| Abstract |
Background: Nursing handover is a process that has been carried out in almost all hospital nursing departments for decades. Nursing handover is defined as the transfer of necessary information between nurses at the change of shift, together with the relevant authority, accountability and responsibility
Aim: The aim of this study was the recording and qualitative assessment of the information and processes involved in nursing handover, oral and written, and how it contributes to the improvement of the nursing care provided. The individual aims of the study are determining the type of information, whether the information is incorporated in nursing practice, and finally the views of the nurses themselves on the handover process and the utility of the information provided in nursing care.
Methods: This observational study was carried out at the University General Hospital of Heraklion, in Crete, Greece, from November 2015 to February 2016. The sampling framework and field of study consisted of eleven clinics out of twenty-seven chosen by stratified random sample design; the clinics participating in the study represent the whole spectrum of medical and nursing care offered by a university hospital in Greece (internal medicine, surgical, pediatrics). The sample originally consisted of 11 oral and written nursing handovers by 22 nurses (3 males/19 females, mean aged 39.3±8.2yrs) who worked shifts on a specific day in the nursing departments and were included in the study based on the hospital shift schedule. Unstructured observation by the researcher, together with a recording audio system, was selected to collect the data in the nurses’ office in the eleven clinics, due to the fact that it leads to the observation of behaviors, interaction, communication and also characteristics such as the quality of the information transferred and the creation or otherwise of action plans to ensure effective nursing management of patients. The data were personally gathered by the researcher, who did not participate in the process in any way. Α semi-structured questionnaire developed by the researchers was also used to collect the data, together with a recording audio system. Six open-ended questions were developed using the international bibliography combined with the researchers’ clinical experiences. These questions were asked face-to-face, addressed to the outgoing and the incoming nurse, allowing us to exploring human experiences and views of nursing handover. In the present study, the researchers, having informed the participants and obtained their written permission, allowed them to choose where the interview would take place and recorded the data arising during the interview. The whole process took an estimated 25 minutes for each interview. Ethical approval was obtained from the Research and Bioethics committee of the University Hospital of Heraklion (Crete, Greece). Data were analyzed using SPSS software (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp). Frequencies of the characteristics were estimated based on clinics or/and department categorization. Binomial and chi-square (χ2) tests were used in comparisons of responses or using 95% confidence intervals (95%CIs). Hierarchical cluster analysis was performed in order to identify relative and homogeneous factors groups. Finally, a content analysis method was used for the systematic codification of the qualitative characteristics identified by the questionnaire and recording transcription. A cluster analysis was also performed in order to identify relative and homogeneous clusters or neighborhood groups as key phrases for each question. Common views, convictions, admissions and deficiencies were observed in the participants’ responses on the nursing handover process. The data of 22 interviews in total were categorized by two independent researchers in the study to ensure credibility. Each category was identified using the basic recording unit of keyword/concept in participants’ answers. The data were finalized following full agreement between the two researchers on including the terms, and the intercoder agreement was k=0.91. Finally, the coders discussed their differences and reached a consensus.
Results: Nursing handover mainly involves medical instructions and nursing outcomes. The criteria by which the nurses determined which pieces of information were significant to transfer to the next shift were the medical instructions, the patient's hemodynamic condition and the care plans implemented by the previous nurse, and also depending on the patient's condition. The information was mainly drawn from events occurring in the previous 24 hours, from the medical instructions, the medical history, the doctors and the nursing outcomes, and to a lesser extent from the events of the previous shifts and the nursing folders. It is important to note that none of the participants had received, as they stated, any training in the handover process. A non-significant difference was observed between the nurse delivering and the nurse receiving the shift in the mean percentage of answers to all six questions as well as between <20 or 20+ years' experience (p > 0.05). Finally, a significant difference (p≤0.05) in the mean percentages of answers to the six questions was observed between the Pediatric and the Internal Medicine departments and between the Surgical and the Internal Medicine departments. Twenty-two nurses participated in the study, of whom 86.4% were female, while the mean age was 39.3±8.2 years. According to the study participants, nursing handover mainly involves medical instructions, detailed records of each patient's general condition, drug administration guidelines and nursing outcomes. Interviewees’ responses revealed many requirements, deficiencies, experiences and convictions. The main characteristics were Fixation on patients’ clinical condition and management, Lack of systematic and common nursing handover implementation method, Lack of faith in their scientific knowledge and skills, Need for systematization of and critical approach to information, Significant parameter for provision of optimum health care, Need to design care plans based on best practice and Need for training.
Conclusions: Our study looked at how this complex and vital procedure is structured and handled by the nurses involved, ensuring patient safety and consistent quality of care. It succeeded in highlighting the importance of organized, standardized and up-to-date handovers, and the fundamental part they play in the health care system. Nurses’ opinions, convictions and experiences showed that effective nursing handover can only be achieved through clearly defined clinical processes, using nursing diagnoses, and by extension through the implementation of best nursing practice. A necessary precondition for achieving nursing handover is nurses’ training on the importance of clinical information transfer, in order to ensure patient safety.
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Η αποτίμηση των πληροφοριών των νοσηλευτικών ενημερώσεων σε ένα νοσοκομείο στην Ελλάδα
