• Subject Name : Nursing

Nurse Perceptions of Traditional and Bedside Shift

Introduction to Nursing Bedside Clinical Handover

The importance of bed side handovers has been found to be quite crucial as per the defined nursing standards. This method is mainly defined as the shift-to-shift reporting method, which is ideally performed by the nurses to ensure sound communication between the nurses and the patients (Whitty, 2017). The purpose of the method is to focus on collecting sound and verified information in patient’s own words to make sure that a good accountability is maintained for the purpose of ensuring effective clinical handovers. It is also defined as a vital part as per the standards of patient care model, enabling transfer of knowledge through accountable and responsible means (NMBA, 2018). Documenting details in a comprehensive manner also enables a healthcare professional to note for abnormal signs and symptoms in an effective manner. This can be fruitful for enabling care and early intervention for the patient. Noting the details also help in keeping a written track of turns of events, which can be a reliable source of information, in cases of uneventful ethical or legal case scenarios. Clinical handover makes up for a vital part of nursing care as per the nursing standards as well (ACSQHC, 2019). With better communication between the patient and the nurse, a good information can be collecting which will eventually be helpful in enabling care as per the medical specifications of the patients. This will also help in establishing good therapeutic relation with the patient, which can be quite fruitful in enhancing the patient’s healthcare outcomes (Slade, 2018). The essay will help in reviewing the articles fetched from authentic databases. These articles have been streamlined pertaining to the subject matter. The review will be helpful in providing an insight for future interventions and management strategies to be included in the process to enable care to the patients, with an aim of reduced medical errors. Thus, delivering comprehensive patient care, by ensuring patient safety through smooth transition of healthcare services to the patients.

PICO Question ((Kloda, 2020)

Is bed side handover, with the help of hand written notes an effective method of handovers for nurses?

P- Nurse professionals

I- Bedside handover with the help of hand over notes

C- Nil

O- Improved communication amongst nurses from the point of view of safety standards.

Review of Literature

Most of the studies included in the PRISMA flow diagram are widely accepted for this subject. The study carried out by Athanasakis in 2013, was based on shift handover in nursing. The study highlighted the value of string communication during hand over management. This is also vital from the point of view of analysing the concerning issues (Athanasakis, 2013). The study included three main themes for handover process, handover component, change in the type of handover and the process of standardization of handover. The study concluded upon the use of effective communication for ensuring effective handovers. Well-structured handovers can help in promoting patient safety and thus, more positive healthcare outcomes.

Another study helped in highlighting upon the issue of preserving patient’s privacy while managing bedside handovers. The study also aimed at developing a practice that can be professionally as well as culturally oriented, to handle the uprising ethical and legal considerations that might arise from this subject. While managing nursing care the privacy of the patient should always be maintained (Malfait, 2019). The study concluded on advice of ensuring proper methods in place to make sure that no breach of privacy is encountered during the process of bedside handover. The use of proper instructions and guidelines in place can make sure of the same. Study carried out by Jane et.al. helped in analysing the experience of patients and the nursing staff towards the process of clinical handover. The study reflected upon the fact as to how an ineffective communication between the two parties involved, leads to documentation errors. Also, the lack of uniformity in the process of data collection can also lead to medical errors and thus, eventually affecting the patient’s security. The study concluded that communication makes up for an integral part of the process and the same should be practiced with due diligence (Jane, 2016). The study highlighted the importance of ward specific training for enabling profound care to the patients. When the nurses will be groom in specific skills, they will be able to collect more accurate information from documentation (Hada, 2018). Oxelmark conducted a study in 2019, analysing the process of handover variance from one shift to another and its overall implication on patient’s care and safety. It was a comparative study based on patient’s handover to be conducted one at the bed side and another away from the bed side. The study showered light upon the fact that both nurses and the patients preferred that the hand over should be taken away from the bedside (Oxelmark, 2019). There was a disparity observed between the choices of patients and nurses. However, as the handover process considers patients as the primary center of attention, they are deemed as an integral part of the process.

Improving the overall process of handover can be helpful in improving patient safety and this fact can be easily established with the help of multiple studies conducted across various healthcare settings. For enhancing the same four main considerations are to be taken into account. The nurse, the patients, the healthcare environment in which the hand over is being conducted and the nurses abiding by the hospital standards as well. With main focus shifted on the same, there can be an assurance of improved care for the patient (Forde, 2020). The process of clinical handover can alter with the type of clinical setting as well. For instance, the situation in emergency care departments is not as simple as it is in other clinical wards (Fealy, 2018). The nurses are required to be present throughout to ensure that the no vital information is left untraced. The study carried by Asrar in 2018, helped in providing an insight to this situational analysis. The study was carried out in an emergency care department and nurses were found to have missed out on multiple facts that were required to be gathered efficiently (Asrar, 2018). The study reflected on the importance of informed and structural approach specific to the clinical settings to make sure that the clinical handover is noted in a schematic and profound manner (Redley, 2018).

Another study carried out by Mardis in 2016, helped in focusing on the same issue. The study was based on a systemic review of literature of analysing the transfer of handover from one shift to another. Various studies along with this one identified the lack of proper communication, as the main root cause for clinical errors (Mardis, 2016). Carrying out bedside handover in such situations can be deemed as the most effective method improving overall quality of care through one-on-one communication basis with the patients. Nurses might also come across multiple challenges while transferring data during clinical handovers. Study conducted by Raheleh in 2015 helped in highlighting the same through their research. The main aim of the study was to analyse the difficulty during shift rotation in various hospitals. The study revealed the ineffective management skills as the main concern for non-fruitful results attained from clinical handover of the patients. The study also reflected on the role of nurse managers as vital for ensuring managed conduction of nursing handover process in various clinical settings (Slade, 2019).

McCloskey also helped in reflecting upon the importance of involvement of patient and their family in the process of handover, through a study conducted in 2019. This can be helpful in collecting a comprehensive information from the patients, especially in scenarios where the patient might not be in a state of mind to provide for a justified and valid information (McCloskey, 2019). The study showed positive results from the research in terms of patients and their family members being happy to be engaged directly in the process of patient care. The study highlighted the inclusion of such system of information sharing to be a vital part of the system so that a flexible and individualized patient-centred approach can be provided for patient care. Bed side handover can thus, be a valid source and a sound platform for developing the same (Bressan, 2019). It helps in enabling care through the means of acknowledging patient’s opinion in the process (Grimshaw, 2020). Patients are also observed to be welcoming the process of bedside handover as they feel empowered in the process through the means of direct participation (Lu, 2014).

Bed side handovers have a direct implication on nursing care and management (Tobiano, 2017). Few of the barriers that can be identified in this process can be patient related, social factors, political as well as legal and ethical factors. These can hinder with the smooth facilitation of collecting all of the valid clues and information pertaining to the patient. This can be directly reflected as a faulty error conduction while managing nursing care for the patient. Educational promotional activities should be carried out in health care settings to impart education to the nurses to help overcome these hurdles. Highlighting the sensitive information can be fruitful in enabling care through a more schematic and professional approach for the patient. with a direct involvement with the patient the process of clinical handover can be standardized, so that the errors can be reduced marginally and patient care can be provided in an effective manner (Walsh, 2018). Patient safety should be a top healthcare priority and therefore, apt communication strategies should be acknowledged to be implemented in the system to reduce the information gap. This is also crucial from the point of delivering care in sync with the defining principles and ethical considerations of nursing care. Collaborative approach can be helpful in attaining more fruitful results as compared to the individualistic approach for enabling care to the patient (Small, 2017).

Conclusion on Nursing Bedside Clinical Handover

In totality the process of bedside handovers can be very helpful for smooth transition of care for the patients. The process enables care through a direct involvement of the patient in the decision-making process for manging his own care. This can be an effective means in improving overall patient’s safety while delivering them care and thus, directly improving the patient satisfaction post healthcare solutions delivery to them. It can be an engaging process for both nurse and the patient, which lays foundational basis of establishing robust therapeutic relationships between both of them. This can be an effective tool of management for ensuring minimum risk to the patient and thus, evidently reducing the chances of medical errors by a large margin. It can also be an effective means in acknowledging for early clinical signs of warnings in patients and enabling them with solutions, based on early recognition and early intervention. With improved communication between the patient and the healthcare provider, the patient safety can also be marked, along with improved healthcare outcomes. This is also deemed as a vital process from the point of view of promoting team work and improving the patient’s perception for the healthcare services offered to him.

References for Nursing Bedside Clinical Handover

Asrar Alrajhi , Taina Sormunen , Hani Alsubhi (2018). Factors Affecting Bedside Handover between Nurses in Critical Care Area. Journal of Nursing and Health Science, 7(4), 53-64. DOI 10.9790/1959-0704025364

Athanasakis, E. (2013). Synthesizing Knowledge about Nursing Shift Handovers: Overview and Reflections from Evidence-Based Literature. International Journal of Caring Sciences6(3). DOI https://doi.org/10.1111/j.1365-2648.2013.05027.x

Australian Commission on Safety and Quality in Health Care (ACSQHC). (2019). Retrieved from https://www.safetyandquality.gov.au/

Bressan, V., Cadorin, L., Pellegrinet, D., Bulfone, G., Stevanin, S., & Palese, A. (2019). Bedside shift handover implementation quantitative evidence: Findings from a scoping review. Journal of Nursing Management27(4), 815-832. DOI https://doi.org/10.1111/jonm.12746

Bruton, J., Norton, C., Smyth, N., Ward, H., & Day, S. (2016). Nurse handover: patient and staff experiences. British Journal of Nursing25(7), 386-393. DOI https://doi.org/10.12968/bjon.2016.25.7.386

Fealy, G., Donnelly, S., Doyle, G., Brenner, M., Hughes, M., Mylotte, E., ... & Zaki, M. (2019). Clinical handover practices among healthcare practitioners in acute care services: A qualitative study. Journal of Clinical Nursing28(1-2), 80-88. DOI https://doi.org/10.1111/jocn.14643

Forde, M. F., Coffey, A., & Hegarty, J. (2020). Bedside handover at the change of nursing shift: A mixed‐methods study. Journal of Clinical Nursing, 32 (7), 26-34. DOI https://doi.org/10.1111/jocn.15403

Grimshaw, J., Hatch, D., Willard, M., & Abraham, S. (2020). A qualitative study of the change-of-shift report at the patients’ bedside. The Health Care Manager39(2), 66-76. DOI 10.1097/HCM.0000000000000291

Hada, A., Coyer, F., & Jack, L. (2018). Nursing bedside clinical handover: A pilot study testing a ward-based education intervention to improve patient outcomes. Journal of the Australasian Rehabilitation Nurses Association21(1), 9. DOI https://doi.org/10.1111/wvn.12031

Kloda, L. A., Boruff, J. T., & Cavalcante, A. S. (2020). A comparison of patient, intervention, comparison, outcome (PICO) to a new, alternative clinical question framework for search skills, search results, and self-efficacy: a randomized controlled trial. Journal of the Medical Library Association: JMLA108(2), 185. DOI https://dx.doi.org/10.5195%2Fjmla.2020.739

Lu S, Kerr D, McKinlay L. (2014). Bedside nursing handover: Patients’ opinions. International Journal of Nursing Practice, 20, 451–459. DOI 10.1111/ijn.12158

Malfait, S., Van Hecke, A., Van Biesen, W., & Eeckloo, K. (2019). Is privacy a problem during bedside handovers? A practice-oriented discussion paper. Nursing Ethics26(7-8), 2288-2297. DOI https://doi.org/10.1177/0969733018791348

Mardis, T., Mardis, M., Davis, J., Justice, E. M., Holdinsky, S. R., Donnelly, J., ... & Riesenberg, L. A. (2016). Bedside shift-to-shift handoffs: a systematic review of the literature. Journal of Nursing Care Quality31(1), 54-60. DOI 10.1097/NCQ.0000000000000142

McCloskey, R. M., Furlong, K. E., & Hansen, L. (2019). Patient, family and nurse experiences with patient presence during handovers in acute care hospital settings: a systematic review of qualitative evidence. JBI Evidence Synthesis17(5), 754-792. DOI 10.11124/JBISRIR-2017-003737

NMBA standards, 2018. Retrieved from https://www.nurinsgmidwiferyboard.gov.au/

Oxelmark, L., Whitty, J. A., Ulin, K., Chaboyer, W., Gonçalves, A. S. O., & Ringdal, M. (2020). Patients prefer clinical handover at the bedside; nurses do not: evidence from a discrete choice experiment. International Journal of Nursing Studies105, 103-144. DOI https://doi.org/10.1016/j.ijnurstu.2019.103444

Raheleh Sabet Sarvestani, Marzieh Moattari (2015). Challenges of Nursing Handover: A Qualitative Study. Clinical Nursing Research 24 (3). DOI 10.1177/1054773813508134

Redley, B., & Waugh, R. (2018). Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings. Applied Nursing Research40, 80-89. DOI https://doi.org/10.1016/j.apnr.2017.12.013

Slade, D., Murray, K. A., Pun, J. K., & Eggins, S. (2019). Nurses’ perceptions of mandatory bedside clinical handovers: An Australian hospital study. Journal of Nursing Management27(1), 161-171. DOI https://doi.org/10.1111/jonm.12661

Slade, D., Pun, J., Murray, K. A., & Eggins, S. (2018). Benefits of health care communication training for nurses conducting bedside handovers: An Australian hospital case study. The Journal of Continuing Education in Nursing49(7), 329-336. DOI https://doi.org/10.3928/00220124-20180613-09

Small, D. C., & Fitzpatrick, J. J. (2017). Nurse perceptions of traditional and bedside shift report. Nursing Management48(2), 44-49. DOI 10.1097/01.NUMA.0000511921.67645.47

Tobiano, G., Whitty, J. A., Bucknall, T., & Chaboyer, W. (2017). Nurses’ perceived barriers to bedside handover and their implication for clinical practice. Worldviews on Evidence‐Based Nursing14(5), 343-349. DOI https://doi.org/10.1111/wvn.12241

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., ... & Hempel, S. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine169(7), 467-473. DOI https://doi.org/10.7326/M18-0850

Walsh, J., Messmer, P. R., Hetzler, K., O'Brien, D. J., & Winningham, B. A. (2018). Standardizing the bedside report to promote nurse accountability and work effectiveness. The Journal of Continuing Education in Nursing49(10), 460-466. DOI https://doi.org/10.3928/00220124-20180918-06

Whitty, J. A., Spinks, J., Bucknall, T., Tobiano, G., & Chaboyer, W. (2017). Patient and nurse preferences for implementation of bedside handover: do they agree? Findings from a discrete choice experiment. Health Expectations20(4), 742-750. DOI https://doi.org/10.1111/hex.12513

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