A Qualitative Study of the Change-of-Shift Report at the Patients’ Bedside

Abstract

Concerns about patient bedside change-of-shift reporting at a community hospital in northern Indiana stimulated the development of this qualitative phenomenological study. A review of the literature revealed a research deficit in acute care nurses' perceptions of bedside reporting in relation to compliance. The research question addressed in this study was, "What are acute care nurses' perceptions of the change-of-shift report at the patients' bedside?" Personal interviews were conducted on 7 medical, surgical, and intensive care unit nurse participants at a community hospital in northern Indiana. Five themes were identified from the collected data, which included the time factor, continuity of care, visualization, and challenges in the communication of discreet information.

Bedside shift report: Nurses opinions based on their experiences

“…Participants of this study reported that one way to minimize interruptions is to conduct BSR using a modified approach, where a portion of hand‐off occurs inside and outside the patient's room. This finding is further validated by a study conducted by Grimshaw et al (2016). Clinical nurses in their study reported that a modified approach should be used to decrease the time BSR takes and ensure all important, information, sometimes sensitive and difficult to discuss in front of the patient, is delivered.…”

“…The findings of this study support the recommendation from AHRQ that some topics are not appropriate to discuss in the patient's presence. This finding is further validated by a qualitative study that found nurses were not able to say everything they wanted to at the bedside for fear of saying something that may upset the patient (Grimshaw et al., 2016). However, this study differed from AHRQ because it found that a modified approach was better, more feasible and made for a better hand‐off than a hand‐off of all critical content at the patient's bedside.…”

“…However, this study differed from AHRQ because it found that a modified approach was better, more feasible and made for a better hand‐off than a hand‐off of all critical content at the patient's bedside. Another study similarly reported that participants in their study felt a modified approach was necessary to ensure that nurses could say everything they needed to say in a timely fashion (Grimshaw et al., 2016). An observational study found the average number of interruptions in the intensive care setting was two interruptions per hand‐off with a range of 0–7 (Spooner et al., 2015).…”

“…One study found that nurses can control hand‐off better if done outside of the patient's room, thus leading to less interruptions (McMurray et al., 2010). Other studies purport that nurses perceived they could not say all of the things they wanted to in hand‐off and were forced to censor information in a way that sometimes led to miscommunication of important information (Bruton et al., 2016; Grimshaw et al., 2016; Johnson & Cowin, 2012; Kerr et al., 2014; Khuan & Juni, 2017; McMurray et al., 2010; Tobiano et al., 2017). As aforementioned, the iPARIHS framework purports that recipients should be allowed to blend practice‐based knowledge with the innovation, to increase the odds of successful implementation (Kitson & Harvey, 2016).…”

“…Nurse bedside shift report (BSR) has been identified as the gold standard because outcomes reported in the literature indicate it improves patient and family satisfaction, nursing quality and patient safety better than the traditional hand‐off outside the patient's room (Grimshaw et al., 2016). BSR occurs at the patient's bedside where patients and their families can participate in the hand‐off of critical content.…”