Bedside Handover Assignment Discussion

Bedside Handover Assignment Discussion

Bedside handover is defined as the delivery of shift handovers from nurse-to-nurse (McMurray et al., 2011). Handovers promote the interchange of information, accountability, and responsibility regarding patients during shifts. In clinical care, handovers are scheduled within a 24-hour- cycle whereby technical, medical and nursing knowledge specific to every patient is supposed to be seamlessly transferred between oncoming and off going nurses with an aim of ensuring patient safety. As explained by Spinks et al., (2015), quality handover information promotes ability to quickly take note of relevant changes in the status of patients and the expected risks and this helps to promote safety in care. Bedside Handover Assignment Discussion

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            In this context, safety refers to being able to reduce risks and prevent errors through effective coordination of numerous aspects of patient care, continuous monitoring, surveillance, identification and interception of hazards and knowing when the status of a patient deteriorates. This means that the information shared during bedside handovers must be accurate, relevant, timely and complete. Present studies lay a lot of emphasis on the handover itself and provide very minimal details on the wider environmental context that handovers take place.

Although it is a commonly used method in nursing, evidence about its compliance, the process of implementation and stakeholders who should be involved to increase the success rates is limited. Evidence-based research reveals that by including patients in the bedside handover process, incidences of miscommunication and the risks that are associated with misleading, inaccurate and incomplete information. On the contrary, in clinical nursing practice, nurses have continuously failed to include patients in handover processes and this negatively impacts patient safety and clinical outcomes. This PICOT paper discusses how patient knowledge in the implementation of handover tends to promote their safety.

Care-Related Gap

            According to the World Health Organization, miscommunication is a key contributory factor to the occurrence of adverse events in hospital settings. For more than a decade, this has been the focus for improvement for most healthcare systems (Whitty et al., 2016). Although it has been possible to achieve some improvement, there are still clinical cases where miscommunication between patients, nurses and other employees has been noted to result to poor clinical health outcomes and endanger patient safety. Bedside Handover Assignment Discussion

More specifically, failure to include patients in routine nursing practices such as daily bedside handovers has been identified as an avenue of relaying inaccurate, misleading and incomplete information. Research reveals that inaccurate information contributes to wrong diagnoses, drug management and care plans which can evidently be avoided. It should also be understood that miscommunication prolongs the duration of stay in the hospital where institutions and patients end up incurring additional medical costs (Street et al., 2011).  It is for this reason that the WHO has concentrated on clinical handovers to enhance patient safety since it is a high-risk area.

Clinical Question

Research has revealed that patients be aware of bedside/clinical handover is an integral aspect of patient-centric care.  Therefore, a good understanding of the perspective of patients tends to provide nurses with a strong foundation to plan handovers that reflect the beliefs and thoughts of patients and to actively encourage their involvement in clinical decision making. Patients place a lot of value in being able to continuously access information. Despite the fact that not all patients may select a similar interaction level, they consider their roles as being essential in ensuring accuracy which generally promotes high-quality care and patient safety.  This, therefore, leads to the following PICOT question:

PICOT Question

Among hospitalized patients aged 18 years or older(P), how does patient involvement in bedside handover (I) compared to the patient non-involvement (C) increase patient safety(O) within 2 days post-admission (T)?

Population Hospitalized Patients Aged 18 years or older
Intervention Patient Involvement  in bedside handover
Comparison Patient non-involvement
Outcome Increase Patient Safety
Time 2 days post-admission

Ethical Issues Involved in Patient Awareness of Bedside Handover

            According to Whitty et al., (2016), a major ethical issue associated with bedside handovers is that of patient privacy and confidentiality which makes its implementation difficult. In most clinical scenarios, nurses fail to protect the confidentiality of patients and to involve them in decision making. During bedside handovers, sensitive patient information is likely to be shared and this presents significant concerns for both patients and nurses.  Nurses have an ethical responsibility to safeguard patient data from unauthorized access (Whitty et al., 2016). The risks of confidentiality are even higher when close family members are involved in bedside handovers. Therefore, in such cases, it is recommended that highly effective strategies that can be used to handle sensitive patient information at the bedside are developed for comfortability of patients and nurses. Some of the most recommended strategies include: developing approaches for handover implementation which are flexible and standardized, providing patients with brochures on bedside handover and including handover practices when assessing the competency of staff (Spinks et al., 2015).

Theoretical Framework

            The most appropriate and recommended theoretical framework for this PICOT is the theory of change by Kurt Lewin and the Diffusion of innovation theory by Roger. This theory or organizational change will be applied to the entire institution and all stakeholders who are directly involved in taking care of patients will be actively involved in the adoption and implementation of the proposed change in different stages (McMurray et al., 2010).  According to the theory of organizational change, the steps followed by an organization to innovate new operating procedures, goals, and ideas are well explained. Bedside Handover Assignment Discussion

The organizational change theory is the most applicable in the implementation of this change since the institution is required to not only recognize but also prioritize patient safety, satisfaction, and clinical health outcomes. As explained by McMurray et al.,(2010), patient safety undeniably leads to quality health outcomes. Nurses should also be involved in supporting change at all points of care. The top to bottom  involvement of patients and nursing personnel  positively influenced bedside handover  through: stakeholder motivation and support  in EBP adoption in the care of the patients, establishment of positive  relations  between nurses and patients  which empowers  them to  recognize  the  need to involve patients in bedside handovers to ensure accuracy and  reliability of information and developing  positive work relations  to strengthen teamwork  which promotes the implementation of an EBP  to deliver effective, efficient and quality care that addresses all patient’s needs(McMurray et al., 2010).

The problem identification, initiation, institutionalization, and implementation of change. Throughout the change process, it is very important to identify the driving and restraining forces so as to recognize the ability to involve all stakeholders in clinical patient care, to build trust, integrate new ideas in clinical care and encourage change.

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Literature Review

In a discrete choice experimental design study by Whitty et al., (2016), the objective was to make a comparison and describe the preferences of nurses and patients on bedside handover implementation. The study was done in the hospital setting of two hospitals and involved 401 patients aged 18 years and older. Exactly 200 nurses were also sampled from medical wards to participate in the study (Whitty et al., 2016). Six characteristics were used in the study to describe patient handover choices as follows: a patient invitation to participate, caregiver/family member invitation to participate, the content of information, patient involvement level, privacy, the number of nurses present (Whitty et al., 2016).

The results confirmed that both bedside handovers was considerate than handovers that took place at any other places. The most vital choices for patients were two-way communication and active participation of a caregiver/friend in the process, and participation of nurses in the handover process (Whitty et al., 2016). Most patients did not prefer their sensitive information to be exchnaged at the bedside whether quietly or verbally. Nurses preferred delicate patient data to be verbally far from the bedside. The study concluded that bedside handover is supported by both patients and nurses and the active involvement of patients improves the experience of patients and clinical health outcomes (Whitty et al., 2016). Besides, the involvement of patients in bedside handover was also evidenced as a safety initiative in care settings. Bedside Handover Assignment Discussion

In another study by Tobiano et al., (2018) which was a systematic mixed-method review, it was noted that there are a lot of reviews on nursing bedside handover but very little or none have focused on the role of the patient. Therefore, the researchers sought to find out how the participation of patients in bedside handovers from one nursing shift to another can be implemented and its effect on patient care (Tobiano et al., 2018). A detailed search strategy that focused on the role of patients was done in several databases. The search yielded 44 articles, 25 of which were QI projects and 21 were studies.

The results revealed two contrast categories: nurse-centered handover and patient-centered handover. It was identified that the role of patients in bedside handover is to provide clinical information associated with the care that they receive that can enhance the safety of patients. Nurses were however worried that patient involvement would promote the sharing of sensitive information and hesitancy. In order to include patients in the process of bedside handover, nurses should receive rigorous training, handovers should be made predictable and both nurses and patients should be included in the change process(Tobiano et al., 2018).

It was concluded that it is important to standardize handovers and make them predictable for patient involvement to promote patient-centric care. However, there are several barriers that may be witnessed from nurse’s perspectives and this requires a lot of caution during clinical implementation (Tobiano et al., 2018).

Khuan & Juni (2017) purposed to popularize the involvement of patients in different care aspects including beside handovers and when changing shifts in order to facilitate patient-centric care. The study objective was to explore the Malaysian nurse’s view on the involvement of patients in the process of bedside handover and whether it promoted patient safety and patient-centric care (Khuan & Juni, 2017). The qualitative-study used 4 focused group discussions with 20 RNs. These nurses were recruited from the general wards of a Malaysian public hospital. Data was gathered through semi-structured interviews to take note of them and analyzed through content analysis (Khuan & Juni, 2017).

Based on the results, most participants used methods that were inconsistent to involve patients in bedside handovers which resulted in ambiguous interpretations of the patient-centric care concept. Besides, the subjective views of most nurses revealed that patient involvement in bedside handover could not work and they were therefore deliberately excluded from the entire handover process. Khuan & Juni (2017) therefore concluded that the changes witnessed during involvement of patients and nursing practice are consistent with patient-centric care. Therefore, in clinical settings, nurse educators are required to reform nursing education to emphasize more on improving communication skills which are integral in maintaining nurse-patient relations. Besides, the subjective views of specific ward nurses should be used to develop guidelines for patient participation in beside handover, which should be consistent with values, beliefs, and practices that are patient-centered (Khuan & Juni, 2017).  Bedside Handover Assignment Discussion

Conclusion

            Bedside handovers undeniably provide patients with a platform to take part in clinical decision making regarding the care that they receive. Patients place a lot of value in being able to continuously access information related to the care that they receive and consider their role as highly integral in promoting safety and quality. Therefore, it is necessary that nurses involve patients in bedside handovers to promote quality care and safety and clinical health outcomes.

References

Khuan, L., & Juni, M. H. (2017). Nurses’ Opinions of Patient Involvement in Relation to Patient-centered Care During Bedside Handovers. Asian nursing research, 11(3), 216-222.

McMurray, A., Chaboyer, W., Wallis, M., Johnson, J., & Gehrke, T. (2011). Patients’ perspectives on bedside nursing handover. Collegian, 18(1), 19-26.

McMurray, A., Chaboyer, W., Wallis, M., & Fetherston, C. (2010). Implementing bedside handover: strategies for change management. Journal of clinical nursing, 19(17‐18), 2580-2589.

Street, M., Eustace, P., Livingston, P. M., Craike, M. J., Kent, B., & Patterson, D. (2011). Communication at the bedside to enhance patient care: A survey of nurses’ experience and perspective of handover. International Journal of Nursing Practice, 17(2), 133-140.

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, 5(11), e008941.

Tobiano, G., Bucknall, T., Sladdin, I., Whitty, J. A., & Chaboyer, W. (2018). Patient participation in nursing bedside handover: a systematic mixed-methods review. International journal of nursing studies, 77, 243-258.

Whitty, J. A., Spinks, J., Bucknall, T., Tobiano, G., & Chaboyer, W. (2016). Patient and nurse preferences for implementation of bedside handover: do they agree? Findings from a discrete choice experiment. Health Expectations, 20(4), 742-750.

Bedside Handover Assignment Discussion

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