients’ experience on bedside nursing handovers: Findings from a qualitative study

The purpose of this study was to describe the experiences of postoperative cardio-thoracic surgical patients experiencing nursing bedside handover. A descriptive qualitative approach was undertaken. A purposeful sampling technique was adopted, including 14 patients who went through cardio-thoracic surgery and witnessed at least two bedside handovers. The study was performed in a Cardio-thoracic ICU localised in a Joint Commission International accredited Academic Hospital in north-eastern Italy from August to November 2014. The experience of patients participating at the bedside handover is based on four main themes: (1) 'discovering a new nursing identity', (2) 'being apparently engaged in a bedside handover', (3) 'experiencing the paradox of confidentiality' and (4) 'having the situation under control'. With the handover performed at the bedside in a postoperative setting, two interconnected potential effects may be achieved with regard to patients, nurses and the nursing profession. Nurses have a great opportunity to express their closeness to patients and to promote awareness of the important growth that nursing has achieved over the years as a profession and discipline. Therefore, patients may better perceive nursing competence and feel safer during the postoperative care pathway. They can appreciate nurses' humanity in caring and trust their competence and professionalism.

Need for a hands-on approach to hand-offs: A study of nursing handovers in an Indian Neurosciences Center.

Context:Standardized nursing handovers have been known to improve outcome, reduce error, and enhance communication. Few, if any, studies on nursing handovers have been conducted in the India.Aim:The aim was to study nursing handover practices in a Neurosciences Center in India.Subjects and Methods:This study was conducted in a 200 bedded public sector Neurosciences Center in New Delhi, to assess nursing handover practices across five wards, all shifts, weekdays, and weekends using a pretested checklist. Ten elements were observed under the categories of time, duration, process, nurse interaction, and patient communication.Statistical Analysis:Analysis of variance, Z-test, and Spearman's correlation coefficient.Results:Totally, 525 nursing handovers revealed varying compliance levels among (63%) time, place (76%), process (82%), staff interaction (53%), and patient communication (44%) related elements. Poorer compliance was seen in morning shifts and weekends; the difference being statistically significant. Bedside handovers were more frequent during weekends and night shifts and were positively correlated with increased staff interaction and patient communication and negatively related to handover duration. Though nurses showed better adherence to process related elements, background patient information, and assessment was explained less frequently. Differences between wards were insignificant except in categories of nurse interaction and patient communication which was better in the neurosurgery than neurology wards.Conclusion:Study revealed a need for a system change and standardization of handovers. Greater administrative commitment, use of technology, training, and leadership development will aid in continuity of care, promote patient safety, and ensure better outcomes.

Communicating about the management of medications as patients move across transition points of care: an observation and interview study

As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure. A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure. Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication. Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.

The impact of an integrated nursing handover system on nurses' satisfaction and work practices.

This study examined the impact of an Integrated Nursing Handover System--structured content, a minimum data set and an electronic module within the patient clinical information system--on nurses' satisfaction with handover and changes to practice. Poor transfer of patient information between clinicians at handover has been associated with adverse patient outcomes. A mixed methods pre-post evaluative approach was used. The Integrated Nursing Handover System was introduced and evaluated within an Australian hospital. Changes to nurses' satisfaction were measured using the modified Bradley Clinical Handover Survey (n = 40 pre, n = 80 post). Three focus groups with clinicians (2) and mangers and educators (1) examined changes to clinical practice. The location of handover was observed. Nurses' satisfaction with handover was improved. A two stage approach to handover emerged: nurses received handover of all patients within meeting rooms followed by handover delivered at the bedside. Major categories identified through content analysis included: implementation and the transition, work practice changes and bedside handover, accessible and standardised patient information, accountability for information transfer and a central repository of patient information. An integrated system has been implemented with positive outcomes of: improved nurse satisfaction with handover, nurses being informed about all patients, enhanced patient transfers and improved patient information for all health professionals. Further research into the potential use of stored patient handover data for research is recommended. This comprehensive system of nursing handover represents the first integrated system of this nature ever reported in the nursing and health literature. This integrated nursing handover system has been successfully implemented resulting in delivery of more comprehensive, logical and standardised patient information at handover.

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

IntroductionNursing 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...

Perspectives of clinical handover processes: a multi-site survey across different health professionals.

To examine the perspectives of health professionals of different disciplines about clinical handover. Ineffective handovers can cause major problems relating to the lack of delivery of appropriate care. A prospective, cross-sectional design was conducted using a survey about clinical handover practices. Health professionals employed in public metropolitan hospitals, public rural hospitals and community health centres were involved. The sample comprised doctors, nurses and allied health professionals, including physiotherapists, social workers, pharmacists, dieticians and midwives employed in Western Australia, New South Wales, South Australia and the Australian Capital Territory. The survey sought information about health professionals' experiences about clinical handover; their perceived effectiveness of clinical handover; involvement of patients and family members; health professionals' ability to confirm understanding and to clarify clinical information; role modelling behaviour of health professionals; training needs; adverse events encountered and possibilities for improvements. In all, 707 health professionals participated (response rate = 14%). Represented professions were nursing (60%), medicine (22%) and allied health (18%). Many health professionals reported being aware of adverse events where they noticed poor handover was a significant cause. Differences existed between health professions in terms of how effectively they gave handover, perceived effectiveness of bedside handover vs. nonbedside handover, patient and family involvement in handover, respondents' confirmation of understanding handover from their perspective, their observation of senior health professionals giving feedback to junior health professionals, awareness of adverse events and severity of adverse events relating to poor handovers. Complex barriers impeded the conduct of effective handovers, including insufficient opportunities for training, lack of role modelling, and lack of confidence and understanding about handover processes. Greater focus should be placed on creating opportunities for senior health professionals to act as role models. Sophisticated approaches should be implemented in training and education.

Leadership and communication: what are the imperatives?

Leadership and communication: what are the imperatives?

One size fits all? Challenges faced by physicians during shift handovers in a hospital with high sender/recipient ratio.

The aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio. A multifaceted approach was adopted, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders' and recipients' verbal communication, and recipients' handwritten notes) and handover environmental factors were analysed. The relationship between 'to-do' tasks, and information transfer, handover quality and handover duration, were examined using analysis of variance. Verbal handovers for 152 patients were observed; handwritten notes on 102 (67.1%) patients and handover quality ratings for the handovers of 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of nonmodifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication), allowed interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location. Handovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised.

Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India

ABSTRACT Background Standardized handovers have been known to improve outcome, reduce error and enhance communication. Few, if aany, comparative studies on clinical handovers have been conducted in the India. Objective To study clinical handover practices among nurses and doctors in a neurosciences center in India. Design and setting This descriptive and cross-sectional study was conducted over 4 months in a 200 bedded public sector tertiary care facility in New Delhi, India. Materials and methods The handover practices of nurses and resident doctors in a neurology ward were assessed across shifts, weekdays and weekends using a pretested checklist. Ten elements were observed under the categories of time, place, record, process, staff interaction and patient communication. Outcomes were analyzed using z-test, analysis of variance (ANOVA) and Spearman's correlation coefficient. Results Three hundred and eighty-two handovers each of nurses and doctors revealed varying adherence for time (44%), place (63%), documentation (50%), process (78%), staff interaction (50%) and patient communication (45%) related elements with overall compliance being 55%. Doctors fared better only in process elements and bedside handovers; however, only nurses had a statistically significant fall in levels over weekends and in night shifts. Staff interaction and patient communication were positively correlated and bedside handover was negatively related to handover duration in both groups. No statistically significant difference was found between the two groups when assessed as categories. Conclusion Study revealed a need for a system change and standardization of clinical handovers. Greater administrative commitment, use of technology, customized training and leadership development will aid in continuity of care, promote patient safety and ensure better outcomes. How to cite this article Kumar P, Jithesh V, Vij A, Gupta SK. Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India. Int J Res Foundation Hosp Healthc Adm 2015;3(1):33-40.

Nursing bedside clinical handover - an integrated review of issues and tools.

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. 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. An integrated literature review. A literature review of 45 articles was undertaken to understand bedside clinical handover and the issues related to the implementation of this process. 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. 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. 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.

Nurses' expert opinions of workplace interventions for a healthy working environment: a Delphi survey.

Much has been written about interventions to improve the nursing work environment, yet little is known about their effectiveness. A Delphi survey of nurse experts was conducted to explore perceptions about workplace interventions in terms of feasibility and likelihood of positive impact on nurse outcomes such as job satisfaction and nurse retention. The interventions that received the highest ratings for likelihood of positive impact included: bedside handover to improve communication at shift report and promote patient-centred care; training program for nurses in dealing with violent or aggressive behaviour; development of charge nurse leadership team; training program focused on creating peer-supportive atmospheres and group cohesion; and schedule that recognizes work balance and family demands. The overall findings are consistent with the literature that highlights the importance of communication and teamwork, nurse health and safety, staffing and scheduling practices, professional development and leadership and mentorship. Nursing researchers and decision-makers should work in collaboration to implement and evaluate interventions for promoting practice environments characterized by effective communication and teamwork, professional growth and adequate support for the health and well-being of nurses.

The effect of a transforming care initiative on patient outcomes in acute surgical units: a time series study

To examine the relationship between the implementation of a transforming care initiative and two patient outcomes, inpatient falls and hospital acquired pressure ulcers. Patients continue to experience harm in hospitals from adverse events such as inpatient falls and hospital acquired pressure ulcers. These and other patient safety concerns led to transforming care initiatives. This cohort study used historical controls and a time series design. The setting was two surgical units of an acute care hospital; 7125 patients discharged from these units between July 2008-December 2010 were included. Those patients discharged during the initial 3 months of implementation were excluded. Several interventions were adopted as part of the transforming care initiative such as bedside handover and bedside whiteboards. Coded administrative data were accessed to identify patients who had experienced a fall or acquired a pressure ulcer during their hospital stay. Statistical process control was used to identify changes in outcomes over time. The findings demonstrated variation in the proportion of patients experiencing a fall in both units and for the proportion of patients acquiring a pressure ulcer in one unit, following implementation. These results demonstrate that implementing a transforming care initiative may have some influence on the quality and safety of patient care as measured by patient falls and pressure ulcers but findings varied. Further research is required to gain an understanding of the inconsistency of the impact of these initiatives across all clinical contexts.

Measurement of the frequency and source of interruptions occurring during bedside nursing handover in the intensive care unit: An observational study

BackgroundEffective clinical handover involves the communication of relevant patient information from one care provider to another and is critical in ensuring patient safety. Interruptions may contribute to errors and are potentially a significant barrier to the delivery of effective handovers. ObjectivesThe study objective was to measure the frequency and source of interruptions during intensive care (ICU) bedside nursing handover. MethodsTwenty observations of bedside handover in an ICU were performed and the frequency and source of interruptions were recorded by the observer for each handover. Observations occurred Monday to Friday during shift change; night to day shift and day to evening shift. Interruptions were defined as a break in performance of an activity. ResultsThe mean handover time was 11 (±4)min with a range of 5–22min. The mean number of interruptions was 2 (±2) per handover with a range of 0–7. The most frequent number of interruptions was seven, occurring during a 15min handover. Doctors, nurses and alarming intravenous pumps were the most frequent source of interruptions, with administration staff and wards people also disrupting handovers. ConclusionNurses, doctors and alarming intravenous pumps frequently interrupt ICU bedside handovers, which may lead to loss of critical information and result in adverse patient events. Increased knowledge in this area will ensure appropriate strategies are developed and implemented in healthcare areas to manage interruptions effectively and improve patient safety.

Adopting a patient‐centred approach: an investigation into the introduction of bedside handover to three rural hospitals

To study empirically the process and outcomes of the implementation of nurse-to-nurse bedside handover in three rural South Australian hospitals. While the importance of handover is identified in literature, little is written about its implementation. It is, however, suggested that bedside handover is a more patient-focussed approach than others available. A mixed-method, pretest post-test evaluative approach involving quasi-experimental and ethnographic elements was used. The self-selected sample comprised nine inpatients (five women, four men) and forty-eight self-selected enrolled/registered nursing staff (forty-seven women, one man) from three acute hospital wards in rural South Australia. Lewin's (Human Relations, 1, 1947a, 2; Readings in Social Psychology. Henry Holt, New York, 1947b, 197) 3-stage model of change provided a theoretical basis and structure for the study. Patient perceptions were obtained using ethnographic interviewing. Staff perceptions of patient involvement were obtained through questions rated on a 7-point Likert scale and ethnographic interviewing. Results indicated that patients preferred the bedside handover method over the traditional closed-door office handover approach. The key differences (as defined by patients) are that the bedside handover process incorporates social aspects for the patient, patients have the opportunity to know who is looking after them and patients are included in discussion related to their care. Furthermore, results suggest that staff believed the level of patient involvement in their care had increased under the bedside handover process. The results demonstrate that both patients and staff perceive patients to be more involved in their care under the bedside handover approach. The literature notes a recent move towards adopting patient-centred care approaches in clinical settings and the many benefits associated with this style of care. This study has proven that implementing bedside handover has resulted in a patient-centred approach. This study generates further knowledge about rural nursing and contributes insight into the importance of handover implementation method--areas that are not widely documented in existing literature.

Bedside nursing handover: Patients' opinions

Within the context of contemporary nursing practice, bedside handover has been advocated as a potentially more suitable mode for achieving patient-centred care. Given that patients can play an important role in the process, better understanding of patients' perspectives of bedside handover could be a critical determinate for successful implementation of the practice. Using a phenomenological approach, this study attempted to explore patients' perceptions of bedside nursing handover. Four key themes emerged from the patient interviews: 'a more effective and personalised approach', 'being empowered and contributing to error minimization', 'privacy, confidentiality and sensitive topics', and 'training need and avoidance of using technical jargon'. Patients welcome bedside handover as they can be empowered through participation in the process. Nevertheless, attention is needed to ensure that adequate training is provided to nurses and to minimize the use of technical jargon so that handover is delivered with a professional and consistent approach.

Towards patient-centred care: perspectives of nurses and midwives regarding shift-to-shift bedside handover.

The aim of this descriptive qualitative study was to explore perspectives of nurses and midwives towards the introduction of shift-to-shift bedside handover. Semistructured interviews with nurses (n = 20) and midwives (n = 10) occurred 12 months after the introduction of bedside handover. Data were analyzed using thematic content analysis. Two main themes were identified: enhanced individual patient care and documentation, along with improved patient-clinician partnerships; and protection of confidentiality and privacy. The newly introduced bedside handover model improved efficiency and accuracy of the handover process and led to the provision of safe, high-quality care. Development of ward-specific tools and relevant educational resources, along with clinical support, are identified as the facilitators to ensure the new model can be successfully integrated into normal clinical practice.

Bedside Handover Enhances Completion of Nursing Care and Documentation

Bedside handover has been proposed as a patient-focused nursing practice model with the potential to reduce adverse events and improve standards of care. This pre-/postintervention study examined changes in completion of nursing care tasks and documentation after the implementation of bedside handover. Analysis of 754 cases revealed significant improvements in several nursing care tasks and documentation, whereas there was no variation in handover duration. Implementing bedside handover may enhance nursing care for hospitalized patients.

Attitudes of emergency department patients about handover at the bedside

To explore patients' perspectives of bedside handover by nurses in the emergency department (ED). International guidelines promote standardisation in clinical handover. Poor handover can lead to adverse incidents and expose patients to harm. Studies have shown that nurses and patients have favourable opinions about handover that is conducted at the bedside in hospital wards; however, there is a lack of evidence for patients' perspective of nursing handover in the ED environment. Qualitative descriptive study. Semi-structured interviews with 30 ED patients occurred within one hour of bedside handover. Data were analysed using thematic content analysis. Two main themes were identified in the data. First, patients perceive that participating in bedside handover enhances individual care. It provides the opportunity for patients to clarify discrepancies and to contribute further information during the handover process, and is valued by patients. Patients are reassured about the competence of nurses and continuum of care after hearing handover conversations. Second, maintaining privacy and confidentiality during bedside handover is important for patients. Preference was expressed for handover to be conducted in the ED cubicle area to protect privacy of patient information and for discretion to be used with sensitive or new information. Bedside handover is an acceptable method of performing handover for patients in the ED who value the opportunity to contribute and clarify information, and are reassured that their information is communicated in a private location. From the patients' perspective, nursing handover that is performed at the bedside enhances the quality and continuum of care and maintains privacy and confidentiality of information. Nurses should use discretion when dealing with sensitive or new patient information.

Study fails to find benefit in bedside handovers

Study fails to find benefit in bedside handovers

Handover: Faster and safer

Objective: This study aimed to introduce bedside handover to three rural South Australian hospitals. Design: A mixed‑method, pre‑test post‑test evaluative approach involving quantitative (quasi‑experimental) and qualitative (ethnographic) elements was used. Setting: This study was set in three acute hospital wards. Subjects: The sample comprised forty‑eight self‑selected enrolled/registered nursing staff; forty‑seven females and one male. Main outcome measure(s) A 7‑point Likert scale (19 items) and ethnographic interview questions covered themes relating to nurses satisfaction of pre and post‑handover processes, frequency of incidents and estimations of time taken to conduct handover processes. Pre and post‑handover processes were digitally timed. Documentation review of pre and post incident frequencies and journaling were also undertaken. Results: With regard to handover duration, the average total time taken to conduct handover had decreased between 13% and 70% depending on the site. From a practical aspect, this can be regarded as significant. With regard to incident comparison, there is a clear trend from pre to post; the total number of incidents dropping from eighteen to seven. Conclusions: The results of this study indicate that bedside handover approach is significantly less time consuming than the closed door approach previously adopted. The findings indicate a trend in the reduction of frequency of incidents under the bedside handover process. Literature suggests that incident reduction is directly correlated with increased information accuracy, however, this was not found to be the case in this study. Further research is warranted into factors, other than information accuracy, that may increase safety in clinical settings.