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J Nurs Care Qual Vol. 29, No. 2, pp. 149–154 c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
Patients’ Views on Bedside Nursing Handover Creating a Space to Connect Lianne Jeffs, PhD, RN; Susan Beswick, MN, RN; Ashley Acott, BMSc; Elisa Simpson, MSc; Roberta Cardoso, PhD, RN; Heather Campbell, MS, RN; Terri Irwin, MN, RN 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. Key words: bedside handover, communication, handoff, nursing handover, patient preferences, qualitative research
H
ANDOVER COMMUNICATION at the change of shift is an essential component of nursing practice linked to patient safety and quality care.1,2 Historically, shift handover between nurses has occurred away from the bedside through verbal, written, or taped reports either in a group or a one-onone setting. Key challenges identified with this approach include that it is not patientcentric and not necessarily safe for the patient, as pertinent information can be missed
Author Affiliations: St. Michael’s Hospital (Drs Jeffs and Cardoso and Mss Beswick, Acott, Simpson, Campbell, and Irwin), and Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation, University of Toronto (Dr Jeffs), Toronto, Ontario, Canada. The authors declare no conflict of interest. Correspondence: Lianne Jeffs, PhD, RN, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada ([email protected]). Accepted for publication: October 6, 2013 Published ahead of print: November 18, 2013 DOI: 10.1097/NCQ.0000000000000035
or care delayed because of the length of the shift report.2-6 There is growing interest in a patient-centered approach to handover during critical episodes in the care process such as shift handovers7,8 and other care transition points.9 With a patient-centered approach, patients are partners in their care with the expectation that their participation may lead to better outcomes and satisfaction.7,8 Moving to a more patient-centered approach, many organizations have been implementing a standardized approach for nurse-to-nurse shift reporting through bedside reporting (bedside nursing handover) where the outgoing nurse provides report to the incoming nurse at the patient’s bedside.1,2,6-8,10-19 Key benefits for nurses associated with bedside nursing handover include the opportunity for nurses to (1) clarify issues and ask questions to enhance the accuracy of the report,13 (2) visualize the patient and prioritize care,20 and (3) engage patients in their care.10,14,16 Studies have also identified a range of benefits for patients associated with bedside nursing handover including that patients (1) report greater satisfaction with care,1,8,18,19 (2) have 149
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improved perceptions of safety during handovers21 related to the patient being able to correct inaccuracies in care,7 (3) are informed of their plan of care,12 (4) experience fewer patient falls at shift change19 and fewer medication errors,6,19 and (5) have increased risk assessments for pressure ulcers (Braden scale) completed by nurses.6 Most of these studies have used patient satisfaction scores and survey results, with only a few studies involving interviews with patients to gain insight into their experience in the handover process.7,11,16,21 Efforts to improve patient handover can benefit from understanding how patients value and view their participation in the handover process.22-24 In this context, a qualitative study was undertaken to explore patients’ perspectives of bedside nursing handover on several units in one hospital. METHODS Setting and design The implementation of bedside nursing handover took place in a 500-bed, innercity acute care teaching hospital in Toronto, Canada, in 2010-2012. This represented a key strategy to enhance a patient-centered approach and exchange of information, led by the nursing professional practice department and aligned with the hospital’s corporate quality agenda. A more detailed description of the implementation rollout is provided in another article.20 Ethics approval was obtained from the institutional research ethics board. Eligibility criteria for patients included aged 18 years or older, a patient on one of the units that had implemented bedside nursing handover, able to understand English, and able to provide informed consent. Written informed consent was obtained from patients prior to their participation in an interview. Interviews were scheduled on the basis of the availability of the patient during the hospitalization and took place either in the hospital room or in a private room on the unit.
Interviews were conducted in July 2012 by 2 research students who were trained by a team of experienced qualitative research personnel to ensure consistency. Both students were observed and coached while interviewing patients and their family members until the research team was confident in their skills. An interview guide with the following 4 questions was used: (1) “Tell me about (describe to me) your experience with the nurse-to-nurse bedside shift reporting that is part of your care here”; (2) “What are the benefits you experience with nurses providing shift report with you at the bedside?”; (3) “What are the challenges you experienced with nurses providing shift report with you at the bedside?”; and (4) “What recommendations do you have to improve the nurse-to-nurse bedside shift reporting?” Interviews were conducted until saturation was achieved for themes and categorical data and no new insights were derived from the interviews. Interviews lasted between 3.5 and 34 minutes. Interviews were recorded on audiotape and transcribed for analysis. Data were analyzed using a directed content analysis approach.25,26 Specifically, the analytical process involved 3 investigators and 2 research students independently reviewing all transcripts line by line to identify sections of text that serve as codes. Throughout the analytical process, concepts from the literature related to what is known about the nature of bedside handover reporting, benefits, and challenges from a patient’s perspective were compared with and contrasted to the emergent categories. The most frequently reported codes were then collapsed into categories. Data collection and analysis were iterative in nature, where preliminary analysis began after the first 6 interviews had been conducted to enable consideration of potential themes and refinement of the interview guide. The initial coding schema from the first 6 transcripts of each team member was reviewed by the research team. From this cross-checking measure, reliability among the research staff was determined. The remaining analysis of transcripts was iterative in nature, where
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Patients’ Views on Bedside Nursing Handover development of themes, subthemes, and subcategories were added to reflect variations in data. To ensure methodological rigor and trustworthiness of the data set, the principal investigator developed an audit trail that included the triangulation of responses to the open-ended questions and the summative content analysis.25 RESULTS Sample description A total of 45 interviews were conducted with patients from the following clinical cohorts: nephrology, 27% (n = 12); general surgery, 29% (n = 13); respirology, 18% (n = 8); and obstetrics and gynecology, 27% (n = 12). Sixty-six percent of patients were female and the length of stay ranged from 1 to 120 days, with an average of 12 days. Emergent themes Three key themes emerged from the qualitative interview data set. 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. Creating a space for personal connection This first theme reveals how patients perceived that the bedside nursing handover created a space where they could connect and bond with the nurses in a more personal manner. The focus of this theme is the patients’ perceptions of their level of involvement in the bedside shift handover with the 2 nurses. The introduction of the incoming nurse was the most common positive aspect of the bedside nursing handover reported by patients. Patients explained that they appreciated knowing when change of shift occurred and being introduced early in the shift to the nurse who would be providing their care. These introductions were important to patients even if they could not remember the name of their nurse, and that being introduced to the oncoming nurse was a personal touch
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that gave them a sense of security and level of comfort. For example, one patient described that knowing who was going to provide care was not only comforting but also a key step in ensuring that they received the best care by the incoming nurse over the course of their shift. The following narrative excerpts illustrate this theme: You know who your nurse is. It [bedside nursing handover] creates a space in the day where we can talk about it [what is on my mind now]. It forces nurses to work at being personable. It gets patients more connected to the nurses, and it helps nurses feel more connected to the patients. It’s good, I like it, it feels more personal.
Within this theme, participants also described the bedside nursing handover as having a space created in the day to ask questions, provide input around their care, and correct information with the incoming and outgoing nurses. Feeling comfortable to ask questions and have them answered by nurses during bedside shift handover was highly valued by patients. This was due to the perception that patients were being listened to and that their input about their preferences for care and how they were feeling were being taken into account by the incoming nurses. In turn, this interaction was described by some patients as alleviating their anxieties and fears about their current health status and care plan. Several participants described that they were able to identify mistakes and potential errors during bedside nursing handover. Through this interaction, errors were addressed and corrected, averting side effects and harm to the patients. Most of the errors identified were related to medications or missed care. For example, one patient shared an experience in which he notified the nurses at the bedside shift handover that his antibiotic dose was decreased. By sharing this information, the incoming nurse was alerted to the dose change and was able to administer the correct dose to the patient. Other examples of this theme include the following: That [bedside nursing handover] makes me feel good because sometimes they say that my dose is
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every 4 hours when it’s not, it’s every 3 hours. I can add that in at the end . . . and they look back and they’re like “oh you’re right.” There is a benefit because if they’ve missed anything I can add what they’ve missed. I can say “no, remember this also took place.” My input I can make known at that time. If something I didn’t like, I would always share with them: “I didn’t like that drug you gave me, don’t give me that drug or whatever.”
“Bumping up to speed” This second theme reflects how study participants described that bedside nursing handover enabled patients to be aware of what was going on and being kept up to date on their care. The focus of this theme is the patients’ perceptions of the information exchange and knowledge of the outgoing and incoming nurses during bedside shift handover. Referred to as “bumping up to speed,” patients explained that the outgoing nurse would share information with the incoming nurse about their status and history and the plan of care for the shift. In turn, the oncoming nurse had a better understanding of how to plan and manage their care. Participants also described that the bedside nursing handover provided the opportunity for nurses to pass along information important to the patient. For example, one patient described the nurses explaining arrangements made for the patient to attend mosque. Participants explained that they had more confidence in their care knowing that pertinent information had been passed along and that the oncoming nurse knows about them and their current situation. Interestingly, one patient described feeling empowered by the nurses knowing what is going on about the patient’s status and care plan discussed during bedside shift handover. This is noted in the following excerpts: It also makes me more aware of what’s going on in my health care. Sometimes they change things or do things throughout the day that maybe I’m not aware of, or maybe I am aware of it but didn’t really pay attention when they were doing it. This just kind of bumps me up to speed.
It empowers you. You have a hand in what’s going on by having the knowledge you need to make decisions about what’s going on next, or whether you want to be conservatively treated or not.
Varying preferences The third theme reflects variation in patients’ preferences on their level of engagement and what information they want to be disclosed or discussed at the bedside nursing handover. Most patients preferred to be part of the daily bedside nursing handovers; however, others did not see the need for daily bedside nursing handovers, viewing them as redundant. The later was typically reported by long-term–stay patients whose status did not change every day and preferred for bedside nursing handover not to occur on a daily basis. Some patients preferred to have a more passive role in the bedside nursing handover and would listen only to the 2 nurses exchanging information. Patients were also divided in their preference to be woken up to participate in morning bedside reporting. Patients who did not want to be woken up explained that either there was no new information to discuss, as their clinical status had not changed, or they should be resting to recover from their surgery. Most patients were comfortable with their information being shared during the bedside report. However, there were a few participants who were not comfortable with the information exchange taking place at the bedside. These patients expressed concerns with the loudness of nurses communicating the information during the bedside nursing handover, the use of their full name, and sharing information about their condition. The following excerpts illustrate this theme: To be honest, I think something like that [bedside nurse handover] would probably phase out or disappear over a course of 2 days, because after a day or 2 you’ve heard their bed report, they have heard your bed report.
DISCUSSION The study provides an analysis of patients’ perceptions of bedside nursing handover at
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Patients’ Views on Bedside Nursing Handover one organization. This work adds to a small body of evidence that elucidates patients’ perspectives of bedside nursing handover through qualitative inquiry. In the study, patients described bedside nursing handover as an engaging, personal, and informative approach to shift handover. This finding is similar to that of other studies, which found that bedside nursing handover increased patients’ engagement in their care and kept them informed about their health status and care plan.7,8,11,12 The finding that being introduced to the oncoming nurse is patients’ most commonly reported positive aspect of bedside handover is consistent with the finding of other studies.7,8 This finding serves as a reminder of the power of an introduction and its importance in establishing a relationship with patients. In the study, patients described feeling less anxious about their care, having a sense of security, and experiencing greater satisfaction as a result of their participation in the bedside nursing handover. This finding adds to the finding of other studies that demonstrated patients reporting greater satisfaction with care after participating in bedside nursing handover.1,8,18,19 Although not defined as patient-centered care7,8 by study participants, the bedside nursing handover enabled a partnership between patients and nurses, as patients were able to ask questions and clarify their care plan. Furthermore, patients identified errors to the nurses during the bedside handover, which were subsequently corrected. This finding is similar to that of the previous work that described that bedside handover enabled nurses to “amend inaccuracies of care” to prevent harm to patients7 and that patients are valuable sources of information to inform their care and practice improvements.22-24 Participants emphasized the importance of considering their clinical status as well as the preferences of each individual patient before performing bedside nursing handover. The finding that some patients viewed daily bedside nursing handover to be redundant or unnecessary is similar to the finding of other
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studies that identified patient frustrations associated with hearing their history repeated frequently at shift handover.16,19 The finding that some patients preferred to have a more passive, listening role in bedside nursing handover is consistent with the finding of another study.7 One potential explanation of this finding is that not all patients want to assume a participatory role in their care or care decision making because either they are not interested or they do not feel sufficiently knowledgeable to assume this role.27 Further research efforts could explore how best to engage patients in bedside nursing handover to ensure the interaction is patient centered. To fully realize the benefits associated with bedside nursing handover, health care leaders should ensure that handover becomes a routine patient-centered process that engages patients to be involved in their care according to their preferences. The study findings indicate the importance of recognizing and being sensitive to patients’ choice regarding involvement in bedside nursing handover, requiring adaptability on the part of nurses to respect and respond to their preferences. Study limitations Overall, the transferability of study findings is limited in the following 3 ways: First, study participants were drawn from one acute care hospital and findings may not hold true in other health care settings. Second, some patients had only experienced bedside nursing handover twice because of inconsistencies in practice. In some situations, patients did not recall bedside handover because of being “groggy” from the anesthetic. Third, the data analyzed are from patients’ self-reporting of their experience with bedside nursing handover. CONCLUSION This study revealed 3 key themes from patients’ perceptions of bedside nursing handover at one organization. Study findings elucidate mainly benefits associated with bedside nursing handover, with insights into how
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this type of handover reporting is engaging, personal, and informative to patients. Despite these benefits, health care leaders and nurses need to take into account that there are varying preferences on the level of engagement and what information patients want to be
disclosed or discussed during the bedside nursing handover. Clearly, the study findings support a patient-centered approach to bedside handover and suggest the need to engage patients to determine their desired level of involvement.
REFERENCES 1. Thomas L, Donohue-Porter P. Blending evidence and innovation: improving intershift handoffs in a multihospital setting. J Nurs Care Qual. 2012;27(2):116124. 2. Benson E, Rippin-Sisler C, Jabusch K, Keast S. Improving nursing shift-to-shift report. J Nurs Care Qual. 2007;22(1):80-84. 3. Ong M, Coiera E. A systematic review of failures in handoff communication during intrahospital transfers. Jt Comm J Qual Patient Saf. 2011;37(6):274284. 4. Davis S, Priestly MJ. A reflective evaluation of patient handover practices. Nurs Stand. 2006;20(21):49-52. 5. Kerr D, Lu S, McKinlay L. Bedside handover enhances completion of nursing care and documentation. J Nurs Care Qual. 2013;27(3):217-225. 6. Riesenberg LA, Leisch J, Cunningham JM. Nursing handoffs: a systematic review of the literature. Am J Nurs. 2010;110(4):24-34. 7. McMurray A, Chaboyer W, Wallis M, Johnson J, Gehrke T. Patients’ perspectives of bedside nursing handover. Collegian. 2011;18(1):19-26. 8. Anderson C, Mangino R. Nurse shift report: who says you can’t talk in front of the patient? Nurs Adm Q. 2006;30(2):112-122. 9. Hesselink G, Flink M, Ollsson M, et al. Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Qual Saf. 2012;21(1):i39-i49. 10. Chaboyer W, McMurray A, Wallis M. Bedside nursing handover: a case study. Int J Nurs Pract. 2010;16(1):27-34. 11. Chaboyer W, McMurray A, Johnson J, Hardy L, Wallis M, Fang Ying C. Bedside handover: quality improvement strategy to “transform care at the bedside.” J Nurs Care Qual. 2009;24(2):136-142. 12. Maxson P, Derby K, Wrobleski D, Foss DM. Bedside nurse-to-nurse handoff promotes patient safety. Medsurg Nurs. 2012;21(3):140-145. 13. Alvarado K, Lee R, Christoffersen E, et al. Transfer of accountability: transforming shift handover to enhance patient safety. Healthc Q. 2006;9(special issue):75-79. 14. Grant B, Colello S. Engaging the patient in handoff communication at the bedside. Nursing. 2009;39(10):22-23.
15. Laws D, Amato S. Incorporating bedside reporting into change-of-shift report. Rehabil Nurs. 2010;35(2):70-74. 16. Cahill J. Patient’s perceptions of bedside handovers. J Clin Nurs. 1998;7(4):351-359. 17. Kassean HK, Jaggo ZB. Managing change in the nursing handover from traditional to bedside handover—a case study from Mauritius. BMC Nurs. 2005;4:1. 18. Wakefield D, Ragan R, Brandt J, Tregnago M. Making the transition to nursing bedside shift reports. Jt Comm J Qual Patient Saf. 2012;38(6): 243-254. 19. Sand-Jecklin K, Sherman J. Incorporating bedside report into nursing handoff evaluation of change in practice. J Nurs Care Qual. 2013;28: 186-194. 20. Jeffs L, Acott A, Simpson E, et al. The value of bedside shift reporting: enhancing nurse surveillance, accountability, and patient safety. J Nurs Care Qual. 2013;28(3):226-232. 21. Chin G, Warren N, Kornman L, Cameron P. Patients’ perceptions of safety and quality of maternity clinical handover. BMC Pregnancy Childbirth. 2011;11:58. doi:10.1186/1471-2393-11-58. 22. Flink M, Ohlen G, Hansagi H, Barach P, Olsson M. Beliefs and experiences can influence patient participation in handover between primary and secondary care—a qualitative study of patient perspectives. BMJ Qual Saf. 2012;21:i76-i83. 23. King A, Daniels J, Lim J, Cochrane DD, Taylor A, Ansermino JM. Time to listen: a review of methods to solicit patient reports of adverse events. Qual Saf Health Care. 2010;19(2):148-157. 24. Vincent C, Davis R. Patients and families as safety experts. Can Assoc Med J. 2012;184(1):15-16. 25. Hickey G, Kipping C. Issues in research. A multi-stage approach to coding of data from open-ended questions. Nurs Res. 1996;15(9):81-91. 26. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288. 27. Longtin Y, Sax H, Leape L, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010;85(1):53-62.
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J Nurs Care Qual Vol. 29, No. 2, pp. 149–154 c 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
Patients’ Views on Bedside Nursing Handover Creating a Space to Connect Lianne Jeffs, PhD, RN; Susan Beswick, MN, RN; Ashley Acott, BMSc; Elisa Simpson, MSc; Roberta Cardoso, PhD, RN; Heather Campbell, MS, RN; Terri Irwin, MN, RN 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. Key words: bedside handover, communication, handoff, nursing handover, patient preferences, qualitative research
H
ANDOVER COMMUNICATION at the change of shift is an essential component of nursing practice linked to patient safety and quality care.1,2 Historically, shift handover between nurses has occurred away from the bedside through verbal, written, or taped reports either in a group or a one-onone setting. Key challenges identified with this approach include that it is not patientcentric and not necessarily safe for the patient, as pertinent information can be missed
Author Affiliations: St. Michael’s Hospital (Drs Jeffs and Cardoso and Mss Beswick, Acott, Simpson, Campbell, and Irwin), and Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation, University of Toronto (Dr Jeffs), Toronto, Ontario, Canada. The authors declare no conflict of interest. Correspondence: Lianne Jeffs, PhD, RN, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada ([email protected]). Accepted for publication: October 6, 2013 Published ahead of print: November 18, 2013 DOI: 10.1097/NCQ.0000000000000035
or care delayed because of the length of the shift report.2-6 There is growing interest in a patient-centered approach to handover during critical episodes in the care process such as shift handovers7,8 and other care transition points.9 With a patient-centered approach, patients are partners in their care with the expectation that their participation may lead to better outcomes and satisfaction.7,8 Moving to a more patient-centered approach, many organizations have been implementing a standardized approach for nurse-to-nurse shift reporting through bedside reporting (bedside nursing handover) where the outgoing nurse provides report to the incoming nurse at the patient’s bedside.1,2,6-8,10-19 Key benefits for nurses associated with bedside nursing handover include the opportunity for nurses to (1) clarify issues and ask questions to enhance the accuracy of the report,13 (2) visualize the patient and prioritize care,20 and (3) engage patients in their care.10,14,16 Studies have also identified a range of benefits for patients associated with bedside nursing handover including that patients (1) report greater satisfaction with care,1,8,18,19 (2) have 149
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improved perceptions of safety during handovers21 related to the patient being able to correct inaccuracies in care,7 (3) are informed of their plan of care,12 (4) experience fewer patient falls at shift change19 and fewer medication errors,6,19 and (5) have increased risk assessments for pressure ulcers (Braden scale) completed by nurses.6 Most of these studies have used patient satisfaction scores and survey results, with only a few studies involving interviews with patients to gain insight into their experience in the handover process.7,11,16,21 Efforts to improve patient handover can benefit from understanding how patients value and view their participation in the handover process.22-24 In this context, a qualitative study was undertaken to explore patients’ perspectives of bedside nursing handover on several units in one hospital. METHODS Setting and design The implementation of bedside nursing handover took place in a 500-bed, innercity acute care teaching hospital in Toronto, Canada, in 2010-2012. This represented a key strategy to enhance a patient-centered approach and exchange of information, led by the nursing professional practice department and aligned with the hospital’s corporate quality agenda. A more detailed description of the implementation rollout is provided in another article.20 Ethics approval was obtained from the institutional research ethics board. Eligibility criteria for patients included aged 18 years or older, a patient on one of the units that had implemented bedside nursing handover, able to understand English, and able to provide informed consent. Written informed consent was obtained from patients prior to their participation in an interview. Interviews were scheduled on the basis of the availability of the patient during the hospitalization and took place either in the hospital room or in a private room on the unit.
Interviews were conducted in July 2012 by 2 research students who were trained by a team of experienced qualitative research personnel to ensure consistency. Both students were observed and coached while interviewing patients and their family members until the research team was confident in their skills. An interview guide with the following 4 questions was used: (1) “Tell me about (describe to me) your experience with the nurse-to-nurse bedside shift reporting that is part of your care here”; (2) “What are the benefits you experience with nurses providing shift report with you at the bedside?”; (3) “What are the challenges you experienced with nurses providing shift report with you at the bedside?”; and (4) “What recommendations do you have to improve the nurse-to-nurse bedside shift reporting?” Interviews were conducted until saturation was achieved for themes and categorical data and no new insights were derived from the interviews. Interviews lasted between 3.5 and 34 minutes. Interviews were recorded on audiotape and transcribed for analysis. Data were analyzed using a directed content analysis approach.25,26 Specifically, the analytical process involved 3 investigators and 2 research students independently reviewing all transcripts line by line to identify sections of text that serve as codes. Throughout the analytical process, concepts from the literature related to what is known about the nature of bedside handover reporting, benefits, and challenges from a patient’s perspective were compared with and contrasted to the emergent categories. The most frequently reported codes were then collapsed into categories. Data collection and analysis were iterative in nature, where preliminary analysis began after the first 6 interviews had been conducted to enable consideration of potential themes and refinement of the interview guide. The initial coding schema from the first 6 transcripts of each team member was reviewed by the research team. From this cross-checking measure, reliability among the research staff was determined. The remaining analysis of transcripts was iterative in nature, where
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Patients’ Views on Bedside Nursing Handover development of themes, subthemes, and subcategories were added to reflect variations in data. To ensure methodological rigor and trustworthiness of the data set, the principal investigator developed an audit trail that included the triangulation of responses to the open-ended questions and the summative content analysis.25 RESULTS Sample description A total of 45 interviews were conducted with patients from the following clinical cohorts: nephrology, 27% (n = 12); general surgery, 29% (n = 13); respirology, 18% (n = 8); and obstetrics and gynecology, 27% (n = 12). Sixty-six percent of patients were female and the length of stay ranged from 1 to 120 days, with an average of 12 days. Emergent themes Three key themes emerged from the qualitative interview data set. 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. Creating a space for personal connection This first theme reveals how patients perceived that the bedside nursing handover created a space where they could connect and bond with the nurses in a more personal manner. The focus of this theme is the patients’ perceptions of their level of involvement in the bedside shift handover with the 2 nurses. The introduction of the incoming nurse was the most common positive aspect of the bedside nursing handover reported by patients. Patients explained that they appreciated knowing when change of shift occurred and being introduced early in the shift to the nurse who would be providing their care. These introductions were important to patients even if they could not remember the name of their nurse, and that being introduced to the oncoming nurse was a personal touch
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that gave them a sense of security and level of comfort. For example, one patient described that knowing who was going to provide care was not only comforting but also a key step in ensuring that they received the best care by the incoming nurse over the course of their shift. The following narrative excerpts illustrate this theme: You know who your nurse is. It [bedside nursing handover] creates a space in the day where we can talk about it [what is on my mind now]. It forces nurses to work at being personable. It gets patients more connected to the nurses, and it helps nurses feel more connected to the patients. It’s good, I like it, it feels more personal.
Within this theme, participants also described the bedside nursing handover as having a space created in the day to ask questions, provide input around their care, and correct information with the incoming and outgoing nurses. Feeling comfortable to ask questions and have them answered by nurses during bedside shift handover was highly valued by patients. This was due to the perception that patients were being listened to and that their input about their preferences for care and how they were feeling were being taken into account by the incoming nurses. In turn, this interaction was described by some patients as alleviating their anxieties and fears about their current health status and care plan. Several participants described that they were able to identify mistakes and potential errors during bedside nursing handover. Through this interaction, errors were addressed and corrected, averting side effects and harm to the patients. Most of the errors identified were related to medications or missed care. For example, one patient shared an experience in which he notified the nurses at the bedside shift handover that his antibiotic dose was decreased. By sharing this information, the incoming nurse was alerted to the dose change and was able to administer the correct dose to the patient. Other examples of this theme include the following: That [bedside nursing handover] makes me feel good because sometimes they say that my dose is
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every 4 hours when it’s not, it’s every 3 hours. I can add that in at the end . . . and they look back and they’re like “oh you’re right.” There is a benefit because if they’ve missed anything I can add what they’ve missed. I can say “no, remember this also took place.” My input I can make known at that time. If something I didn’t like, I would always share with them: “I didn’t like that drug you gave me, don’t give me that drug or whatever.”
“Bumping up to speed” This second theme reflects how study participants described that bedside nursing handover enabled patients to be aware of what was going on and being kept up to date on their care. The focus of this theme is the patients’ perceptions of the information exchange and knowledge of the outgoing and incoming nurses during bedside shift handover. Referred to as “bumping up to speed,” patients explained that the outgoing nurse would share information with the incoming nurse about their status and history and the plan of care for the shift. In turn, the oncoming nurse had a better understanding of how to plan and manage their care. Participants also described that the bedside nursing handover provided the opportunity for nurses to pass along information important to the patient. For example, one patient described the nurses explaining arrangements made for the patient to attend mosque. Participants explained that they had more confidence in their care knowing that pertinent information had been passed along and that the oncoming nurse knows about them and their current situation. Interestingly, one patient described feeling empowered by the nurses knowing what is going on about the patient’s status and care plan discussed during bedside shift handover. This is noted in the following excerpts: It also makes me more aware of what’s going on in my health care. Sometimes they change things or do things throughout the day that maybe I’m not aware of, or maybe I am aware of it but didn’t really pay attention when they were doing it. This just kind of bumps me up to speed.
It empowers you. You have a hand in what’s going on by having the knowledge you need to make decisions about what’s going on next, or whether you want to be conservatively treated or not.
Varying preferences The third theme reflects variation in patients’ preferences on their level of engagement and what information they want to be disclosed or discussed at the bedside nursing handover. Most patients preferred to be part of the daily bedside nursing handovers; however, others did not see the need for daily bedside nursing handovers, viewing them as redundant. The later was typically reported by long-term–stay patients whose status did not change every day and preferred for bedside nursing handover not to occur on a daily basis. Some patients preferred to have a more passive role in the bedside nursing handover and would listen only to the 2 nurses exchanging information. Patients were also divided in their preference to be woken up to participate in morning bedside reporting. Patients who did not want to be woken up explained that either there was no new information to discuss, as their clinical status had not changed, or they should be resting to recover from their surgery. Most patients were comfortable with their information being shared during the bedside report. However, there were a few participants who were not comfortable with the information exchange taking place at the bedside. These patients expressed concerns with the loudness of nurses communicating the information during the bedside nursing handover, the use of their full name, and sharing information about their condition. The following excerpts illustrate this theme: To be honest, I think something like that [bedside nurse handover] would probably phase out or disappear over a course of 2 days, because after a day or 2 you’ve heard their bed report, they have heard your bed report.
DISCUSSION The study provides an analysis of patients’ perceptions of bedside nursing handover at
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Patients’ Views on Bedside Nursing Handover one organization. This work adds to a small body of evidence that elucidates patients’ perspectives of bedside nursing handover through qualitative inquiry. In the study, patients described bedside nursing handover as an engaging, personal, and informative approach to shift handover. This finding is similar to that of other studies, which found that bedside nursing handover increased patients’ engagement in their care and kept them informed about their health status and care plan.7,8,11,12 The finding that being introduced to the oncoming nurse is patients’ most commonly reported positive aspect of bedside handover is consistent with the finding of other studies.7,8 This finding serves as a reminder of the power of an introduction and its importance in establishing a relationship with patients. In the study, patients described feeling less anxious about their care, having a sense of security, and experiencing greater satisfaction as a result of their participation in the bedside nursing handover. This finding adds to the finding of other studies that demonstrated patients reporting greater satisfaction with care after participating in bedside nursing handover.1,8,18,19 Although not defined as patient-centered care7,8 by study participants, the bedside nursing handover enabled a partnership between patients and nurses, as patients were able to ask questions and clarify their care plan. Furthermore, patients identified errors to the nurses during the bedside handover, which were subsequently corrected. This finding is similar to that of the previous work that described that bedside handover enabled nurses to “amend inaccuracies of care” to prevent harm to patients7 and that patients are valuable sources of information to inform their care and practice improvements.22-24 Participants emphasized the importance of considering their clinical status as well as the preferences of each individual patient before performing bedside nursing handover. The finding that some patients viewed daily bedside nursing handover to be redundant or unnecessary is similar to the finding of other
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studies that identified patient frustrations associated with hearing their history repeated frequently at shift handover.16,19 The finding that some patients preferred to have a more passive, listening role in bedside nursing handover is consistent with the finding of another study.7 One potential explanation of this finding is that not all patients want to assume a participatory role in their care or care decision making because either they are not interested or they do not feel sufficiently knowledgeable to assume this role.27 Further research efforts could explore how best to engage patients in bedside nursing handover to ensure the interaction is patient centered. To fully realize the benefits associated with bedside nursing handover, health care leaders should ensure that handover becomes a routine patient-centered process that engages patients to be involved in their care according to their preferences. The study findings indicate the importance of recognizing and being sensitive to patients’ choice regarding involvement in bedside nursing handover, requiring adaptability on the part of nurses to respect and respond to their preferences. Study limitations Overall, the transferability of study findings is limited in the following 3 ways: First, study participants were drawn from one acute care hospital and findings may not hold true in other health care settings. Second, some patients had only experienced bedside nursing handover twice because of inconsistencies in practice. In some situations, patients did not recall bedside handover because of being “groggy” from the anesthetic. Third, the data analyzed are from patients’ self-reporting of their experience with bedside nursing handover. CONCLUSION This study revealed 3 key themes from patients’ perceptions of bedside nursing handover at one organization. Study findings elucidate mainly benefits associated with bedside nursing handover, with insights into how
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this type of handover reporting is engaging, personal, and informative to patients. Despite these benefits, health care leaders and nurses need to take into account that there are varying preferences on the level of engagement and what information patients want to be
disclosed or discussed during the bedside nursing handover. Clearly, the study findings support a patient-centered approach to bedside handover and suggest the need to engage patients to determine their desired level of involvement.
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