Nursing Handover Research Articles

Skills for safe practice - A qualitative study to evaluate the use of simulation in safeguarding children teaching for pre-registration children's nurses.

Safeguarding children teaching is a required component in all pre-registration nursing curricula. A structured approach to this teaching as part of preparation for registration as a children's nurse was developed jointly by the Course Leader and the Designated Nurse for Safeguarding Children. This approach aims to equip children's nurses with the necessary theoretical knowledge and practical skills needed for safe practice. A key element in this curriculum is simulation, where students must assess injuries on manikins, select and complete appropriate documentation, and perform a nursing handover. Simulation has recognised value in nurse education but its use in safeguarding children teaching for student children's nurses has not previously been widely reported. This small-scale qualitative study explored the student experience and the impact of simulation teaching in the development of relevant knowledge and the core safeguarding skill set of observation, interpretation, documentation and communication. The methodology for this small, qualitative study was triangulated, comprising observation of the simulation teaching and two sets of semi-structured interviews. The resultant data was investigated using thematic analysis. The outcome of the study suggested that students were able to transfer learning from the simulation into clinical practice, and that simulation as an approach to safeguarding children teaching resonated with the students' preferred learning style and merits further consideration and evaluation.

The factors to be considered when evaluating bedside handover.

This paper sought to identify the factors that should be considered in the study of bedside handover at the change of nursing shift. The introduction of bedside handover at the change of nursing shift has been linked to increased patient safety; bedside handover is not a simple change of location but a fundamental change in nursing practice. An integrative review of the literature was performed, to identify factors that should be considered when exploring and describing the process and content of nursing handover when performed at the patient bedside. Nursing handover conducted at the patient's bedside is different to other forms of clinical handover in that the patient is part of the process. A dedicated tool is required to comprehensively study and understand the complexities of the bedside handover at the change of nursing shift. The factors identified in this literature review should be used to develop a tool to study the phenomenon that is nursing bedside handover. Handover at the change of nursing shift is a high risk, high volume nursing practice, therefore the introduction of bedside handover should be systematically studied.

Nurse Handover and Its Implication on Nursing Care in the University of Calabar Teaching Hospital, Calabar, Nigeria

Nurse Handover and Its Implication on Nursing Care in the University of Calabar Teaching Hospital, Calabar, Nigeria

The application and effects of mind map in nursing handover

Objective To evaluate the application and effects of mind map in nursing handover. Methods Two wards which had similar scale, environment, property and level of nursing were randomly chosen as the experimental group and the control group by tossing a coin in Tianjin Hospital of ITCWM Nankai Hospital, 28 nurses were selected in each group, according to the inclusion and exclusion criteria, control group takes routine handover, the experimental group takes handover by following the guidance of mind map. The mind map of clear mind were designned. The Chinese version of Handover Evaluation Scale was used to evaluate the effects of mind map in the nursing handover, the inpatients’ satisfaction was compared between the experimental group and the control group after the application of min-d map. Results After3-month intervention, results showed that the score of handover evaluation scale in the experimental group were (31.39±1.34) points, (19.57±1.23) points, (17.61±1.29) points, (68.57±2.49) point, the score of handover evaluation scale in the control group were (26.71±1.24) points,(18.71±1.33) points,(16.68±1.33) points, (62.11±2.94) points, the difference was statistically significant(t=2.504-13.530, P<0.05); in the experimental group, the score of handover evaluation scale increased significantly than that before intervention, and the difference was statistically significant (t=-17.450--5.663, P<0.05); the inpatients′ satisfaction in the experimental group was 98.89%(89/90), the control group was 90%(81/90) after intervention, and the difference was statistically significant(χ2=6.776, P<0.05); in the experimental group, the inpatients′ satisfaction was better than that before intervention, and the difference was statistically significant (χ2=4.211, P<0.05). Conclusion: The application of mind map in the n-ursing handover can improve the level of nursing handover and the quality of nursing care, contributing to dveloping high quality of nursing service. Key words: Mind map; Nursing handover; Effect analysis

Exploring Socio-Technical Insights for Safe Nursing Handover.

Current efforts to improve nursing handover frequently use prescriptive approaches based on research evidence of handover issues within a single nursing ward or nursing specialty. Despite reported handover improvement, few studies adequately consider the transferability of results to other nursing handover environments or acknowledge the unique attributes that supported sustained improvement. With the increasing diffusion of electronic tools it has become even more critical to ensure that socio-technical issues that may impact on the quality and safety of nursing handovers are identified. This paper describes a qualitative research project that examined nursing handover in three different wards - General Medicine, General Surgery and Department of Emergency Medicine in a tertiary teaching hospital. Through conduct of a detailed analysis of nursing handover processes, this paper highlights the similarities and differences in the handover among the three different wards and presents five key socio-technical insights to support safe nursing handover.

A tailored intervention to improving the quality of intrahospital nursing handover

IntroductionNursing handover is a process central to the delivery of high-quality and safe care. We aimed to improve the quality of nursing handover from the emergency department to ward and intensive care unit (ICU). MethodsA quasi-experimental non-equivalent control group pre-test — post-test design was applied. Handover quality was measured using the Handover Evaluation Scale (HES). A tailored intervention, inspired by appreciative inquiry, was designed to improve the implementation of an existing handover form and procedure. ResultsIn total 130 nurses participated, 66 before and 64 after the intervention. Initial structure of the HES showed no good fit to our data; the questions were reshaped into 3 dimensions: Quality of information, Interaction and support, and Relevance of information. Following the intervention, mean changes in HES factor scores ranged from −3.99 to +15.9. No significant difference in factor scoring by ward and ICU nurses was found. Emergency department nurses, however, perceived Interaction and support to be improved following the intervention. ConclusionThe intervention did not result in an improved perception of handover quality by ward and ICU nurses. There was improvement in the perception of Interaction and support among emergency department nurses. The intervention positively effected teamwork and mutual understanding concerning nursing handover practice amongst emergency nurses. In order to improve intrahospital nursing handover, hospital-wide interventions are suggested. These interventions should be aimed at creating a generative story, improving mutual understanding, and establishing a supportive attitude regarding standardised procedures to reduce human error.

Developing a guideline for structured content and process in mental health nursing handover.

The process of handover has received recent attention within Australian health care, as evidence linking patient safety with the quality of handover emerges. Such links between clinical handover and patient safety have been reported elsewhere in the literature, where it is posited that the safe care of patients relies not only on the expertise and judgment of individual clinicians, teamwork, and effective management, but hinges to a large extent on the quality of information transferred from team to team. The present qualitative, descriptive study used participant observations, focus groups, and interviews to investigate the nursing handover in two acute mental health inpatient units in New South Wales, Australia. Data collected as part of that investigation contributed to the development of a handover guideline that incorporates the key components of structure, content, and leadership. The research indicated a link between these components, and further revealed the necessity to have other forums, such as supervision and clinical review, to ensure that handover serves its intended purpose in an efficient manner.

Clinical Handover at the bedside

Background: Clinical nursing shift handover is a process whereby the patient's care and treatment plan is being passed over by the preceding nurse to the on-coming nurse in a structured and standardized way. In March 2014, Joanna Briggs Institute's recommended evidence on clinical handover and ‘ISHAPED’ were implemented in a medical ward, and all the nurses used the ‘ISHAPED’ acronym to hand over patients’ care and treatment plan. The acronym, ‘ISHAPED’ stands for “Introduction, Story, History, Assessment, Plan of care, Error prevention and Dialogue”. However, a sustaining audit showed that the handover process was not consistently practiced. Thus, this project is the follow-up phase conducted to monitor and sustain the implemented practice. Objective: The follow-up phase aims to achieve 80% compliance rate of RNs on a general medical ward to ISHAPED handover process. It also aims for the handover process to take place at the patients’ bedside and update patients about the plan of care by involving them during shift handover. Methods: This follow-up phase was conducted in three phases after the last post implementation audit. At the first phase, the sustaining audit was conducted at 6 months to monitor the nurses’ compliancy rate to the practice change. The audit criteria were adopted from Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES). The data were gathered from 20 shift handovers on an adult medical ward. Data was analysed and, using JBI Getting Research Into Practice (GRIP) online programme, strategies were designed to close the gaps. One of the strategies was to incorporate the acronym ‘STRIPS’ which stands for surveillance, tubes, referral, intervention, plan, and special note into the Trendcare, an online tracking of patients’ acuity care. The second phase started with sharing of the audit results and implemented the strategy by educating nurses on how to apply the ‘STRIPS’ in addition to the ‘ISHAPED’ structure during handover. Another audit was conducted 4 weeks post implementation and data were analysed in PACES and disseminated to the nurses. Results: The sustaining audit after 6 months of the new practice, found that nurses were inconsistent to perform handover report at patient's bedside and patient was not involved in the plan of care. The results of the post implementation follow-up project showed that the compliance rate had improved for three criteria: an improvement of 90% compliance rate for verbal communication between nurse and patient during nursing handover; compliance rate for patient identification achieved 100% and 75% for the plan of care. Whereas, the compliance rate for relevant history and detail observations remained 100% and 95% respectively. Discussion/Conclusion: In order to sustain a practice change, monitoring compliant to the process and adhering to the practice has to be continuously carried out. Involving patients in the shift handover process and plan of care ensures the continuity of care and has improved the communication between nurses and patients and also between the nurses.

Best of both worlds: combining evidence with local context to develop a nursing shift handover blueprint.

Standardization of the handover process is deemed necessary to ensure continuity and safety of care. However, local context is considered of equal importance to improve the handover process. Our objective was to determine what recommendations on standardized shift handover nurses make, if we combine evidence from the literature with the local context of the nurses. A RAND-modified Delphi consensus process that combines evidence from systematic reviews with expert opinion of local nurses and an evaluation of the consensus process with a survey. One academic medical center in the Netherlands. Twentynurses from surgical, medical, neurological, psychiatric, cardiology, children's and gynecology departments. Four systematic reviews on nursing handover were included to compose provisional recommendations on how, what, where and the preconditions of shift handover. Nurses reached consensus on a final set of 18 recommendations for a nursing shift handover blueprint: how (1 recommendation), what (12 recommendations), where (3 recommendations) and the preconditions (2 recommendations), which were structured with the mnemonic NURSEPASS. The nurses assessed the method as an effective approach to develop a local blueprint. Evidence-based consensus is a feasible method to combine evidence from the literature with local context. We anticipate that implementation of the resulting tailored blueprint for nursing shift handover will be facilitated due to the method used. Through evaluation of its effectiveness, we intend to add to the body of evidence on development and implementation of effective nursing handover, which is an essential link for continuity and safety of care.

Safe and effective nursing shift handover with NURSEPASS: An interrupted time series

AimImplementation of a locally developed evidence based nursing shift handover blueprint with a bedside-safety-check to determine the effect size on quality of handover. MethodsA mixed methods design with: (1) an interrupted time series analysis to determine the effect on handover quality in six domains; (2) descriptive statistics to analyze the intercepted discrepancies by the bedside-safety-check; (3) evaluation sessions to gather experiences with the new handover process. ResultsWe observed a continued trend of improvement in handover quality and a significant improvement in two domains of handover: organization/efficiency and contents. The bedside-safety-check successfully identified discrepancies on drains, intravenous medications, bandages or general condition and was highly appreciated. ConclusionUse of the nursing shift handover blueprint showed promising results on effectiveness as well as on feasibility and acceptability. However, to enable long term measurement on effectiveness, evaluation with large scale interrupted times series or statistical process control is needed.

Empowering nurses through action research for developing a new nursing handover program in a pediatric ward in Iran

This study aimed at developing a new nursing handover program in pediatric wards in Iran through action research. Nursing handover is the handover of patient information among nurses between shifts. The participants, including 12 nurses, 2 assistants, a head nurse, and academic researchers as facilitators, worked through two cycles of reflection and action for change over a period of 20 months from 2012 to 2014. The data were collected and analyzed using the concurrent mixed method. Reflection on actions in two cycles resulted in designing and implementing action plans for change, learning in both participants and facilitators, and improvement in nurses' satisfaction with the new nursing handover program. Furthermore, the quantitative data showed a significant decrease in time and cost of nursing handover. This study resulted in the participants' deep understanding about the principles of nursing handover in real world, applicable knowledge through action for change, and reflection on it. Finally, the nurses could establish the foundation of sustainable nursing handover successfully.

Nurse handover: patient and staff experiences.

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 the purpose and value of office handover. Bedside handover differed in style, content, and place of delivery, often driven by concerns regarding confidentiality and talking over patients, and there were varied views on the benefits of patient involvement in bedside handover. Nurses worked beyond their shift end to complete handover. Communication problems within the clinical team were identified by staff and patients. while it is important to agree the purpose of handover and develop appropriate structure, content and style, it need not be a uniform process in all clinical areas. Nurse training to deliver bedside handover and patient information on the purpose of handover and the patient's role would be beneficial.

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.

What is the best nursing handover style to ensure continuity of information for hospital patients?

The systematic review informing this Cochrane Nursing e Corner investigated nursing handover for evidence ted to safety, quality and measures of satisfaction eulers et al., 2014). The Institute of Medicine (United tes) released a seminal report in 2001 that included criptions of clinical handover (Committee on Quality of lth Care in America, 2001). Clinical handover incorpos the communication between nursing staff during a ft change about patients and their continuing care. The titute of Medicine described handover as time where in absence of good practice, the risk of miscommunicais high, and that risks to patient safety as well as erse events can be directly attributed to ineffective munication during clinical handover (Committee on lity of Health Care in America, 2001). The Institute of dicine report details that information communicated ut patients and their care should have two features, being both accurate and timely (Committee on Quality of Health Care in America, 2001). Potential adverse events associated with inaccurate or untimely clinical handover have been established. As the authors of this systematic review identify, handover that is erroneous may include increased risk of delays in diagnosis or treatment, inappropriate treatment or omission of care (Smeulers et al., 2014). Further more, handover that is not timely may increase the risk of duplication, redundant communication, lower satisfaction ratings for staff and patients, and at the organisational level may also lead to prolonged hospitalisation, with associated increases in costs. These findings (from individual studies) indicate how significant a process clinical handover is, not only for patient care, but also for organisational outcomes. While the literature indicates handover is a critical aspect of patient care and quality, studies also indicate that handover is often characterised by a lack of consistency in method, are time consuming and variable in terms of what is communicated. Handover while a critical aspect of continuity of patient care is characterised by a general lack of formalised training, therefore nurses learn and adapt according to current practices and cultural expectations, rather than develop evidence-based skills and knowledge. This systematic review was conducted to address the knowledge gap on effective strategies for clinical handover to reduce risks and improve the effectiveness and quality of communication.

Medication communication during handover interactions in specialty practice settings.

To investigate what and how medication information is communicated during handover interactions in specialty hospital settings. Effective communication about patients' medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care. An exploratory qualitative design and observational study. Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed. Over 130hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients' medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover. Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings. For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered.

Nursing clinical handover in neonatal care.

Clinical handover ensures continuity of care, providing the opportunity to transfer responsibility and accountability for the care of a patient from nurse to nurse. The aim of this study was to examine afternoon nursing clinical handover from the perspective of nurses, exploring the quality of information, the interactions and support, the efficiency and the involvement of parents in a private neonatal unit. An exploratory, descriptive, prospective quantitative survey with qualitative elements was undertaken using The Handover Evaluation Scale (O'Connell, MacDonald, & Kelly, 2008). All nurses working in the Neonatal unit who attend afternoon handover, were invited to participate in the study (N = 22), with N = 16 responses received. The quantitative and qualitative results indicate that the quality of the information handed over in neonatal care units can be maintained despite intrinsic limitations. Additionally, high levels of support and interaction between nursing staff in this stressful practice environment occur during the handover period. Given the vulnerability of neonates it is important that accurate information is efficiently handed over. In order to do this distractions should be minimised. Finally, parental involvement in handover should be actively encouraged whenever feasible.

Nursing clinical handover in neonatal care

Background: Clinical handover ensures continuity of care, providing the opportunity to transfer responsibility and accountability for the care of a patient from nurse to nurse. Aim: The aim of this study was to examine afternoon nursing clinical handover from the perspective of nurses, exploring the quality of information, the interactions and support, the efficiency and the involvement of parents in a private neonatal unit. Methods/Design: An exploratory, descriptive, prospective quantitative survey with qualitative elements was undertaken using The Handover Evaluation Scale (O’Connell, MacDonald, & Kelly, 2008). All nurses working in the Neonatal unit who attend afternoon handover, were invited to participate in the study (N = 22), with N = 16 responses received. Results/Findings: The quantitative and qualitative results indicate that the quality of the information handed over in neonatal care units can be maintained despite intrinsic limitations. Additionally, high levels of support and interaction between nursing staff in this stressful practice environment occur during the handover period. Conclusion: Given the vulnerability of neonates it is important that accurate information is efficiently handed over. In order to do this distractions should be minimised. Finally, parental involvement in handover should be actively encouraged whenever feasible.

Patients' participation during a nursing handover: the role of handover characteristics and patients' personal traits.

To describe the quality and scope of patients' participation in the handover process, in relation to their personal attributes (the big-5 model of personality) and the handover encounter's characteristics (presence of the head nurse, escorts, ward overload-namely nurse-patient ratio). The scant research, previously addressing patient participation during a nursing handover, generally indicated that there is stillroom for improvement. A quantitative and qualitative cross-sectional design. During 2012-2013, we collected data on 100 handovers in five surgical wards. Data on factors of the handover encounter were collected through structured observations of the event and data on personality attributes and demographics were assembled through validated questionnaires; we content-analysed transcriptions of the handover's verbal content for typical content, frequency and quality of the communication. Patient participation proved bi-directional, consisting of patient's initiative and nurse's initiative. Whereas patient's initiative improved when the head nurse and escorts were present and the unit was less loaded, nurse's initiative was facilitated by the presence of escorts and less overload. As for personality attributes, whereas patient's imitative improved with patient's high neuroticism, high agreeableness and low openness to experience, nurse's initiative decreased with patient's high neuroticism, extraversion and conscientiousness. Findings illustrated the different communication preferences of patients with different personal attributes, as well as the different approaches by nurses to each of these different personalities. Nurses should be taught about communication and ways to engage patients during handover. Patients' education is also warranted including how and when to approach the different caregivers.

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

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. 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. 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. 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. Two review authors independently assessed trial quality and extracted data. 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. 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.

Patients' Views on Bedside Nursing Handover

A study was undertaken to explore patients' experiences and perceptions associated with implementation of bedside nursing handover. Interviews were conducted with patients and analyzed using a directed content analysis. Three themes emerged through which patients described their experience with bedside nursing handover as follows: (1) creating a space for personal connection; (2) "bumping up to speed"; and (3) varying preferences. Health care leaders and nurses can use study findings to tailor strategies to engage patients, taking into account their preferences, in bedside nursing handover.