Bedside handover: structure, process and content - a mixed methods study
University College Cork
Background: The handover (also termed handoff) of patient information and patient care is an essential, albeit risk laden and time consuming activity in clinical nursing practice. Therefore, this nursing practice is both of importance and concern for patient safety and nursing management. The continuity of care and patient safety are dependent on the accuracy and completeness of the information exchanged during the transfer of responsibility for patient care from one nursing shift to another. A desire to increase patient participation, improve effective communication and minimise risk, are the primary driving forces for implementing bedside handover. Aim: The aim of this study was to describe the structures, processes and content of bedside handover at the change of nursing shift. Methods: A mixed methods design was used. Data were collected via observation and audio recording 30 episodes of bedside handover. The study was conducted in a private acute-care hospital, and included six diverse clinical areas, encompassing both medical and surgical wards. Utilising the dedicated HoW4 tool, designed to capture the discrete factors unique to bedside handover, the observations were documented. The audio recordings of the episodes of handover were analysed using content analysis. The five domains of the British Medical Association’s Safe Handover – Safe Patients framework (BMA 2004) were used to structure the observations. The quantitative and qualitative data generated, were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient’s bedside during the change of nursing shift. Findings: The HoW4 tool, modelled on the BMA framework, established a clear plan for describing the structure, process and content of bedside handover at the change of nursing shift. Triangulation of the quantitative and qualitative datasets exposed areas of importance. How information is shared at the patient’s bedside during the change of nursing shift is of particular relevance. There is a reliance on both verbal and nonverbal communication skills. Large volumes of complex patient information are shared at a fast pace between nurses in the presence of the patient. The outgoing nurse leads the dialogue during the handover and influences the degree of patient participation. Furthermore, handover at the bedside is an opportunity for the development of a caring connection between the nurse and the patient. Conclusion: Bedside handover is a multifaceted nursing skill that encompasses the exchange of a large volume of complex patient information, the transfer of responsibility from the outgoing to the oncoming nurse necessitating intricate human interactions within a limited timeframe. Bedside handover does not infer patient participation; however, it does have potential to involve the patient. Greater clarity is need in defining the patient’s roles in handover. Bedside handover needs to be aligned with strategic goals and be supported by an organisational culture that values patient participation. Healthcare organisations need to consider the support structures that are required to balance the competing the objectives of implementing bedside handover, which are: improved communication, increased patient participation, reduced risk and increased efficiency.
Bedside handover , Nursing shift handover
Forde, M. F. 2018. Bedside handover: structure, process and content - a mixed methods study. PhD Thesis, University College Cork.