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An Improved Strategy as an Implication of an EBP Study

Executive Summary

Meeting the needs of patients in the setting of a nursing institution is a rather challenging task since it requires both a very sharp focus on the unique characteristics of the target audience, particularly, a significant improvement in the information management process, and the upgrade in the contemporary methodological approach toward carrying out the corresponding researches to identify the applicable nursing strategies. Herein lies the necessity to conduct a vast assessment of the methodologies and the implications of some of the latest studies on the subject matter. Evaluating the viewpoints adopted by the authors of the studies critically is a crucial step toward understanding why the modern nursing frameworks may become shallow, lacking in efficacy, or even inapplicable to some of the nursing settings and some of the patients’ backgrounds. As a result, a significant improvement in the modern strategy of managing the needs of patients can be designed.

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The issue of bedside handover (BH) has been the focus of several researches, yet with quite a small effect so far. Although the outcomes of the studies carried out so far seem quite legitimate, some of them fail to work in the contemporary nursing setting despite their sensibility.

The dents in the methodological framework used to conduct the corresponding studies and evaluate the needs of patients emerging in the course of BH proved to be one of the major impediments on the way to improving the quality of services. Specifically, one must admit that the current methodological approaches, in general, and the ones considered in the studies under analysis, in particular, lack consistency and pose a variety of limitations. As a result, the outcomes received in the course of the analysis can be viewed as rather biased or applicable to only a small group of people that the research could embrace. Particularly, the issue regarding the communication between the patient and the nurse needs to be brought up. According to the studies analyzed in the paper, the current framework of a nurse-to-patient communication could use a significant improvement.

Introduction

Transferring the patient’s information from one nurse to another is a crucial step in providing the patient with the services of the required quality and meeting the needs of the target population appropriately. However, due to the specifics of the contemporary nursing setting, as well as the bedside handover (BH) strategies adopted by nurses, the quality of the corresponding services may turn out to be debatable. In light of the identified issue, the significance of BH as a regular nursing practice may be questioned. The current study focuses on the overview of the researches detailing the problems in the current BH framework, as well as on the opportunities that the identified practice offers to nurses.

When implemented in the context of a specific nursing setting, the subject matter becomes even more controversial, as the patients become frustrated with the unceasing threat of their personal data disclosure to the third parties due to the structure of a ward, as well as the physical discomfort and the lack of regard for their opinion among nurses. Therefore, the subject matter deserves a closer attention since its viability as a legitimate tool for carrying out the transfer of the patient’s personal data and health records from one nurse to another turns out to be rather questionable. The stress that the patient appears to be under during the handover process is likely to impede the further intervention and, therefore, slow the recovery down significantly. Consequently, it is essential to determine whether the BH approach has the right to exist in the contemporary nursing setting, and, if it does, how it can be improved so that the needs of the key stakeholders, including both nurses and patients, could be satisfied.

Applying the EBP approach to the study of the phenomenon, one may find out that the lack of focus on the specific needs of patients and, therefore, the absence of a patient-centred approach in BH is the primary reason for concern and the source for the emergent issues. Herein lies the importance of applying the EBP framework to the analysis; it helps view the problem from the perspective that is rarely considered in nursing, i.e., the viewpoint of the patient. As a result, an array of new issues, as well as the suggestions for their solution, can be discovered once the EBP framework is incorporated into the study. The EBP tool will help locate the patterns in the current nursing processes, therefore, allowing one to highlight the recent tendencies and, consequently, get a deeper insight on the needs of the target population appearing in the course of BH. In other words, the EBP tools will point to the direction, in which the nursing strategy used for BH procedures should evolve, as well a highlight the essential steps that will have to be completed to reach the goals. Once the significance of the patients’ opinions, as well as the threat to their personal data safety, is recognized by nurses, a rapid progress in improving the current BH framework is expected.

Search Details

The search was aimed at two primary outcomes, i.e., locating the articles that belonged to the scholarly sources category, with a well developed methodology, and focusing on the studies that were related directly to the issue of BH in nursing, including its pros and cons, the current strategies, the limitations, etc.

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When selecting the nursing journals with the articles on the required topic, a range of keywords was used. At first, a combination of the terms “bedside handover” and “nursing” were used to create the bulk of sources that would later on be processed. Afterward, the keywords such as “evidence-based practice” and “EBP” were added so that the search results could be narrowed down to the topic of interest. Finally, the located articles were sorted according to their publishing date, only the ones that were released over the past five years being taken into account. As a result, three papers were retrieved.

The inclusion criteria concerned the type of process (i.e., BH), the data types (i.e., primary data retrieved in the course of the study), and the language (English). The exclusion criteria, in their turn, involved the studies that were carried out in any other setting than a nursing facility, as well as the researches that did not involve the adoption of the EBP approach.

Main Body

Paper Critique

Article 1

Focus

Chaboyer, McMurray, and Wallis (2010) address the effects that the use of NH has on the patients and their quality of life. In some way, it could be argued that the authors of the paper explore the communication-related issues that a nurse and a patient may face in the context of a nursing facility during the BH process.

Background

The authors stress inconsistency between the traditional definition of BH and the outcomes that it typically has on the patients. Particularly, the fact that BH is often viewed as the strategy for promoting patient-centered care in the nursing setting needs to be brought up. However, the authors stress that the outcomes of BH are often viewed a dissatisfactory by the patients, which calls for a reconsideration of the current approach toward the BH procedures. Chaboyer et al. (2010) explain that the problem in question can be deemed as rather large since it causes the customers to feel dissatisfied with the nursing services.

Aim

The goal of the data collection is to review the existing framework of BH and locate the benefits and the negative characteristics thereof. Particularly, the researchers seek the ways to improve the communication processes in the context of the contemporary nursing environment.

Methodology or broad approach

The authors used a qualitative (descriptive) case study as the means to research the phenomenon. Seeing that Chaboyer et al. (2010) focus on retrieving primarily qualitative information about the subject matter from their analysis, the tools used for the paper methodology can be deemed as rather adequate. The close attention that the authors of the study pay to the responses of the patients, including the description of their emotional experience and the impediments that they faced during the BH process matches the aim of the research and allows locating the BH approach that will help meet the needs of any patient.

Tools of data collection

The authors mentioned that they used interviews and semi-structured observations as the main tool for data collection. Needless to say, the application of interviews to a qualitative study design is a common practice that helps receive detailed feedback from the participants and have a clear, if somewhat subjective, picture of the problems that the target environment faces. Despite being a rather common device for data retrieval in qualitative studies, the use of interviews works fine in the design of this study as it helps get an insight on the quality of the communication process between the nurse and the patient.

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Methods of data analysis and presentation

Since two types of data were retrieved, i.e., the observational one and the one from the patients, the content analysis, which allowed for using two modes of analysis, was applied. The application of the specified tool helped make the analysis not only descriptive but also iterative; as a result, the researchers gained an opportunity to interpret the information retrieved in the course of interviews so that the assessment of the BH practice could be carried out. The use of a two-dimensional approach mentioned above can be viewed as an important step toward improving the veracity of the research results and addressing the limitations of interviews as a tool.

Sample

In the course of the study, three samples were drawn, one from each hospital considered in the case (15, 19, and 34 people correspondingly). The researchers did not state the specific criteria for inclusion and exclusion of the participants, which can be viewed as a minor dent in the design of the research.

Ethical considerations

The authors do not indicate that their study was approved by any ethical committee. However, the research does not seem to violate any of the existing principles of ethical research.

Main findings

The results of the study indicate that the SBAR technique was the most common approach to carrying out the BH process. Furthermore, the study showed that the patient participation in the BH process was unreasonably low, with only 1/3 of 1/2 customers taking active part in the information transfer process and providing the nurses with the required data. Moreover, the research showed that at least four people were present during the BH stage, which took less than a minute in most instances. The issues regarding the efficacy of patient-nurse communication, as well as the tools that could be utilized in the process, emerged from the discussion of the findings. The accuracy of the themes, however, was not checked.

Overall strengths and limitations

The close focus on the needs of patients is an obvious strength of the paper.

Conclusion and recommendations

The researchers answered quite clearly to the aim of the study, proving that BH was a crucial part of the essential nursing processes and that it needed further improvement.

Application to practice

The findings of the study are linked directly to practice as they indicate that changes must be made to the currently used approach to BH. Specifically, a more active engagement of the patients into the BH process and the information exchange must be promoted as the outcomes of the study have shown.

Article 2

Focus

Lu, Kerr, and McKinlay (2014) address a similar issue of BH in their study, yet the measurable variables are slightly different in their case. The authors focus on locating the patients’ opinions on the procedure of BH, therefore, helping identify the problems in the current design.

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Background

The authors prove the significance of their topic by outlining that efficient communication between a customer and a nurse is one of the foundational factors of patient safety. Therefore, the reasons for the study to exist are rather solid.

Aim

As stressed above, Lu et al. (2014) seek to locate the impressions that the patients have about the BH process, as well as their concerns and complaints about the subject matter. The general goal of the paper is clear and simple.

Methodology or broad approach

To carry out the research, the authors use a descriptive qualitative approach. Seeing that their main focus is on locating the opinions of the target audience, and that no quantification of the research results is required, the framework can be deemed as rather reasonable.

Tools of data collection

Semi-structured interviews were used as the primary data collection tool. The use of interviews can be viewed as a rather sensible approach in the case in point since the authors aimed at retrieving the information related to the personal impressions and experiences of the target audience. Therefore, the subjective viewpoints that the tool in question provides are perfect for the study.

Methods of data analysis and presentation

The use of the close textual analysis as the primary data analysis tool can be considered a significant advantage of the study as it helped locate every theme that was raised during the interviews. As a result, the feelings and emotions of the participants were deciphered carefully for the further identification of the appropriate methods of problems mitigation. However, the identified framework may lead to retrieving the results with rather questionable accuracy and objectivity. Indeed, since the patients’ judgments are based primarily on their emotions, the objectivity rates are rather low.

Sample

A sample of 30 patients was retrieved for the further analysis. The identified number of participants can be deemed as appropriate for the retrieval of credible results.

Ethical considerations

The authors state explicitly that the study was approved by the ethics committees of the organizations that the participants were recruited from. Therefore, there are no major ethical issues in the study. Furthermore, Lu et al. make it clear that informed consent was retrieved from each of the participants.

Main findings

The findings of the study answered the main question of the research directly. Particularly, the authors discovered that four essential themes were typically brought up by the patients when addressing the issue of BH, namely, a patient-focused, customized approach, reduction in the number of errors made, personal data security and management of delicate topics, and understanding issues due to the use of professional jargon by nurses. Therefore, the outcomes of the study addressed the research question directly, outlining essential areas of concern that would have to be managed.

Conclusion and recommendations

The authors make it clear that a patient-focused approach is the best means of improving the current BH procedure. Furthermore, they admit that the development of the bets models for BH should be the focus of the further research. Overall, the recommendations seem quite sensible and applicable, as well as in line with the key research question.

However, one still has to admit that its methodological framework could use a significant improvement. Naturally, it is virtually impossible to create the methodology that would allow for an impeccable analysis and the retrieval of crystal-clear, completely independent results. In one way or another, the outcomes of the study will be affected by extraneous variables. Nevertheless, reducing the effects thereof so that the results could be deemed as credible and verifiable is still a necessity.

Overall strengths and limitations

The authors did an outstanding analysis of the patients’ opinions, addressing some of the crucial aspects of BH. However, the number of themes that they identified in the course of the research could have been larger.

Application to practice

The results are related to practice directly as they inform the further design of BH practices and approaches. Thus, the connection to practice is evident.

Article 3

Focus

Spinks et al. also consider the issue of BH in their research, yet the focus of their study is slightly different from the two papers mentioned above. In contrast to the previously mentioned researchers, Spinks et al. consider the preferences that patients and nurses have for the BH process. The study, therefore, considers the experiences of nurses and patients alike.

Background

Spinks et al. (2010) state quite clearly that BH is a crucial process in the nursing care area. Specifically, they determine the process as the transfer of not only specific instructions but also responsibilities from one nurse to another. Therefore, the significance of the study is proven by emphasizing the implications of the process for the wellbeing of the patient.

Aim

The authors of the study aim at locating the preferences that nurses and patients have for the BH process, as well as comparing and contrasting these preferences and determining the strategies that can be used to meet the expectations of the parties involved.

Methodology or broad approach

Since there is no need to quantify the study results, the authors use a qualitative approach. Specifically, the case study approach was used as the means of data analysis. The opportunities that it opens for observations and the further design of adequate strategies make it a very sensible research method in the case in point.

Tools of data collection

A survey was used as the means of retrieving the essential data. The use of a survey is quite typical for clinical studies. One might argue that the use of a survey reduces the results credibility since it does not simply allow for much variability in the participants’ responses. An interview could be viewed as an equally reliable tool to use.

Methods of data collection and presentation

The use of the DCE tool can be viewed as an innovative approach toward the analysis of the data. The application of the tool helps determine the precision of the nurses’ and the patients’ responses to a greater degree than other tools allow for. Therefore, it can be considered a perfect tool for locating the results of the study.

Sample

The sample size of the patients (400) was twice as large as the one of the nurses (200). Because of the specifics of the analysis, data saturation occurred at a very slow pace.

Ethical considerations

The university ethics committee approved the study, which meant that it was carried out legitimately. Furthermore, the provision of information sheets to the participants allowed informing them about their role in the study. Each of the participants signed an informed consent.

Main findings

The study showed that there is a lack of patient participation in the BH process. However, not all nurses approved of the patient being included in BH.

Conclusion and recommendations

It is recommended that a follow-up study that could help find a compromise between the nurses’ and the patients’ demands could be conducted.

Overall strengths and limitations

Since the study was conducted in Australia, the significance of the outcomes may be restricted to the identified area. The use of DCE, however, is an evident strength as the framework helps improve the accuracy of the results.

Application to practice

The results can be used to shape the current approach to the BH process and make it more patient-oriented.

Paper Discussion

According to Lu et al. (2014), there is an unceasing need in the enhancement of the personalized framework usage. Despite the fact that the significance of a patient-centred strategy is quite self explanatory, it is still neglected in a variety of nursing institutions, the study outcomes show. Hence, it is imperative to apply the approach that will help concentrate on meeting the specific needs of every single patient, at the same time maintaining the uniform nature of the nursing tool.

Spinks et al. (2015), in their turn, focus on addressing the issue of communication, evaluating the efficacy of the Discrete Choice Experiment Protocol as one of the tools for transferring the essential information to the target audience. At this point, however, one must mention that Spinks et al. (2015) considers the conversation issues that emerge between nurses in the course of BH as opposed to the problems that the patients may have due to the lack of communication with the staff members. More importantly, the author addresses some of the most debatable issues of the contemporary nursing environment, i.e., the patient burden, therefore, touching upon the problem of the workplace burnout. Despite the fact that the authors never mention the latter directly, they make it quite obvious that the issue remains a significant impediment to the quality services provision in the setting of most modern facilities: “To decrease patient burden, nursing shift managers will first assess if a patient is considered to be eligible and ask if they are willing to be approached by a researcher with more information” (Spinks et al. 2015, p. 6). One might argue that the time issue touched upon by the authors is mentioned as causing fewer issues nowadays than it used to several years ago due to a shift in the nursing focus:

Previous researchers have demonstrated that nurses felt pressured and lacked time to conduct bedside handovers. However, contrasting views were shown by Anderson and Mangino who found nurses’ perceived bedside handover to be less time-consuming compared to Jeffs et al. who found it to be more time-consuming. (Spinks et al. 2015, p. 2)

Indeed, there are indications of significant changes in the time management framework applied to the process of BH in most nursing facilities, as the research by Spinks et al. (2015) shows. Nevertheless, numerous issues remain unresolved, the issue of confidentiality as an essential part of the identified phenomenon raised by Chaboyer et al. (2010):

Handovers should occur in places that allow patients the chance to hear what is being said, correct any misinformation and ask questions about their care. While there is evidence that in general, nurses support patient participation, nurses control the physical location for bedside handover, not always conducting handover at the bedside, instead standing outside the patient’s room or at the nurses’ station which may hinder patient participation. (Spinks et al. 2015, p. 1)

In other words, the tendency for the researchers mentioned above to incorporate different aspects of the problem into account can be deemed as an admittedly important feature that makes their studies quite credible, and the results thereof worth being taken into account. It is quite peculiar that the significance of the patient-centred care has been acknowledged and reinforced by every single paper analyzed. For instance, much like to Lu et al. (2014), Chaboyer et al. (2010) also insist that the current framework lacks the application of a patient-focused therapy desperately: “Although our interview participants explained legitimate reasons for this low participation rate, it appears that nurses must work to actively involve patients” (Chaboyer et al. 2010, p. 32).

It could be argued that each of the papers focuses on an entirely different aspect of the patient-centred approach; indeed, while Lu et al. (2014) stress the need for nurses to locate the unique needs of patients as far as their diagnoses are concerned, Chaboyer et al. (2010) insist that the nurses should maintain consistent communication with the target audiences to facilitate feedback and, therefore, make sure that the target audience should understand the implications of the therapy, as well as the severity of their condition, the steps taken by the nursing staff to maintain their health rates bearable, etc. Spinks et al. (2015), in their turn, address a different aspect of the patient-centred framework by pointing out the necessity to encourage the patient to participate in the BH process directly (i.e., share the relevant information with the nurses, explain what changes they have been experiencing, commenting on their current health record, etc.).

Despite the fact that the implications of the studies seem strikingly different, all of them address an essential issue regarding the importance of the patient-centred approach.

Furthermore, the time-related concerns must be mentioned. Although Lu et al. (2014) do not mention the issue of time directly they address the problem concerning the number of errors committed in the course of tending to the needs of customers. Given the fact that the errors committed in the course of the nursing services provision are related closely to the density of the schedule, the research can also be considered related to the issue of time management, though with a rather big stretch. Therefore, it could be assumed that the authors also adders the issue of the busy schedule, which nurses often have to face, and which affects the quality of the BH process to a considerable extent.

Furthermore, each of the articles contributes to proving that the phenomenon of BH has a tremendous significance in the contemporary nursing practice and, therefore, should be preferred to other tools despite its evident problems. Each of the studies makes it quite clear that BH is extremely useful as the means of transferring the patient’s data to another nurse so that the demands of the customer could be met and that the required objectives could be attained in the course of the theory or the intervention. For instance, Lu et al.’s (2014) study, which purports for conveying the opinions of the patients and, therefore, provides an opportunity to view the process from the patient’s perspective, claims that customers are very supportive of the idea of BH once it is done correctly: “It is apparent that patients were supportive of bedside handover as this patient-centred practice improved communication and changed the social dynamic of the traditional nursing practice” (Lu et al. 2014, p. 457). Therefore, the authors of the paper insist on the necessity to continue the BH practice as an integral part of the contemporary set of the nursing services and one of the most successful strategies for carrying out the process of information transfer.

Review of Practice

The unit that I work in does not imply the use of BH. As a result, the patients’ privacy is not an issue; more importantly, the concern for the customers’ personal data safety is the reasons for the nurses to abstain from carrying out the BH procedures. In light of the fact that the nursing facility in question caters to the needs of VIP clients, who have extensive financial resources for creating the environment, in which they are most comfortable, the usage of the BH procedures was abandoned as it was bringing the satisfaction rates among the patients down.

The reasonability of the approach used at the identified nursing facility, however, can be questioned. Indeed, as the studies mentioned above have shown, there are a number of advantages that the offers, particularly, in terms of improving the quality of the services provided to the target population. Indeed, as the studies reviewed above have shown, despite evident problems in the modern design of BH, it, nevertheless, serves as a powerful tool for transferring the crucial information from one nurse to another: “Nursing bedside handover in hospital has been identified as an opportunity to involve patients and promote patient-centred care” (Spinks et al. 2015). Thus, dismissing the identified framework as a completely unnecessary element of the nursing practice would not be an adequate step to take. However, it needs to be altered so that the people whose needs the nurses cater to in the facility could feel secure.

The fact that the patients in the facility under analysis have separate wards can be viewed as the direct indication of the opportunities for carrying out an improved BH process. Seeing that the threat of other patients overhearing the conversation between the nurses is one of the most common causes for concern among the customers, the availability of individual wards can be interpreted as a premise for successful BH implementation (Lu, Kerr, & McKinlay 2014).

The fact that the patients at the identified facility do not want to be disturbed during the handover process, however, may be an impediment to the successful implementation of the strategy. Seeing that BH requires a patient-centred approach as stated above, it is desirable that patients should engage in active communication with the nurses. The customers at the facility in question, however, prefer not to be bothered in the course of the BH. Therefore, asking them to participate may cause the subsequent drop in satisfaction. The incorporation of the tools for a rapid and successful data transfer, however, may solve the problem. By using the devices that will allow receiving the corresponding patient information fast, nurses will be able to carry out the essential procedures without disrupting the patient’s daily routine and creating the environment in which one is likely to feel uncomfortable.

Therefore, it is recommendable that BH should be included in the set of strategies used at the facility mentioned above. Despite the problems that the BH practice has, it will serve as the tool for improving the quality of services.

Recommendations and Conclusions

It is strongly recommended that the issue regarding the communication between the nurse and the patient should be addressed properly. It could be argued that some of the patients may be unwilling to engage in regular communications with the nurses; indeed, the study by Chaboyer et al. (2010) has proven that patients were quite reluctant to converse with nurses: “It was interesting that, despite being intended as a patient-centred approach, patients actively participated in less than half of observed handovers, a finding also confirmed in a survey” (Chaboyer et al. 2010, p. 32). After more detailed scrutiny, however, the authors of the study admitted that the lack of engagement among the patients could be attributed to the nurses’ failure to engage the patients: “Although our interview participants explained legitimate reasons for this low participation rate, it appears that nurses must work to actively involve patients” (Chaboyer et al. 2010, p. 32). Therefore, a strategy for patient engagement should be designed for the identified setting. When considering the tools that will allow for a more active participation in the BH process, one may consider improving the quality of communication between the nurse and the patient in general. Specifically, the use of innovative IT tools should be considered as an option. For example, the adoption of the latest technological advances in the IT realm must be viewed as an option for improving the quality of the handoff communication between nurses. Thus, the time issue mentioned above will be addressed successfully, allowing nurses to save time and transfer the necessary data within a very short amount of time.

Reference List

Chaboyer, W, McMurray, A, & Wallis, M 2010, ‘Bedside nursing handover: A case study’, International Journal of Nursing Practice, vol. 16, no. 1, pp. 27–34.

Lu, S, Kerr, D, & McKinlay, L 2014, ‘Bedside nursing handover: patients’ opinions’, International Journal of Nursing Practice, vol. 20, no. 5, pp. 451–459.

Spinks, J, Chaboyer, W, Bucknall, T, Tobiano, G, & Whitty, J A 2015, ‘Patient and nurse preferences for nurse handover—using preferences to inform policy: a discrete choice experiment protocol’, BMJ Open, vol. 5, no. 008941, pp. 1-9.

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