Georgia Tobiano1, Tracey Bucknall2, Ishtar Sladdin3, Jennifer A Whitty4, Wendy Chaboyer5. 1. Menzies Health Institute Queensland, Griffith University, Gold Coast Campus,Parklands Drive, Southport, QLD 4222 Australia. Electronic address: g.tobiano@griffith.edu.au. 2. Centre for Quality and Patient Safety, School of Nursing and Midwifery, Faculty of Health, Deakin University and Alfred Health, 221 Burwood Hwy, Burwood, Victoria 3125, Australia; Alfred Health, The Alfred, 55 Commercial Rd, Melbourne, VIC 3004 Australia. Electronic address: tracey.bucknall@deakin.edu.au. 3. Menzies Health Institute Queensland, Griffith University, Gold Coast Campus,Parklands Drive, Southport, QLD 4222 Australia. Electronic address: ishtar.sladdin@griffithuni.edu.au. 4. Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, United Kingdom. Electronic address: Jennifer.Whitty@uea.ac.uk. 5. National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222 Australia. Electronic address: w.chaboyer@griffith.edu.au.
Abstract
BACKGROUND: Numerous reviews of nursing handover have been undertaken, but none have focused on the patients' role. OBJECTIVES: To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. DESIGN: Systematic mixed- methods review. DATA SOURCES: Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. REVIEW METHODS: Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. RESULTS: Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barrier to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. CONCLUSIONS: Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and patient views. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
BACKGROUND: Numerous reviews of nursing handover have been undertaken, but none have focused on the patients' role. OBJECTIVES: To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. DESIGN: Systematic mixed- methods review. DATA SOURCES: Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. REVIEW METHODS: Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. RESULTS: Segregated synthesis of research of patients' perceptions revealed two contrasting categories; patient-centred handover and nurse-centred handover. Segregated synthesis of research of nurses' perceptions included three categories: viewing the patient as an information resource; dealing with confidential and sensitive information; and enabling patient participation. The segregated synthesis of QI projects included two categories: nurse barrier to enacting patient participation in bedside handover; and involving patients in beside handover. Once segregated findings were configured, we discovered that the patient's role in bedside handover involves contributing clinical information related to their care or progress, which may influence patient safety. Barriers related to nurses' concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. CONCLUSIONS: Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and patient views. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
Authors: Anne Maria Eskes; Anne Marthe Schreuder; Hester Vermeulen; Els Jacqueline Maria Nieveen van Dijkum; Wendy Chaboyer Journal: Int J Nurs Sci Date: 2019-09-12