Midwifery Team Research Articles

Proactive behavior in midwifery: A qualitative overview from midwifery student's perspective.

In the process of continuing developments and contemporary working conditions, this study provides an in depth exploration of proactive behavior in midwifery. Exploring 55 midwifery students' perceptions on facilitators and/or barriers of proactive behavior in midwifery practice, this study uncloses additional insights of proactive behavior in midwifery and aims to confirm and/or supplement previous results. Four key themes were identified: 1) Nature-nurture, supported by good communication and lifelong learning. 2) Willingness, regulated by the midwife's norms and values and the organizational culture of the midwifery team. 3) The impact of awareness and feedback on the reflective tendencies to strengthen the midwife's beliefs and convictions to behave proactively. 4) Time was identified as something gained in the presence of proactive behavior as well as a barrier if time was limited. Providing midwives with knowledge of the key factors required to successfully effect proactive behavior in midwifery, this study has merit for future midwifery education, policy and practice. Strengthening intrinsic motivation of midwives integrated into midwifery education, focus on feedback as part of the daily routine of the midwife and the gaining of time as an effect of proactive behavior, needs clear attention in midwifery practice.

Maternal critical care: Informing and influencing local commissioners

Background Relatively little is known about women who receive higher levels of care within maternity services, such as women with unanticipated pregnancy complications, high-risk pregnancies, complex maternal medical conditions and/or obstetric complications, and women who are or become critically ill. Aim To inform local health commissioners on the complexity of activity in a tertiary referral maternity and neonatal service. Methods A retrospective audit was completed, applying a local modification of the Intensive Care Society's levels of support for critical care agreed by obstetric, anaesthetic and midwifery teams. The audit included 525 women cared for in the designated critical care rooms over 1 year. Findings The findings show that haemorrhage (40%), hypertensive disorders (16%) and sepsis (12%) were the main reasons for maternal critical care, with 44% of women requiring levels 2 and 3 critical care. This audit confirmed adequate, equitable provision of appropriate maternal critical care, but identified a need for written guidance and training programmes on the transfer of critically ill pregnant or postpartum women. Conclusions This audit found that a standardised approach to local and regional data collection and agreed definitions of maternal critical care levels were essential for effective commissioning of maternity services to ensure funding by the local commissioning group is influenced by acuity and not births alone.

Midwifery Caseloading

Continuity of Care and team midwifery are buzzwords in maternity, long since a part of the way childbearing, childbirth and childrearing are organised. In the UK, women cared for by professionals call for care by midwives they recognise, and ‘know your midwife’ schemes (or variations on the theme) are well tried and tested. This four-part series looks at caseloading in theory and practice, with implications for all the multi-disciplinary team, service providers and service users alike. This first article in the series examines the advantages and disadvantages of caseloading. Some training tools – to be utilised by managers who generate discussion among practitioners, take initiative, set up effective teams and support caseloading projects – are also provided.

Homebirth organised in a caseload midwifery model with affiliation to a Danish university hospital – A descriptive study

ObjectiveTo describe birth and neonatal outcome in women initiating a homebirth and cared for by a caseload midwifery teams with affiliation to a university hospital. Further, to describe the rate, time, and reasons for transfer between home and hospital. DesignA descriptive study using prospectively collected registry data on initiated homebirths. ResultsA total of 268 women initiated a homebirth and 192 actually gave birth at home, equal to 1.99% of all births in Aarhus Municipality. The majority of the women who initiated a homebirth experienced a vaginal birth (92%) regardless of birthplace. Approximately 28% of the women were transferred from home to hospital during or after birth and 72% of the women had a homebirth as planned. Two children (both born in hospital) were admitted to the neonatal care unit requiring minor observation or treatment. ConclusionThe majority of the women included in this study experienced a vaginal birth including those being transferred from home to hospital. Main reasons for being transferred were slow labor progress and rupture of membranes >18 h. The majority of those being transferred were nulliparous women and most transfers happened during birth.

Improving practice and reducing significant postpartum haemorrhage through audit

Background In 2012, there was a concern about the incidence of postpartum haemorrhage (PPH) and the prevalence of physiological third stage management at a midwife-led birthing unit. Aims To determine whether midwives considered risk factors for PPH and provided informed choice when planning third stage management, and whether there was any relationship between third stage management and PPH. Methods A cohort of 57 women who experienced a PPH >500mL was identified, and their records audited. Findings were shared with the midwifery team, who generated solutions. These were implemented in 2013/14 and a re-audit was conducted in 2015. Findings The re-audit showed that the incidence of PPH >1000mL had decreased. As a result of improvements in risk assessment and informed consent surrounding third stage management, no women were inappropriately managed physiologically during the third stage. Using an agreed pathway and PPH boxes was associated with an improvement in the quality and speed of treatment. Conclusions The audit cycle was used effectively to review practice. It identified deficiencies and helped the midwifery team to generate solutions, which resulted in improved outcomes for women.

MedNav – helping midwives manage neonatal resuscitation in resource poor settings

We set out to understand whether MedNav, a digital decision support tool, improves the quality of neonatal resuscitation practice in resource poor settings. A 6-month long trial in Uganda showed that adherence to good practice increased from a mean of 46% without MedNav to 94% with MedNav. The mean system usability score was self-assessed at 84.5%. While the younger midwifery team liked MedNav, it was unpopular with senior members of staff who felt that staff should not rely on support tools even if they improved -clinical practice. Next steps include a larger scale study -looking at neonatal survival outcomes and greater attention to the -barriers that need to be overcome in order to enhance -acceptance and adoption.

Evaluation of a bespoke training to increase uptake by midwifery teams of NICE Guidance for membrane sweeping to reduce induction of labour: a stepped wedge cluster randomised design

BackgroundNational guidance recommends pregnant women are offered membrane sweeping at term to reduce induction of labour. Local audit suggested this was not being undertaken routinely across two maternity units in the West Midlands, UK between March and November 2012.MethodsBespoke training session for midwifery teams (nine community and one antenatal clinic) was developed to address identified barriers to encourage offer of membrane sweeping, together with an information leaflet for women and appointment of a champion within each team.The timing of training session on membrane sweeping to ten midwifery teams was randomly allocated using a stepped wedge cluster randomised design. All women who gave birth in the Trusts after 39 + 3/40 weeks gestation within the study time period were eligible. Relevant anonymised data were extracted from maternity notes for three months before and after training. Data were analysed using a generalised linear mixed model, allowing for clustering and adjusting for temporal effects.Primary outcomes were number of women offered and accepting membrane sweeping and average number of sweeps per woman. Sub-group comparisons were undertaken for adherence to Trust guidance and potential influence of pre-specified maternal characteristics. Data included whether sweeping was offered but declined and no record of membrane sweeping.ResultsTraining was given to all teams as planned. Analyses included data from 2787 of the 2864 (97%) eligible low-risk women over 39 + 4 weeks pregnant. Characteristics of the women were similar before and after training. No evidence of difference in proportion of women being offered and accepting membrane sweeping (44.4% before training versus 46.8% after training (adjusted relative risk [aRR] = 0.90, 95% confidence interval [CI] = 0.71–1.13), nor in average number of sweeps per woman (0.603 versus 0.627, aRR = 0.83, 95% CI = 0.67–1.01). No differences in any secondary outcomes nor influence of maternal characteristics were demonstrated. The midwives evaluated training positively.ConclusionsThis stepped wedge cluster trial enabled randomised evaluation within a natural roll-out and demonstrates the importance of robust evaluation in circumstances in which it is rarely undertaken. While the midwives evaluated the training positively, it did not appear to change practice.Trials registrationISRCTN14300475. Registered on 23 August 2016.

Infiuence of midwives' perceived professional benefit on their occupational commitment

Objective To investigate the current situation of midwives' perceived professional benefit and occupational commitment and to analyze the influence of perceived professional benefit on occupational commitment in midwives, so as to provide reference for the construction and stablization of midwifery team. Methods Totally 285 midwives were investigated using the nurses' perceived professional benefit questionnaire and occupational commitment scale, with the results analyzed by t-test, analysis of variance (ANOVA) , Pearson correlation, and hierarchical regression analysis. Results The mean score of the perceived professional benefit and the occupational commitment for midwives were (4.20±0.49) and (3.30±0.63) , respectively. Midwives' perceived professional benefit was positively correlated with occupational commitment (P<0.01) . After controlling demographic variables, the overall status of perceived professional benefit could explain 33.8% of the variances for midwives' occupational commitment. Conclusions It is suggested to play close attention to midwives' perceived professional benefit and take effective measures to improve occupational commitment so as to stabilize the midwives team. Key words: Nurse midwives; Perceived professional benefit; Occupational commitment; Infiuencing factor

Comprehensive maternity support and shared care in Switzerland: Comparison of levels of satisfaction.

According to the woman-centred care model, continuous care by a midwife has a positive impact on satisfaction. Comprehensive support is a model of team midwifery care implemented in the large Geneva University Hospitals in Switzerland, which has organised shared care according to the biomedical model of practice. This model of care insures a follow up by a specific group of midwives, during perinatal period. The goal of this study was to evaluate the satisfaction and outcomes of the obstetric and neonatal care of women who received comprehensive support during pregnancy, childbirth and the postpartum period, and compare them to women who received shared care. This was a prospective comparative study between two models of care in low risk pregnant women. The satisfaction and outcomes of care were evaluated using the French version of the Women's Experiences Maternity Care Scale, two months after giving birth. In total, 186 women in the comprehensive support group and 164 in the control group returned the questionnaire. After adjustment, the responses of those in the comprehensive support programme were strongly associated with optimal satisfaction, and they had a significantly lower epidural rate. No differences were observed between the two groups in the mode of delivery. The satisfaction relative to this support programme was associated with a birth plan for intrapartum and postnatal care. Team midwifery had a positive impact on satisfaction, with no adverse effects on the obstetric and neonatal outcomes, when compared to shared care.

A better start for Bradford?

Bradford was one of five areas across the UK successful in a bid for funding from the Big Lottery Fund's A Better Start initiative. The £49 million funding that Bradford won is being used to further develop 22 projects to improve the social and emotional development, communication and language development, and health and nutrition of children aged 0–3 years. One of these projects is a 3-year pilot of a personalised midwifery care team. Using a ‘buddy’ system, the midwifery team aims for the named midwife or buddy to provide 90% of all antenatal and postnatal midwifery care. Each midwife has a maximum caseload of 60 women and is, therefore, able to offer an enhanced care package, individualised to each woman's needs. The pilot began in October 2015 and the learning from this model of care is being fed into the local discussions about the National Maternity Review.

Management of systemic lupus erythematosus during pregnancy: challenges and solutions.

Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease predominantly affecting women, particularly those of childbearing age. SLE provides challenges in the prepregnancy, antenatal, intrapartum, and postpartum periods for these women, and for the medical, obstetric, and midwifery teams who provide their care. As with many medical conditions in pregnancy, the best maternal and fetal–neonatal outcomes are obtained with a planned pregnancy and a cohesive multidisciplinary approach. Effective prepregnancy risk assessment and counseling includes exploration of factors for poor pregnancy outcome, discussion of risks, and appropriate planning for pregnancy, with consideration of discussion of relative contraindications to pregnancy. In pregnancy, early referral for hospital-coordinated care, involvement of obstetricians and rheumatologists (and other specialists as required), an individual management plan, regular reviews, and early recognition of flares and complications are all important. Women are at risk of lupus flares, worsening renal impairment, onset of or worsening hypertension, preeclampsia, and/or venous thromboembolism, and miscarriage, intrauterine growth restriction, preterm delivery, and/or neonatal lupus syndrome (congenital heart block or neonatal lupus erythematosus). A cesarean section may be required in certain obstetric contexts (such as urgent preterm delivery for maternal and/or fetal well-being), but vaginal birth should be the aim for the majority of women. Postnatally, an ongoing individual management plan remains important, with neonatal management where necessary and rheumatology followup. This article explores the challenges at each stage of pregnancy, discusses the effect of SLE on pregnancy and vice versa, and reviews antirheumatic medications with the latest guidance about their use and safety in pregnancy. Such information is required to effectively and safely manage each stage of pregnancy in women with SLE.

Problems and prospect existing in the development of midwifery in China

Midwifery plays an important role in guaranteeing the maternal and newborn health. This paper elaborated the developing history of midwifery in our country and the developing status home and abroad. This paper also pointed out the problems existing in the development of midwifery in our country such as the shortage of midwivies, functional shrinkage, technology degeneration and imperfect education system, etc. We should promote the construction and development of midwifery in our country through building higher education system, forming a larger midwifery team, and promoting the midwifery legislation. Key words: Review; Midwifery; Problems; Prospect

Umbilical Cord Management and Stump Care in Normal Childbirth in Slovenian and Croatian Maternity Hospitals.

The aim was to investigate first-care procedures for the newborn's umbilical cord at maternity hospitals in Slovenia and Croatia. The study was based on an empirical survey research approach and quantitative research paradigms and included all Slovenian (n=14) and all Croatian (n=35) maternity hospitals. Leaders of midwifery team of 14 Slovenian and 35 Croatian labor wards were invited to participate. The study was conducted in 2013, with 67% of Slovenian and 66% of Croatian maternity hospitals having responded. A causal and non-experimental method of empirical research was used. The research instrument was a questionnaire. Descriptive statistics was used on data analysis. The independence hypothesis was tested with the χ2-test or Kullback 2Î-test. A vast ma-jority of study wards employed delayed umbilical cord clamping, i.e. clamping the cord after pulsa-tion had ceased. Only 10% of Slovenian in comparison with 36.4% of Croatian maternity hospitals practiced dry cord care. Others applied disinfectant on the cord, in Slovenia most frequently 6% po-tassium permanganate, and in Croatia a combination of octenidine and phenoxyethanol. Most Croa-tian -maternity wards (95.7%) still covered the stump, while it was not regular practice in Slovenia. The authors estimate that the prevailing Slovenian and Croatian practices in regard to cord clamping are in accordance with the evidence, while improvements could be made regarding stump care, since dry cord care is the recommended method.

Applying Lean Six Sigma methodology to reduce cesarean section rate.

This study aims to reduce cesarean section rate and increase rate of vaginal delivery. By using Lean Six Sigma (LSS) methodology, the cesarean section rate was investigated and analyzed through a 5-phase roadmap consisting of Define, Measure, Analyze, Improve, and Control. The principal causes of cesarean section were identified, improvement measures were implemented, and the rate of cesarean section before and after intervention was compared. After patients with a valid medical reason for cesarean were excluded, the main causes of cesarean section were maternal request, labor pain, parturient women assessment, and labor observation. A series of measures was implemented, including an improved parturient women assessment system, strengthened pregnancy nutrition guidance, implementation of painless labor techniques, enhanced midwifery team building, and promotion of childbirth-assist skills. Ten months after introduction of the improvement measures, the cesarean section rate decreased from 41.83% to 32.00%, and the Six Sigma score (ie, Z value) increased from 1.706 to 1.967 (P<.001). LSS is an effective way to reduce the rate of cesarean section.

Experiences of student midwives learning and working abroad in Europe: The value of an Erasmus undergraduate midwifery education programme

Backgrounduniversities in the United Kingdom are being challenged to modify policies and curricula that reflect the changing global reality through internationalisation. An aspect of internationalisation is study abroad which the European Commission Erasmus exchange programme is just one means of addressing this. Objectiveto explore the experiences of student midwives who are engaged in the Erasmus exchange programme and the effect it has on their learning and working in an international context. Designapproval for the small phenomenological cohort study was obtained from two participating universities: the University of Malta and University of Nottingham. Data were collected from 13 student midwives from a total of five cohorts in the form of diaries to explore their experiences of learning and working in another country. Thematic analysis supported by Computer-Assisted Qualitative Data Analysis Software was used to identify five recurrent themes emerging from the data: the findings of which have served further in developing this programme. Findingsstudents valued the opportunity of undertaking study and midwifery practice in another culture and healthcare system, extending their knowledge and development of clinical competence and confidence. For some, this was the first time outside of their home country and adaptation to a new environment took time. Support from their contemporaries, lecturers and midwife mentors however, was overwhelmingly positive, enabling the students to feel ‘part of the local university / midwifery team’ By the end of the programme, the students recognised that they had become more independent and felt empowered to facilitate developments in practice when they returned home. Implications for Education / Practicethis innovative development embracing internationalisation within the curricula has the potential to increase students’ employability and further study within Europe and beyond. It can be used as a vehicle to share best practice within an international context, ultimately making a difference to the quality of care childbearing women, their babies and families experience worldwide.

Clinical handover practices in maternity services in Ireland: A qualitative descriptive study

Objectivethe objective was to examine and describe clinical handover practices in Irish maternity services. Designthe study design incorporated interviews and focus group discussions with a purposive sample of healthcare practitioners working in Irish maternity services. Settingfive maternity hospitals and fourteen co-located maternity units. Participantsmidwives, obstetricians and other healthcare professionals, specifically physiotherapists and radiologists, midwifery students and health care assistants working in maternity services. Findingsthe study participants provided nuanced and differentiated accounts of clinical handover practices, which indicated a general absence of formal policy and training on clinical handover and the practice of midwifery and medical teams holding separate clinical handovers based on their separate, respective needs for transferring information and clinical responsibility. Participants spoke of barriers to effective clinical handover, including unsuitable environments, lack of dedicated time and fatigue during duty shift clinical handover, lack of supportive information technology (IT) infrastructure, and resistance of some staff to the adoption of new technologies to support clinical handover. Key conclusionswhether internal and external to clinical handover events, the barriers to effective clinical handover represent threats to patient safety and quality of care, since effective clinical handover is essential to the provision of safe quality care. Implications for practiceclear and effective communication between collaborating professionals within maternity teams is essential.

Readiness for practice change: Evaluation of a tool for the Australian midwifery context.

Midwifery is a research-informed profession with a mandated requirement to utilise latest best evidence. It is now recognised, however, that the introduction of new evidence into practice is complicated and uncertain. Growing awareness of this fact has led to the establishment of a new discipline, Implementation Science (IS), which is focused on developing ways to expedite the timely movement of evidence into practice. To date though, the wider midwifery profession has yet to make use of IS change-facilitation tools and methods. The aim of this study was to determine the fitness for use in midwifery of one established IS tool: the UK NHS Spread & Adoption tool, which is designed to enable clinicians to assess their organisational context for change readiness. A qualitative descriptive methodology was used for this study, which was set in two Australian states. Focus groups were used to collect data. The sample comprised ten Australian change-leader midwifery teams who had led evidence-based practice change initiatives in the previous 12 months. Three themes emerged from the data which together convey that although poor internet access was problematic for some, and some of the language was found to be inappropriate, the tool was ultimately viewed as very useful for helping the implementation of practice change in midwifery settings. This study provides valuable information about the broad suitability of the tested tool for Australian midwifery settings. Further research is required to evaluate a revised version.

Post-Traumatic Stress Disorder after childbirth and the influence of maternity team care during labour and birth: A cohort study

Objectivewe examined the prevalence of Post-Traumatic Stress Disorder (PTSD) and the role of personal and obstetric risk factors, as well as the role of midwifery team care factors in a cohort of Flemish women. Designprospective cohort study. Data collection was performed at two times post partum: During the first week, socio-demographic and obstetric data as well as information related to midwifery team care factors were assessed using self-report measures. To asses PTSD symptomatology, the Impact of Event Scale-Revised (IES-R) and the Traumatic Event Scale (TES) were used. At six weeks post partum, PTSD symptoms were reassessed either by telephone interviews or e-mail. Results were calculated in frequencies, means and standard deviations. Differences between week one and six were analysed using parametrical and non-parametrical statistics. Multiple and logistic regression was performed to determine risk factors for PTSD symptomatology. P-value was set at 0.05. Settingmaternity wards in Flanders, Belgium. Participantsthe first (week 1) and follow-up (week 6) sample of the data collection consisted of 340 and 229 women respectively. Resultsthe prevalence of PTSD symptoms after childbirth ranged from 22% to 24% in the first week and from 13% to 20% at six weeks follow-up. Multiple regression analysis showed that Islamic belief, a traumatic childbirth experience, family income <€2500, a history of psychological or psychiatric consults and labour/birth with complications significantly predicted PTSD symptomatology at six weeks post-birth. Midwifery team care and the opportunity to ask questions, as well as experiencing a normal physiological birth were significantly associated with less postnatal PTSD symptoms. Key conclusions and implications for practisethe results of this study suggest that contextual factors such as religion, socio-economic status, and childbirth experience might be important factors to address by the midwifery team. Midwifery team care factors such as ‘providing the opportunity to the mother to ask questions’ and the ‘perception of the midwife being in control’ proved to be potential protective factors for postnatal PTSD symptoms. Despite its prevalence, PTSD symptoms after birth are not yet well understood by health care workers. Further research concerning the influence of midwifery team care factors on developing childbirth related PTSD is required.

A realist evaluation of an antenatal programme to change drinking behaviour of pregnant women

Objectiveto use realist evaluation to describe and explain how and in what circumstances screening and alcohol brief interventions work in routine antenatal care. Designa realist evaluation incorporating systematic reviews and qualitative data. SettingNHS Lothian, which is one of the 14 Scottish health boards. Participantsparticipants were recruited from two maternity units. In phase one, interviews were conducted with four participants responsible for policy implementation. These data were supported by two systematic reviews. In phase two, 17 pregnant women and 15 midwives participated in interviews, with a further six midwifery team leaders involved in a focus group. Findingstraining and resources provided to midwives as part of the programme acted as facilitating mechanisms that improved their skills and confidence to screen and deliver alcohol brief interventions. The programme elicited positive change in attitudes to drinking in pregnancy and possibly stimulated drinking behaviour change amongst pregnant women. However, the small numbers of pregnant women being identified for alcohol brief interventions meant delivery was infrequent and resulted in the programme not working as anticipated. The findings also revealed contextual issues around midwife–pregnant woman relationship and the challenges of negotiating the timing of screening and alcohol brief interventions delivery. ConclusionsDrinking in pregnancy is an emotive issue, therefore delivering alcohol brief interventions at the first antenatal appointment when they are more likely to achieve the most benefits poses challenges. When training midwives to screen and deliver alcohol brief interventions, special attention is needed to improve person-centred communication skills to overcome barriers associated with discussing sensitive prenatal alcohol use and enhance early identification and delivery of alcohol brief interventions at the first antenatal appointment.

G583(P) Improving interdisciplinary communication on a postnatal ward

Context Our hospital serves a surrounding population of over two hundred and fifty thousand people and caters to about three thousand deliveries a year. There is one postnatal ward with nineteen beds for mothers and their babies. It is usually staffed by three midwives, two healthcare assistants and one paediatric SHO during working hours. Problem Communication between the obstetric, midwifery and paediatric staff regarding any babies on the postnatal ward was casual and ad hoc with no set verbal or written handover between daytime and out of hours staff. This appeared to lead to delays in treatment of certain babies, for instance antibiotic administration, screening for sepsis and serum bilirubin measurements. Assessment of problem and analysis of its causes A multidisciplinary survey of those involved in obstetric and neonatal care was undertaken to identify the cause of these problems and to garner suggestions for improvement. Intervention A more formalised handover system was developed. Information was passed between the daytime paediatric SHO to the on call team using a printed handover sheet passed from the daytime paediatric SHO to the on call team. The sheet contains a list of babies needing specific paediatric input and includes aide memoires of NICE guidelines concerning early onset neonatal sepsis and neonatal jaundice. At change of shifts patients are discussed with the written sheet as a reminder. Study design This study was carried out as a clinical practice improvement project. Strategy for change The printed handover sheet was introduced on a Monday morning for a trial of four weeks. It was used at each morning, early evening and night-time handover. Its introduction followed discussion with the paediatric medical staff and the midwifery team via the ward sister. Measurement of improvement The staff of both departments were surveyed a month later to feed back any changes brought about through the new handover system. The results were very encouraging with 100% respondents reporting an improvement in communication of postnatal duties. Effects of changes There was a improvement in both the speed at which babies were reviewed and management plans instigated. The number of bleeps to the postnatal SHO decreased. No problems were encountered throughout the period of quality improvement. The midwifery staff are now considering introducing a similar system for their daily handover. Lessons learnt Importance of asking for feedback from all staff involved on the ward to obtain opinions on the need for change was the best way to do this. It has ensured any improvement introduced has been user friendly and staff are enthusiastic with regards to the change. If the authors were to repeat this quality improvement project, it would be useful to assess the implication of poor handover on infant care. For example missed/ late blood samples or delayed discharge. Message for others The message conveyed by this project is that every ward should have an effective handover and that with using simple measures dramatic differences can be made. This project identified a lack of effective handover on a postnatal ward which led to delayed or missed patient care. Using a handover tool designed following staff feedback, handover between staff members improved significantly and this positively impacted on patient care. Effective handover helps ensure patients receive appropriate and timely care. Potentially serious results are not forgotten about or missed when staff finish duty. It is essential as clinicians to ensure patients receive the best care and effective handover is an integral part of this.