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Abstract

Bedside shift reports are viewed as an opportunity to reduce errors and important to ensure communication between nurses and communication. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education. Nurse shift reports and nurse handovers are 2 of the most critical processes in patient care that can support patient safety and reduce medical errors in the United States. Nurses continue to not recognize the evidence supporting this practice and adopt bedside report into practice.
JONA
Volume 44, Number 10, pp 541-545
Copyright B2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
THE JOURNAL OF NURSING ADMINISTRATION
Bedside Shift Reports
What Does the Evidence Say?
Sean Gregory, PhD, MBA, MS
Debra Tan, MPH
Michael Tilrico, BS
Nicholas Edwardson, PhD, MS
Larry Gamm, PhD
Bedside shift reports are viewed as an opportunity to
reduce errors and important to ensure communica-
tion between nurses and communication. Models of
bedside report incorporating the patient into the triad
have been shown to increase patient engagement and
enhance caregiver support and education. Nurse shift
reports and nurse handovers are 2 of the most critical
processes in patient care that can support patient safety
and reduce medical errors in the United States. Nurses
continue to not recognize the evidence supporting this
practice and adopt bedside report into practice.
Two major foci of modern medical care are patient-
centered care and improved quality and safety in pa-
tient care. Central to both of concerns is improved
communication among care professionals and be-
tween this team and the patient. Evidence supports
that breakdowns in communication and occurrences
of medical errors occur during patient handoffs.
1,2
Handoffs of the patient acrosscare settings during an
episode of care are often of concern in this regard,
1
but handoffs of patients from nurse-to-nurse during
shift changes are receiving increased attention, as well.
2
Bedside shift report (BSR) is viewed as an opportunity
to reduce errors
3-12
and ensure improved communica-
tion between nurses.
9,12-14
BSR also has been reported
to support communication with and engagement of
patients and their family caregivers.
4-12
Nurse shift
report and nurse handovers are 2 of the most critical
processes in patient care that can improve patient
safety and reduce medical errors in the United States.
In response to the Joint Commission’s National
Patient Safety Goals,
15
BSR has been supported as im-
proving patient safety, patient-centered care, and nurse
communication as well as reduce medical errors.
15
In
most models,
2
BSR occurs at the patient’s bedside be-
tween incoming and off going nurses. Many models
include interaction with the patient and informal care-
giver as part of the process.
2
According to literature,
moving shift reportto the patient bedside can contrib-
ute to additional benefits including nurse empower-
ment,
16-19
patient-centeredness,
1-3,5-10,14,16,20-24
patient
satisfaction,
1,2,5-7,9,14,16-18,23,24
and increased commu-
nication.
1,4,6,10-14,16,18,22,24-27
This article summarizes a
systematic literature review of BSRs and serves as a
mechanism to relate the support for improving quality
of care,
2
patient safety,
15
and patient-centered care.
2,3
The Evidence About Bedside Report
Methods
A computer-assisted search was conducted in the
MEDLINE, PubMed, and the Ovid interface to Medline
databases to identify relevant published articles. An
additional search was also conducted in Google Scholar
to identify any missing literature. Manual searches of
references from relevant articles were performed to
identify studies that were missed by our computer-
assisted search. The computer-assisted search yielded
310 potentially relevant citations. After the initial
review, 100 titles were deemed potentially appropri-
ate, and these abstracts were reviewed by the team. A
total of 33 studies met all inclusion criteria including
JONA Vol. 44, No. 10 October 2014 541
Author Affiliations: Assistant Professor (Dr Gregory), Graduate
Research Assistant (Ms Tan), Research Assistant (Mr Tilrico), and
Professor (Dr Gamm), Department of Health Policy & Management,
School of Public Health,Health Sciences Center, Texas A&M Uni-
versity, College Station; Assistant Professor (Dr Edwardson), School
of Public Administration, University of New Mexico, Albuquerque;
and Assistant Professor (Dr Gregory), Department of Pediatrics, Col-
lege of Medicine, Health Sciences Center, Texas A&M University
College Station.
The authors declare no conflicts of interest.
Correspondence: Dr Gregory, Health Sciences Center, Texas
A&M University, TAMU 1266, College Station, TX 77843
(gregory@tamhsc.edu).
DOI: 10.1097/NNA.0000000000000115
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
(i) data specific to nurses and (ii) shift reports at the
patient’s bedside. Studies with (i) nonempirical data,
(ii) nonYpeer-reviewed articles, (iii) overlapping cohort
studies, (iv) articles not in the English language, and
(v) published abstracts were excluded. The review of
the 33 articles produced 6 categories of work: (1) team-
based variables, (2) dyadic relationships, (3) individual
benefits, (4) confidentiality concerns, (5) accountabil-
ity, and (6) cost containment. Results are summarized
by category in the Table 1. A brief summary of each
category of findings follows.
Team-Based Variables
Twenty-five studies reporting team-based variables dis-
cussed positive attitudes
1,5,13
and feedback such as
improved patient-centered care,
1-3,5-10,14,16,20-24
family-
centered care,
1,5,13
care coordination,
3,7,20-22
team col-
laboration,
1,4,8,13,18,21,22,28
and engagement
5,6,29,9,10
after implementation of BSR. In 64% of these studies
(n = 16), increased patient care after implementation
of BSRs was noted.
1-3,5-10,14,16,20-24
By including the pa-
tient in the model of report, BSR was additionally shown
to clarify and contribute further significant information
to the care process.
20
Few articles (12%; n = 3) cited
increased family-centered care within team-based vari-
ables.
1,5,13
Models of BSRs provided a sense of ease
because family members were able to listen to informa-
tion communicated between nurses during the process
of transition.
1,5,13
This prompted family members to
participate and become aware of nursing treatments,
interventions, and plans for care that were provided.
28
Enhanced team collaboration was noted in 8 articles
(32%). Nurses reported thattheylikedworkingin
teams because it increased communication and brought
nursing teams together.
21,22
Not only did BSRs con-
tribute to increased teamwork, but also the process
Table 1. Studies Fitting Inclusion Criteria: Summary of Findings
Category Summary of Findings
Team-based variables &Positive attitudes
1,5,13
&Improved patient-centered care
1-3,5-10,14,16,20-24
&Improved family-centered care
1,5,13
&Care coordination
3,7,20-22
&Team collaboration
1,4,8,13,18,21,22,28
&Engagement after implementation of BSR
5,6,9,10,29
Dyadic relationships &Nurse-patient dyadic relationship
)Patients are able to ask questions
3,8,11,17,19,28,30
)Share information regarding medical history
3,16,28
)Participate in the decision-making process
3,6,8,10,17,28
&Nurse-nurse dyadic relationship
)Increased socialization by sharing stories and experiences
21,31
)Emotional support to one another
11,21,31
)Communication
9,12-14
)Mentoring and coaching
4,17,18,21
)Networking opportunities
18,23
Individual benefits &Patient individual benefits
)Patient empowerment by being able to ask questions about their care
2-4,6,14
)Increased patient satisfaction
1-3,5-7,9, 14,16-18,23, 24
)Patients feel safer being able to see two nurses at shift change
3,5,6,16
)Increased patient safety
3-12
)Increased communication with nurses
3,4,6,10,16,18,22,24-26
)Increased understanding of care
4,5,14,22,28
&Nurse individual benefits
)Increased communication skills and accurate information
1,3,11-14,16,26,27
)Nurses’ involvement with care
3-5,13,20,27
)Nurse empowerment
16-19
)Nurses being able to visualize the patient
1,4,6,9,14,18,22
)Nurses leaving shift on time
13,14,21
)Reduction in time spent writing shift reports
2,5,13,14,18,21,23,26,32
)Building rapport with patients
17,31
)Increased nurse satisfaction
1,2,5,9,13,14,16,24,25
Confidentiality concerns &Privacy issues while discussing patient medical history
1-5,7-9,14,16,17,19,21,22,31
&Having to ask visitors to leave the room during BSRs
8,17
Accountability &Lack of confidence on medical knowledge
4,5,16,33
&Burden of having to be in control
2,17
&Higher confidence in thorough, more accurate reporting
6,14
Cost containment &Reduction in overtime accumulated between shift changes
1,7,13,14,18,21,23,32
542 JONA Vol. 44, No. 10 October 2014
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
subsequently improved timeliness and consistency of
information.
13
Five articles (20%) noted improved care
coordination after implementation of BSRs.
3,7,20-22
Because many healthcare provider teams function in
multiplex, dynamic environments, coordination is es-
sential in providing optimum patient care.
20
By bringing
nurses together at the bedside, BSR facilitates increased
care coordination.
20
Dyadic Relationships
Seventeen articles referred to dyadic relationships in the
effectiveness of BSRs, namely, the nature of nurse-nurse
and nurse-patient relationship.
3,4,6,8-14,16-18,21,23,28,31
In
the nurse-nurse dyadic relationship, nurses receive either
increased socialization by sharing stories and experiences
and offer emotional support to one another.
11,21,31
Fur-
thermore, communication, mentoring, and network-
ing opportunities were discussed in the nurse-nurse
relationship dyad.
4,17,18,21
In the nurse-patient relation-
ship, patients are able to ask questions, share infor-
mation regarding medical history, and participate in
the decision-making process.
3,6,8,10,11,16,17,19,28
BSR also improves aspects of nurse-patient dyadic
relationships such as patients being able to ask ques-
tions,
3,8,11,17,19,28,30
share information regarding medi-
cal history,
3,16,28
and participate in the decision-making
process.
3,6,8,10,17,28
Patients reported being pleased
when asked for their input, especially being invited
and encouraged to ask questions.
3,28
Patients stated
that this helped clarify what they wanted to know, as
well as their expectations or misunderstandings.
3,28
Moreover, a model of BSRs encouraged patients to
participate in the decision-making process.
3,28
Of the 17 articles citing dyadic relationships, pos-
itive aspects of nurse-nurse dyadic relationships were
identified, including (1) increased socialization by shar-
ing stories and experiences, (2) providing emotional
support to one another, (3) increased communication,
(4) mentoring and coaching, (5) and networking op-
portunities.
20
Nurses cited overcoming feelings of dis-
comfort during BSRs, as well as the lack of opportunity
to express feelings of stress and exchange thoughts on
patient care.
11,21,31
Moreover, BSRs provided a way
to share stories and experiences to others who under-
stood the same frustrations.
21,31
BSRs presented oppor-
tunities for teaching, mentoring, and coaching.
4,17,18,21
As mentioned earlier, nurses enjoyed working together
in bedside report models because they encouraged and
improved communication between nursing shifts.
14,21,22
BSRs also provided networking opportunities for stu-
dents, clinicians, administrators, and scientists.
23
Individual Benefits
Twenty-nine articles highlighted individual bene-
fits of BSRs for the patient, nurse, and even
physician.
1-4,16-28,31,32
From the patient perspective,
many of these articles focus on the improvement of
care understanding
4,5,14,22,28
and patient empower-
ment
2,4,6,14
by being able to ask questions about their
care. Still other articles report patient benefit from
BSRs through more prompt delivery of care.
3,13
From
the nurse perspective, individual benefits included
empowerment,
16-19
being able to visualize the pa-
tient,
1,4,6,9,14,18,22
building rapport,
17,31
leaving shifts
on time,
13,14,21
reducing time spent writing a shift re-
port,
2,5,13,14,18,21,23,26,32
and improving communica-
tion skills.
1,3,11-14,16,26,27
Of the 29 articles citing individual benefits for
BSRs, there were various subthemes of individual patient
benefits. Five (17.2%) noted patient empowerment by
being able to ask questions,
2-4,6,14
13 (44.8%) indicated
increased patient satisfaction,
1-3,5-7,9,14,16-18,23,24
4 (13.8%) reported the patient feeling safer after seeing
2 nurses change shift,
3,5,6,16
10 (34.5%) noted increased
patient safety,
3-12
10 (34.5%) mentioned increased com-
munication with nurses,
3,4,6,10,16,18,22,24-26
and5(17.2%)
noted an increased understanding of care.
4,5,14,22,28
Patient satisfaction scores significantly improved
after implementation of BSR.
1,4
Longer-term results
also showed significant month-to-month variation, in-
dicating issues with BSR sustainability.
2
Wakefield
and colleagues
2
recommended that continued moni-
toring and periodic reinforcements to support BSRs
should be applied in order to be successful. BSR was
reported as providing patients an opportunity to gain
better understanding of their care plan.
16
Patient safety was improved with regard to BSRs
and led to avoidance of adverse patient events.
14
Nurses were able to visualize the patient and noticed
differences from the initial encounter with the patient
to the time of bedside report.
1,14
Nurses were also able
to assess the environment, including checking the in-
travenous line, site, and chest tube drainage devices
that needed attention.
5,14
Patient falls at shift change
and medication errors were reduced.
6
Patients reported
that they felt safe when experiencing shift reports at
the bedside.
5
Of the 29 articles citing individual benefits for
BSRs, there were also numerous subthemes of individ-
ual nurse benefits. Nine (31%) indicated increased com-
munication and accurate information,
1,3,11-14,16,26,27
6 (20.7%) cited increased nurse involvement with
care,
3-5,13,20,27
4 (13.8%) noted nurse empowerment,
16-19
7 (24.1%) alluded to nurses being able to visualize the
patient,
1,4,6,9,14,18,22
3 (10.3%) indicated that nurses
were able to leave their shift on time,
13,14,21
9(31%)
mentioned a reduction in time spent writing a shift
report,
2,5,13,14,18,21,23,26,32
2 (6.9%) cited building rap-
port with the patient, and lastly
17,31
9 (31%) indicated
increased nurse satisfaction.
1,2,5,9,13,14,16,24,25
JONA Vol. 44, No. 10 October 2014 543
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
After implementing BSRs, average report time
decreased from 45 minutes to 29 minutes.
14
Nurse
satisfaction with the report process increased from
37% to 78%, and white board adherence significantly
improved from 25% to 98%.
14
Reasons for increased
nurse satisfaction are attributed to receiving accurate
handoff without distractions, assessment of the pa-
tient and environment in real time, and avoiding delays
in receiving report and asking questions.
14
BSR has been
associated with staff leaving on time and increased use-
fulness and quality of information on the report.
13
Physicians reported increased satisfaction because they
felt they were ‘‘more informed.’
11(p117)
Furthermore,
BSR was reported to increase staff satisfaction and in-
terpersonal relationships.
1
Anderson and Mangino
1
note that high staff satisfaction could lead to decreased
turnover costs, which could subsequently affect posi-
tive financial outcomes.
1
Confidentiality Concerns
Fifteen articles expressed confidentiality concerns with
reference to BSR.
1-5,7-9,14,16,17,19,21,22,31
Nurses were re-
ported to worry about privacy issues while discussing
patient medical records in semiprivate rooms and hav-
ing to ask visitors to leave the room during BSR.
2,4,5,14
Some staff members had voiced skepticism in being
able to discuss sensitive topics such as infectious diag-
nosis, drug abuse, and psychosocial issues, in front of
and with the patient.
2,4,5,14
Moreover, nurses were
concerned such practices would violate the Health In-
surance Portability and Accountability Act of 1996.
4,14,17
Accountability
Eight articles note pros and cons for accountability
with regard to BSRs. Fear of being accountable for the
patient, lack of confidence on medical knowledge, and
the burden of having to be in control were countered
with the advantages regarding the patient’s ability to
interact with the incoming and outgoing nurses simul-
taneously during the shift change.
2,4-6,14,16,17,33
Nurs-
ing staff voice many concerns regarding their ability
to give BSR.
4
One nurse noted she was worried pa-
tients would ask her questions she could not answer.
4
Nurses were reported to frequently ‘‘apologize for not
knowing enough about the patient or not getting ev-
erything done.’’
18(p394)
Nurses also voiced concern and
anxiety regarding speaking in front of the patient.
33
Cost Containment
Eight articles cited that BSRs are a major contributor to
reducing overtime accumulated between shift changes
and financial savings.
1,7,13,14,18,21,23,32
Evans and col-
leagues
14
found decreased report times when utilizing
BSRs. As a result, nurses spent less time socializing
among themselves, which led to exiting nurses ending
their shift on time, reducing incidental overtime, and
allowing direct patient care to begin sooner for the on-
coming nurse.
14
Decrease in more than 100 hours of
overtime in the 1st 2 pay periods after the implemen-
tation of BSRs was reported in 1 study.
32
Conclusion
Despite strong evidence demonstrating the benefits
of BSRs, issues still remain regarding sustainability of
BSRs after implementation. Few studies report the lon-
gitudinal results of BSRs as inconsistent.
2,5
Researchers
note that after further analysis of postimplementa-
tion data on BSRs, fluctuations in experience ratings
such as ‘‘nurse’s friendliness and courtesy’’ varied month-
to-month.
2
To sustain this practice, many studies
recommend assessing staff attitudes before and after
implementation to identify whether periodic interven-
tions such as ‘‘implementation boosters’’ may be needed
to sustain desired change in practice.
2
The transition
from tape-recorded shift reports or shift reports done
away from the patient in the nursing station or confer-
ence room to the bedside is a complex process, involv-
ing multiple interfaces and system changes. Evidence
in literature suggests standardization of BSR models
to yield greater accuracy, increase patients’ and nurses’
satisfaction, and save nurses time.
29
These results seem
to indicate that a standardized BSRs will increase com-
pliance.
29
Based on this literature, we found little evi-
dence to support the use of specific structure, protocol,
or method for BSR. The evidence is clear that there are
multiple benefits to models of BSR. The challenge for
nurse executives is to identify a model for their orga-
nization and patient populations, ensure consistency
in practice and implementation, set measurable indi-
cators, support the adoption by clinical nurses, and
adjust models as appropriate to attain and sustain the
outcomes. The multitude of evidence should be used
as foundational in developing future studies.
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JONA Vol. 44, No. 10 October 2014 545
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... Clear communication of patients' health history, current care needs and goals of care is essential for safe and effective transitions in care (Australian Commission on Safety and Quality in Healthcare, 2017; Tobiano et al., 2018). In recent years, evidence that patient participation in nursing handover increases patient safety and promotes a positive healthcare experience and has been the catalyst for moving nursing handover from staff areas to the patient bedside (Chaboyer et al., 2009(Chaboyer et al., , 2010Gregory et al., 2014;McMurray et al., 2011;Street et al., 2011). ...
... Patient participation in handover is important for patient-centred care and shared decision-making (Gregory et al., 2014). When patients are better informed and actively involved in their health care, they are less anxious, more likely to follow healthcare advice and have better patient experience (Anderson & Mangino, 2006;McMurray et al., 2011). ...
... Several systematic reviews have detailed nurse-reported barriers for using bedside handovers (Anderson et al., 2015;Gregory et al., 2014;Mardis et al., 2016) and the tension between using standardised handover tools and promoting flexible handovers for patient-centred care (Tobiano et al., 2018). To promote patientcentred care, the role of patients in nursing handover should be explained to patients and methods developed for patients to meaningfully participate in the handover process (Anderson et al., 2015). ...
Article
Aims and objectives: To explore: i) the frequency and nature of patient participation in nursing handover and ii) patients' and nurses' perceived strategies to enhance patient involvement in nursing handover. Background: Patient participation in nursing handover is important for patient-centred care, shared decision-making, patient safety and a positive healthcare experience DESIGN: A multi-site prospective study using a mixed methods design. Methods: Between September and December 2019, nursing handovers were observed on ten randomly selected wards, followed by semi-structured interviews with patients (n = 33), and nurses (n = 20) from the observed handovers. Data were analysed using descriptive statistics for structured observations and thematic analysis of interviews, and triangulated to develop a greater understanding of patient participation in nursing handover. This study is reported using the Good Reporting of Mixed Methods Study guidelines. Results: The median patient age was 77 years and 47% (n = 55) patients were female. Of the 117 handovers, 76.9% (n = 90) were conducted in the patient's presence. Patients were active participants in 33.3% (n = 30) and passive participants in 46.7% (n = 42) of handovers; in 20% of handovers (n = 18), the patient had no input at all. Active participation was more likely in women (vs. men), surgical patients (vs. medical patients) and when nurses displayed engagement behaviours (eye contact, opportunity to ask questions, explanations). Three major themes were identified from the interviews: 'Being Involved', 'Layers of Influence' and 'Information Exchange'. Conclusions: The main finding was that patient participation in handover was low and strongly influenced by a complex interplay of factors including patient and nurse preferences and perceptions. Relevance to clinical practice: Handover is an essential tool in the provision of safe patient care. Patients were able to actively participate in nursing handover when they understood the purpose and timing of handover and had rapport with nurses.
... Next to improved adherence, collaborating with patients can substantially contribute to improved accurate diagnostic work-up, searching for an appropriate treatment, and monitoring and identifying adverse events [1]. To achieve more patient-centred care, the method of interdisciplinary bedside rounding (IBR) is gaining interest in the literature [2,3]. Current studies on IBR describe potential advantages on patient centeredness and involvement [4,5], quality of care [6,7] and team collaboration [8][9][10][11] provided the IBR is conducted in a structured fashion [6,12]. ...
... Moreover, there is a lack of one standardised definition, making it difficult to merge existing evidence [13]. In the absence of consensus regarding terminology, the following definition of IBR was used for this study: (1) a clinical process (2) during which caregivers from different disciplines (3) gather at the patient's bedside to (4) discuss clinical care (5) with the involvement of the patient (and family), meaning that also (6) sufficient time is available to respond to questions that the patient (or family) might have. In order to plan future research strategies and to evaluate the feasibility and effectiveness of IBR, it is important to map current practices and create a clear picture of how physicians' rounds are currently organised. ...
Article
Objectives Interdisciplinary bedside rounds is gaining ground as a method to improve patient centredness and involvement, quality of care and team collaboration. An exploratory study was conducted in Flemish hospitals to (1) map and (2) examine the current form of rounds and the extent to which these were bedside, patient and family participatory and interdisciplinary.Methods In February 2020, a quantitative cross-sectional self-reporting web-based survey was conducted in 23 hospitals in Flanders, 213 head nurses of 213 wards completed the survey. A self-reporting 19-item questionnaire was developed in Lime Survey®. The questionnaire contained a mix of closed-ended questions an open-ended questions. The data were analysed using SPSS 26.0.ResultsMost of the wards in Flanders organise a form of daily rounds at the bedside. In only half of the wards these rounds are organised at a fixed time. The rounds most often include a physician and a nurse. Other disciplines are rarely actively involved. Only a minority of wards uses checklists, structures or protocols to standardise the rounds. The majority of the wards reports that patients (and family) get sufficient time to ask questions and say they are actively stimulated to do so.Conclusion In current practice, most rounds are (partially) bedside, open for patient and family participatory and often include only a physician and a nurse. However, these elements of interdisciplinary rounds are not yet well integrated and vary strongly amongst ward. Most rounds should be considered as an extended form of physician rounds, rather than being interdisciplinary.
... In theory, bedside handover is an expression of a patient-centred approach to care, recognizing a patient's right to participate in their health care. Bedside handovers can facilitate communication between nurses and patients, fostering the nurse-patient relationship and increasing nurse and patient satisfaction (Gregory et al., 2014;Mardis et al., 2016;Tobiano et al., 2018). Including patients in handover helps them stay informed about their condition and care plan, and encourages shared decision-making (McMurray et al., 2011). ...
... In addition to improving communication during handover, our results suggest that training in conducting bedside handover can effectively address nurse attitudes towards this practice that function as a barrier . Consistent with recent research (Anderson et al., 2015;Manias et al., 2015;Tobiano et al., 2018) nurses held particular concerns about maintaining patient confidentiality during bedside handover, despite patients not having a strong preference for how sensitive information is handled The numerous recent reviews on nursing bedside handover are evidence of the multitude of studies investigating different approaches to nursing bedside handover interventions and their impact on patient safety, patient and staff satisfaction and patient participation (Anderson et al., 2015;Bressan et al., 2019;Dorvil, 2018;Gregory et al., 2014;Mardis et al., 2016;Tobiano et al., 2018). ...
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Aims To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient-centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover. Design Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention. Methods Pre-intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital-acquired complication data. Results Notable changes post-intervention included a shift to involve patients in bedside handovers, improved ward-level communication and culture, and an associated decrease in reported hospital-acquired complications. Conclusions Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient-centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success. Impact Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient-centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital-acquired complications. The intervention has been rolled out to a further five wards across two hospitals.
... Therefore, this critical aspect must be competently reported to minimise confusion between nurses and nurse managers and prevent missing patient information (1). While it is plausible that documenting and handing over the report might be arduous, it is fundamental for both nurses and nurse managers to understand its impact on patient safety, patient satisfaction, continuity of care, and other clinical outcomes (9,10). ...
... Enabling consumers to have a greater sense of partnership and collaboration with the nursing team can ensure the continuity of information. The literature mentions the role of the consumer in correcting incorrect information and thereby improving consumer safety (Gregory et al. 2014;Mardis et al. 2016;Ofori-Atta et al. 2015). Olasoji et al. (2019) report a reduced risk of miscommunication and possibly associated adverse events in mental health care. ...
Article
Handovers between nurses are a significant cause of communication problems and possible consumer safety issues. A potential solution for both problems is the nursing handover involving consumers, in which the consumer is present at the time of handover. This practice invites consumers to be more involved in their care process and supports a recovery-oriented practice. Research into nursing handovers involving consumers on inpatient mental health units is however very limited. A qualitative, phenomenological study was conducted. Semi-structured interviews with 13 consumers staying on an inpatient mental health unit of a general hospital were used. The interviews were transcribed verbatim and thematically analysed. Data saturation was reached after 11 interviews when no new themes or codes emerged from the data. Three themes were generated from the interviews: (i) the first moments on the inpatient mental health unit; (ii) the nurse as an ally; and (iii) informing each other. The COREQ-checklist was used. According to consumers, nursing handover involving consumers initiated a change in the relationship between consumers and nurses. Consumers and nurses got to know each other better during handover and built a relationship of trust. The introduction of nursing handover involving consumers created an accessible opportunity for consumers to exchange information with nurses and ask questions concerning their admission. Consumers felt jointly responsible for the continuity of the information about their healthcare process. Due to the use of nursing handover involving consumers, consumers experienced the opportunity to take more control in their health process and ensured that information is correct and complete.
... They benefit nursing profession, patient care and healthcare system, by promoting the efficient communication between nurses, organizing their work, enhancing their professional relationships and team cohesion, improving patient outcomes, maintaining the continuity of care, reducing errors and risks, and ensuring patient safety [1][2][3]. Bedside nursing shift report may offer additional benefits, such as relationship building among nurses, increased satisfaction both to nurses and patients, better communication among nurses and patients, more accurate, quick and precise documentation, prioritization of the care for the shift [4]; moreover, it is one of the most crucial functions for nurses, and a critical process in patient care for reducing errors and improving patient safety [3,5]. ...
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The purpose of this study is to present the design, development and initial evaluation of a smartphone software (mobile app), for the needs of nursing bedside shift reporting and documentation. The app records and process nursing handovers concerning haemodialysis patient data, and it runs on Android smartphones, offering a structured and friendly user interface. Data are collected, processed, stored and accessed easily, quickly and securely by authorized users. The evaluation, based on discussions and semi-structured interviews with a group of nurses, showed positive feedback on the user interface, structure and functions of the prototype. It can be a useful and efficient tool for the reporting and communication needs between nurses. Conclusions about the limitations of the study and future developments are reported.
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Background: A thoroughly standardized nurse bedside shift report, including effective communication, may improve nurses’ satisfaction and patients’ safety. However, a few studies were found that measure the relationships between nurses’ attitudes and satisfaction with bedside shift reports and patient safety outcomes. Purpose: This study aimed to measure nurses’ attitudes and satisfaction with bedside shift reports and their relationships with patient safety culture. Methods: A cross-sectional and descriptive study was conducted between May to August 2021 among 90 bedside nurses conveniently recruited from a public hospital in Lebanon. The Bedside Handover Report Staff Nurses’ Satisfaction Survey and the Survey on Patient Safety (SOPS) were used to collect data. Data were analyzed using descriptive statistics such as mean and standard deviation and inferential statistics, i.e., Pearson correlation coefficient. Results: The results showed that satisfaction scores were high in all the questions in the bedside shift reporting. The participants showed relatively positive attitudes towards bedside shift reports where all the statements recorded above-average mean values. The highest-ranking statement “bedside shift report is completed in a reasonable time” was recorded with a mean value of 3.35 (SD=0.87), while the lowest-ranking statement was “bedside shift report is relatively stress-free” with a mean value of 2.03 (SD=0.86). There were significant relationships between nurses’ satisfaction with shift reports and some patient safety culture composites, such as between nurses’ satisfaction with bedside shift reports and communication about errors and reporting of patient safety events (p
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Introduction:One of the communication models that improves communication between the care team, reduces errors, and increases the quality of care is the SBAR method. The aim of this paper was to determine the effect of using the SBAR model in shift handover on patient and nurse satisfaction. Methods: This quasi-experimental study was conducted in the emergency department of Golestan Hospital in Ahvaz, 2020. According to the statistical formula, 70 shift handover positions (in control and experimental groups) were selected based on inclusion criteria. First, the control group was randomly selected and, after training the SBAR model, the experimental group was randomly selected. Shift handover was performed routinely in the control group, but it was based on the SBAR model in the test group. Data were collected using demographic, nurse, and patient satisfaction questionnaires and a researcher-made shift handover checklist. Data were analyzed by an independent t-test, a paired t-test, and a chi-2. Results: The findings showed that there was no statistically significant difference between the two groups of patients in terms of age, length of hospital stays, gender, marriage, employment, education, and type of disease (p
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Patient transfers from one care giver to another are an area of high safety consequence, as is evident by many studies and the Joint Commission on Accreditation of Healthcare Organization's Patient Safety Goals. The authors describe how one hospital made measurable improvements in a patient handoff process by using an unconventional approach to change called appreciative inquiry. Rather than identifying the root causes of ineffective handoffs, appreciative inquiry was used to engage staff in identifying and building on their most effective handoff experiences.
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To evaluate the associations between selected birth characteristics-prematurity and poor intrauterine growth-and risk factors for coronary artery disease detected among children enrolled in the fifth grade. Children (n = 3054) with matched birth and fifth grade health screening data on body mass index (BMI), systolic blood pressure, and fasting lipid profiles were analyzed using MANOVA with the following independent variables of weight gain by the fifth grade: BMI percentile, normal or overweight/obese (BMI ≥85th percentile), prematurity, and intrauterine growth (ie, small for gestational age [SGA], appropriate for gestational age [AGA], or large for gestational age [LGA]). LGA status at birth was associated with overweight/obesity later in life. In fifth grade, overweight/obese children had elevated systolic blood pressure and abnormal levels of most fasting serum lipids compared with normal-weight children regardless of birth characteristics. Beyond the effects of BMI percentile, preterm infants had higher levels of triglycerides (TG) than term infants by the fifth grade (P < .05). SGA infants who become overweight/obese had higher levels of TGs and very low-density lipoproteins compared with AGA and LGA infants, whether overweight or normal weight (P < .05). BMI ≥85th percentile in the fifth grade is associated with abnormalities in most coronary artery risk factors regardless of birth characteristics. Beyond the effects of BMI percentile in the fifth grade, preterm infants had higher TG levels than term infants. SGA infants who were overweight/obese in the fifth grade had higher TG and very low-density lipoprotein levels compared with AGA and LGA infants who were overweight/obese or of normal weight in the fifth grade.
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Communicating nursing care during the patient's total hospital stay is a difficult task to achieve within the context of high patient turnover, a lack of overlap time between shifts, and time constraints. Clear and accurate communication is pivotal to delivering high quality care and should be the gold standard in any clinical setting. Handover is a commonly used communication medium that requires review and critique. This study was conducted in five acute care settings at a major teaching hospital. Using a grounded theory approach, it explored the use of three types of handover techniques (verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semi-structured interviews with nurses and participant field observations. Textual data were managed using NUD-IST. Transcripts were critically reviewed and major themes identified from the three types of handovers that illustrated their strengths and weaknesses. The findings of this study revealed that handover is more than just a forum for communicating patient care. It is also used as a place where nurses can debrief, clarify information and update knowledge. Overall, each type of handover had particular strengths and limitations; however, no one type of handover was appraised as being more effective. Achieving the multiple goals of handover presents researchers and clinicians with a challenging task. It is necessary to explore more creative ways of conducting the handover of patient care, so that an important aspect of nursing practice does not get classified as just another ritual.
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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.
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Clinical handover is critical to clinical decision-making and the provision of safe, high quality, continuing care. Incomplete and inaccurate transfer of information can result in poor outcomes. To assess the content and completeness of the intensive care unit nursing shift-to-shift handover, a prospective, observational study design was used. A semistructured observation sheet based on 10 key principles for handover was used to overtly observe 20 bedside nursing handovers. Descriptive statistics were used to analyse the data. Overall, the content handed over was consistent with the key principles of clinical handover. However, there were some key principles that were minimally addressed or absent from clinical handovers. Development and implementation of a handover tool specific to intensive care will assist in ensuring that all key principles are adhered to so that adverse events associated with miscommunication during clinical handover are reduced and a high standard of care is maintained.
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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.
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Handoff of patient information during shift report between nurses is a time of risk and liability. A quality improvement project was conducted on a 23-bed inpatient unit to measure the value of a bedside change-of-shift report in improving the effectiveness of shift report. Indicators including end-of-shift overtime, call light usage, nurse perceptions, and patient satisfaction were impacted by the change in process.
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Nurse leaders and telemetry unit staff work together to change the way nurses conduct shift report.This is the first article in a new series on leadership, coordinated by the American Organization of Nurse Executives (AONE), highlighting how nurses are leading change efforts in hospitals. It describes work done in conjunction with the AONE's Care Innovation and Transformation initiative, which provides leadership development and educational opportunities to nurse managers and staff aimed at supporting nurses at the point of care in making changes to improve the quality and safety of patient care.
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Background The analysis of nursing errors in clinical management highlighted that clinical handover plays a pivotal role in patient safety. Changes to handover including conducting handover at the bedside and the use of written handover summary sheets were subsequently implemented. Aim The aim of the study was to explore nurses’ perspectives on the introduction of bedside handover and the use of written handover sheets. Method Using a qualitative approach, data were obtained from six focus groups containing 30 registered and enrolled (licensed practical) nurses. Thematic analysis revealed several major themes. Findings Themes identified included: bedside handover and the strengths and weaknesses; patient involvement in handover, and good communication is about good communicators. Finally, three sources of patient information and other issues were also identified as key aspects. Conclusions How bedside handover is delivered should be considered in relation to specific patient caseloads (patients with cognitive impairments), the shift (day, evening or night shift) and the model of service delivery (team versus patient allocation). Implications for nursing management Flexible handover methods are implicit within clinical setting issues especially in consideration to nursing teamwork. Good communication processes continue to be fundamental for successful handover processes.