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Nurses in Handover Communication Analysis

Abstract

The study represents the evaluation of communication between nurses in handover reports in ward setting. This present the guide and design to improve and develop of flow nursing communication. The information takes place between the nurses is to be said complex. Furthermore, it is not yet known how the barriers and so other problems can be removed as these are the elements of the total issue. We mainly focus on to acquire the understanding of the communication pattern that used to support information transfer during the shift change. The paper begins with the introductory concept of the topic. What is the role of it in medical health care as well as in our daily life. The importance of the issue has been discussed clearly. How it can cause problems in the safety of patient care is also in the discussion. The background of the handover report has been focused on the relevant issues. The role of nurses and their impact on the success of patient’ safety has been focused. In the function of shift change the communication between the nurses in handover report has got the attention. It is expect to develop a set of design implications to support the elements of the communication of handoffs.

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Literature review

The main theme of the total paper is to find the details on the communication in handover reports in ward settings. The abstract of the paper has been discussed at the beginning of the paper. In the total paper some keywords have used such as communication, nurses handover reports, shift change, information flow, impact, patient safety. To complete this thesis paper articles from various sources have been used. At the beginning just after the abstract introductory concept present the clear picture about what we are going to do. After that the background of the topic has been specified to understand more clearly.

Then there is an attempt to give the concept of handover report. How and when these features are used, has got the attention. The communication in content of shift change has focused elaborately. As it is known in everywhere there is an impact of technology whether it is negative or positive. So, at next it has been tried to emphasize on the technology and how it affects & play a major role to run the communication. The role of leadership is also the issue that needs to discuss to improve the communication and many aspect of leadership has mentioned. The complication regarding the issue is very vital thing that has been showed up. Why the issue is perceived worthy to research and why the topic has been selected got the points here. In next there is a questionnaire section by which the real theme of the total paper has been given.

Introductory concept

“Any patient in hospital may become acutely ill. However, the recognition of acute illness is often delayed and its subsequent management may be inappropriate” (CG050. (2007). Clinical work has become more complex due to the increasing population, increased reliability on the technology and for so many other factors. So it becomes necessary to redesign the service delivery. The communication between nurses in handover reports in ward setting is the substantial part of the healthcare daily routine. It is very much essential to make efficient and effective flow of information between the nurses in consecutive shifts. If there occurs any gap between the senders and recipients, then the shift work become very much difficult.

It is because when there is separation then wrong and misunderstanding is must. The handover reports by the nurses is a primary practice It is the total program of several elements such as mental recollection, verbal reports, white board chart, both printed and digital records, printed and handwritten notes. It has to be said that the communication between the nurses in the time of shift change is most probably unreasonably complex. It is very crucial to study and understand the process in the hospital ward, how communication happens between the nurses in handover reports at the time of shift change. What methods they actually use, what type of barriers are involved, what are the other problems and what problems the nurses face with the existing system while they seeking the required information are the million dollar questions. “Communication of information between healthcare providers is a fundamental component of patient care” (Alvarado, et. al. Sep. 2007).

Background

“It is quite likely that with increased acuity and shortened lengths of stay, the work undertaken by nurses has changed” (Duffield, 2005). It is an important practice of report handover by the nurses in content of exchanging the medical information and is a fundamental issue of health care delivery. There is no doubt that the unacceptable and ineffective information transfer can hamper shift work as well as the total function of the medical. It has a massive impact on the entire shift and the overall process of healthcare extended to patients. The information shared during the shift change is of paramount importance.

Notably, the ineffective handover reports in ward setting may lead the wrong treatment, make delays diagnosis, increased the complaints and health care expenditure, and increased hospital length of stay and so many other problems which has direct effect on the health system. Sometimes a number of relevant information misses because of the misunderstanding and distractions. Furthermore, the privacy of the nurse or patients is also an important factor to consider.

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What is handover communication?

“Handover is seen as an important part of each nurse’s shift, not only for information sharing, but from the resource management aspect of both the time and the subsequent financial cost of nurses being involved” (Singh, Thomas, Petersen, and Studdert. 2007). At first it is needed to understand the term “handover communication” and the other synonyms terms that are used in several contexts and clinical settings. There are many relevant terms such as handoff, sign over, cross-out, cross-coverage, and shift change report. The term handover can be defined as “the transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify and confirm” (Friesen, et. al. n.d.). The function of handover is complex and comprises the communication between the shift change, communication between care planners with care providers about the

The benefits from the good handover communication reports:

  • Surety of the safety: – effective handover communication increases the reliability, morbidity and mortality.
  • Less possibility of wrong care: – there is the less possibility of discontinuity of care
  • Reducing the repetition: – the patient become bored, when they answer the same question over and over again.
  • Improve the service satisfaction: – The good handoff reports improve the satisfaction of the patients.

Communication during shift change

“To provide the best possible healthcare to patients, nurses working in different shifts must work collaboratively to ensure all the tasks pertinent to patient care are carried out properly” (Tang and Carpendale, 2006). There are two types of information used to communicate in the time of shift change. One is incoming nurse assembles information and another is outgoing nurse assembles information. Most of the features are same in the function of both incoming and outgoing nurse assembles information. It is understandable that, when the shift ends then another shift starts and the whole process goes in the same manner. In the function of incoming assembles the nurse make complete of the patient care paper-based summary and then prepare the patient chart. All these information are received from the previous shift. This handover is the instruction that the charge nurse give to the incoming nurse staff. And the whole process runs in this systematic manner. In content of incoming assembles, the example note sheet is empty but at the end it become full.

“Comparison of some of the studies reviewed suggests that there are ‘between ward’ differences in behaviour and attitudes towards computerisation that deserve further consideration” (Reviewing the evidence on nursing record systems by Christine Urquhart and Rosemary Currell)

Role of leadership

The key issues of leadership:

  • To make dignity a high priority it is very much necessary of board level commitment.
  • There is no doubt that a strong leadership has the ability to make a difference.
  • It is needed to make a clear communication to the staffs about the commitment.
  • Though every trust is not clear to dignity issues especially for the older people, but most of the trusts were embedded within other policies. In the case of medical, trusts must be express clearly about their commitment and so other issues.
  • There must be some implementation of several relating policies that can be applied on individual wards, which caused differences.
  • There is the possibility to not receiving the reports on dignity.
  • It is strongly recommended that trusts should give a pattern for staff and patients to make them confrontation in dignity without fear.
  • The trusts need to make the link with community organizations and make sure of responsive to the population needs.

The strong leadership consist of the essential characteristics, such as clear policies, ability to provide a lead to dignity issues, working ability in partnership issues, communication and promise to learn. The philosophy of dignity is to be applied in every aspect of the care organization. It is clear requirement to make sure of the commitment to the top level, strong leadership at all levels, reliable policies which make sure of two-way communication process between the care planners and care providers.

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The experience is important to make the policies and other relevant issues active to the changing expectation of the organization. For this, it is vital to ensure the mechanisms which are communicated to all levels. Besides this, the feedback is also play a major role to make the policies effective. Only the reliable commitment can ensure the total function of dignity successful. The handover reports in ward setting is the mechanism for transferring information, initiative responsibility and so others from the off going staff to oncoming staff. Conceptually, the information about the patients’ situation, the communication patterns between the sender and the receiver, the care for transfer responsibility, internal cultures and systems which affect patient safety and so other relevant information are to be provided by the handover reports. There is the risk of patient safety, if the information, communication methods and various factors become complex and undependable. It has a larger negative impact on the efficiency and effectiveness of the handover communication report.

Role of Technology

“Shift handover plays a pivotal role in the continuity of patient care in 24-hour nursing contexts” (Kerr P. Micky. (n.d.).There are some sources by which the nurses maintain their daily shift working communication in handover report settings. These sources may be verbal or may be paper based. The sources are:-

  1. The patient care summary on the basis of paper and so others written consults that includes laboratory and diagnostic results.
  2. The instruction given from the charge nurse and also the verbal handover from the nurse of previous shift.
  3. The patient information which displayed on large whiteboards and the information of the nurse staffs.
  4. The digital records of patient

The methods used in handover communication

Methods of handover, Hamilton Health Sciences
Methods of handover, Hamilton Health Sciences, 2002.
  1. Paper
  2. Taped
  3. Whiteboard
  4. Verbal

Hamilton Health Science (HHS) is a one thousand-bed regional tertiary care facility that has five different hospitals and also a cancer centre. HHS provides service to more than 2.2 million residents of Hamilton and Central South and Central West Ontario. The facility provides over 3400 registered nurses and registered practical nurses. These nurses are involved in communicating patient information.

The complication

Health care now-a-days has become more functional and more specialized. It is now a wide area that ensures simpler and flexible health care facilities, which was more complex just few years ago. Notably, there are some possibility that may occur, if improper health care system makes the gaps in patient care and breaches. “Any errors or omissions made during the handover process may have dangerous consequences” (Pothier David, et. al., n.d.). The risk may be of medication errors, wrong site surgery and may cause the patient deaths. The environment of the clinic is very dynamic and challenging for the health care provider, health care planner, patients and families. As for example, if the nursing units discharge 45 percent to 65 of their patients every day.

So there is the possibility to make the mistake that may lead to the breaches. Therefore, the dynamic and specialized technology has some risks that can provide serious risk to health care delivery as well as the function of handover reports. As the health care has become more complicated because of the advanced technology that have the motive to reduce the riskiness of lives and increase the quality of life. So to increase the patient safety and to deliver the better quality of life, the issue of handover report communication can not be ignored as ineffective handoffs can lead to a host of patient safety problems. So, therefore, the improvement of strategies in this area to ensure overcoming these problems is essentially required.

“An examination of how communication breakdown occurs among other disciplines may have implications for nurses. A study of incidents reported by surgeons found communication breakdowns were a contributing factor in 43 percent of incidents, and two-thirds of these communication issues were related to handoff issues. The use of sign-out sheets for communication between physicians is a common practice, yet one study found errors in 67 percent of the sheets. The errors included missing allergy and weight, and incorrect medication information. In another study, focused on near misses and adverse events involving novice nurses, the nurses identified handoffs as a concern, particularly related to incomplete or missing information.” (Friesen, et. al. n. d.)

Challenges to continuity of information

  • The increased number of patients
  • The flexibility that make the consultant changes
  • Involvement of a number of specialist teams
  • Lack in implementation of proper knowledge
  • Insufficient efficient workforce
  • Unnecessary movements of patients between wards and departments though there is no knowledge of doctor.

“Maintaining continuity between shifts is important, not only in the offshore sector but in all continuous process operations” (Duffield, Christine 2005). Both the nurses and intensive care unit (ICU) are surrounded on the basis of perception. The patients are discharged from the ICU to the ward-based care and at that time it needs to maintain the effective communication. In that cases the handover report in ward settings is important to maintain. The study is also to find out the managing change of nursing handover whether it is traditional or modern. There is the issue of verbal handover that has been derived from the written information. “The shift handover forms an important part of the communication process that takes place twice within the nurses’ working day in the gynaecological ward” (Kassean, and Jagoo. 2005).

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Information assembly and information disassembly during shift change.
Figure: Information assembly and information disassembly during shift change. Source: (Tang and Carpendale, 2006).

Why the issue is perceived as being worthy of research

“One of the most important tasks that a nurse faces in the emergency room, when receiving a patient, is handover and the triage function” (Bruce, and Suserud, 2005). The research is to get the findings of fundamental and important information regarding the communication at the time of daily shift change. The selection to study on the nurses instead of other relevant clinical shift work is a considerable matter. It is known that, nurses are the closest of patient care, spending most of their working time on patients care. The quality of the patients care is largely influenced by the information the nurses get during the shift change. Handover is such a thing that gives the nurses a better opportunity to communicate important medical information. It is to be said that, “Nursing handover or verbal report is different in every unit” (Bruce, and Suserud, 2005).

An example of wrong maintenance

It is very much imperative to give the workers guidance to improve health and safety. How the misunderstanding in the communication of shift handover may create a serious problem. As for example, a man was seriously injured while he was getting the treatment in high pressure line to repair a valve. The accident occurred because of the fault by the workers while they isolated the valve. They knew the isolating valves were not operating, so they shut down the drain-line again. They left a message for the next shift to re-open first to blow line down. Somehow, during the shift handover, the message was not passed on. A fitter removed the clamp bolts and give pressure instead of loosening them. The pressure increased and blew apart. The fitter become very serious injured which will not be fully recovered.

Questionnaire section

The communication in the handover systems on two American very different pediatric wards were selected as case studies, in each ward, 35 handovers were observed and 25 individual and two-group interviews on the nursing staff were conducted. The research was approved by hospital authority. The participants were fully informed about the research.

Dear participant,

I am going to conduct a study on “communication between nurses in handover reports in ward setting” for the requirement of a research. The findings of the study will help me to understand the communication pattern between the nurses in handover reports. The answer will be used for academic purpose only. All information you provide will be strictly confidential.

It would be very much appreciated if you answer all the questions carefully. The following questions are fairly simple and easy. Your true and careful opinion is highly encouraged for conducting the study smoothly.

Important

  1. Please read every question carefully and answer.
  2. Please do not omit any question
  3. Please tick (√)or write where it is necessary

Question regarding personal matters

  1. What is your age and rank?……………………………………………….
  2. Since when you are working here?………………………………………………
  3. What is your working time?………………………………………………………
  4. What are the restrictions in the field of communication with others in handover reports?………………………………………………
  5. What type of method is used in the shift change? Verbal written taped whiteboard
  6. Do you feel that a good leadership can make the differences?
    1. Yes
    2. No
    3. Don’t know
  7. What makes you to work here?………………………………………………
  8. Is there sufficient service provider?
    1. Yes
    2. No
    3. Don’t know
  9. Have you ever seen any complexity regarding shift change?
    1. Yes
    2. No
    3. Don’t know
  10. Has everyone the adequate knowledge of technology used to communicate.
    1. Yes
    2. No
    3. Don’t know
  11. As a patient care provider, are you satisfied with the facility?
    1. Yes
    2. No
    3. Don’t know
  12. Why you are satisfy/why you are not satisfy?………………………………………………
  13. What should be the criteria the organization needs to implement?………………………………………………
  14. Have you the good interrelation with the other colleagues?
    1. Yes
    2. No
    3. Don’t know
  15. What is your recommendation to improve the communication?………………………………………………

Thank you for your active cooperation.

Outcome: the outcome of the survey was very complex. The responses of two different wards were not same. One group was very cooperative that indicates their commitment to their work. On the other hand was responding rather differently.

Critique on some relevant articles

Reviewing the evidence on nursing record system by Christine Urquhart and Rosemary Currell

It should have mentioned how the continuity of information can be ensured to make safety of the patients. It is not easy to run the information handover in a general way. There is a compulsory need to increase the number of individuals caring for patients. Now clinical information is the most important issue in handover reporting. Good and effective handover is such thing, which can be happened by chance. To make it happened regularly, it is necessary to make sure of involvement of everyone. The issue that the author has not pointed out; such as:-

  • The coordination of the shift change
  • The allowance of the sufficient time
  • There is no recommendation regarding the individual and organizational involvement. Besides this the coordination of shift, time schedule, leadership in handover function, technology information and so other issues has been avoided.

The strong and relevant discussion

  • The study emphasize on the patient safety with the recommendation of sufficient and relevant information that should be exchanged.
  • The handover report has been discussed strongly and strategies for further plan have been put into place.
  • The guide contains the informative advice, best practical example and relevant issues.

There is a reliable discussion on the changing patterns of nursing activities in the clinical handover reports and responsibility of the relevant issues. The recognition of training is essential to maintain in the high standards of handover reports for the safety of the patient care. The implementation of the working time has been acted as the driver of the total success.

Effective shift handover- A literature review, 1996

The article has met the core concept of the relevant issues. It has mainly focused on the care for dignity and the relation between the care provider and the care planner. It reviews available function of handover reports or shift handover. It has mainly defined and examined the key issues of the relevant matters. Effective communication and the implication of effective communication have been focused clearly. The incidents for good communication in handover reports are also explored. A lot of data from the studies and articles have described. The existence information on the issues has been analyzed and also compared with the other knowledge. It makes the sense of best implication of practical knowledge and the opportunity to overcome the related problems and barriers.

Recommendations

There are some strategies that without any doubt help to make the accurate and effective communication in the field of handover reports. It is strongly recommended to follow and maintain these strategies to make sure of the patient safety as well as the clinical goodwill. These strategies are shown through the following table understand it more clearly (Friesen, et. al., n. d.)

problem recommendation Example
1 Sometimes the unclear and abbreviation terms are used, that is not understandable by many people. These terms can be misinterpreted. Use the proper language and avoid the complex terms and abbreviation The term QD and QOD are different terms and abbreviation of different things. QD refers only daily and QOD means the ‘every other day’.
2 Implementation of Ineffective communication techniques Increase the use of effective communication techniques and reduce the interruptions. And apply the check-back and read-back techniques. During the transmission of handover report, a clerk to the nurse and inform her about a patients situation. The nurse may assist to the patient or find someone to help her. During this period there may occur some misinterpretation.
3 Wrong method in the process of shift-to-shift and unit-to-unit Make standardization in the process of shift-to-shift and unit-to-unit activities. The medicine units submit shift-to-shift report of two pages that is used for each patient. The report is well structured, good looking and recovering of postoperative patient.
4 Complex handover report settings To ensure flexible handover between settings Emergency department (ED) is the busiest department of the hospital. The patient must be discharged or released out of the emergency department to ensure the reduction of delay and complexity in the ED.
Less use of technology and inefficient transmission of patient information Proper use of technology to enhance communication and efficient transmission of patient information In the hospital there are electronic records and there is also use of computers. The use of this technology allows the nurses to inform and view the details report of the patient.

“Handover should be a critical communicative process that explores care, rather than a descriptive historical narrative of what has already happened” (Davies, and Priestly, 2006).

Clear statements of research issue

So the statement of the research on the communication between nurses in handover reports is to be said as, “Because of the complexity in the communication process in handover reports, it has a strong and sophisticated impact on the patient safety as well as on the clinical reputation” (Olson, 2005).

Conclusion

Shift handover has a vital role in the continuity of 24-hours patient care in the nursing contexts. The communication occurs is recognized within the term of nursing profession. The clear thought of this study is to understand the better realizing of nursing handover report and the function of communication and its effectiveness. “Transferring end of shift information between nurses via both verbal and written routes in an intensive therapy unit (ITU) setting is complex and multifaceted” (Philpin, 2006). The meaning derived from the above discussion is that Handover is the controversial system to conduct in general way. The outcome of the study was the flexible in managing competing elements as for example when they were unaware about the study then the result is different than knowing about the study.

Bibliography

Alvarado, Kim. et. al. (2007). Transfer of Accountability: Transforming Shift Handover to Enhance Patient Safety.

Healthcare Quarterly, 9(Sp) 2006: 75-79.

Bruce, Karin; Suserud, Björn-Ove. (2005). The handover process and triage of ambulance-borne patients: the experiences of emergency nurses. Nursing in Critical Care, Volume 10, Number 4, pp. 201-209(9).

CG050. (2007). Acutely ill patients in hospital, Web.

Davies S, and Priestly MJ (2006). A reflective evaluation of patient handover practices. Nursing Standard. 20, 21, 49-52.

Duffield, Christine. (2005). Nursing skill mix and nursing time: the roles of registered nurses and clinical nurse specialists. Australian Journal of Advanced Nursing.

Friesen, A. Mary., et. al. (n. d.) Handoffs: Implications for nurses. Chapter 34.

Kassean, K. Hemant. and Jagoo B. Zaheda. (2005). Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius. BMC Nurs. 2005; 4: 1. Web.

Kerr P. Micky. (n.d.). A qualitative study of shift handover practice and function from a socio-technical perspective.

Olson E. Nina. (2005). Complexity, Compliance, and Communication: Why Should Taxpayers: Comply in a Complex and Changing Tax Environment?. Presentation to the President’s Advisory Panel on Federal Tax Reform.

Philpin, Susan. (2006). Handing Over’: transmission of information between nurses in an intensive therapy unit. Nursing in Critical Care, Vol. 11, No. 2, pp. 86-93(8).

Pothier David, et. al., (n.d.). Pilot study to show the loss of important data in nursing handover. Web.

Singh H, Thomas EJ, Petersen LA, Studdert DM. (2007). Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 167 (19):2030-6. Web.

Tang, Charlotte. and Carpendale, Sheelagh.(2006). Healthcare Quality and Information Flow during Shift Change. Web.

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