Barriers and Facilitators for the Use of NURSING Bedside Handovers: Implications for Evidence‐Based Practice

Abstract

Background: Previous studies on bedside handovers have identified nurse-related barriers and facilitators for implementing bedside handovers, but have neglected the existing ward's nursing care system as an important influencing factor. Aims:To determine the association between the existing nursing care system (i.e., decentralized, two-tier, or centralized) on a ward and the barriers and facilitators of the bedside handover.Methods: Structured individual interviews (N = 106) on 14 nursing wards in eight hospitals were performed before implementation of bedside handovers. The structured interview guide was based on a narrative review. Direct content analysis was used to determine the nursing care system of a ward and the degree to which barriers and facilitators were present. Pearson's Chi-square analysis was used to determine whether there were associations between the nursing care systems concerning the presence of barriers and facilitators for implementing bedside handovers.Results: Twelve barriers and facilitators were identified, of which three are new to literature: the possible loss of opportunities for socializing, collegiality, and overview; head nurse's role; and role of colleagues. The extent to which barriers and facilitators were present differed across nursing care systems, with the exception of breach of confidentiality (barrier), and an existing structured handover (facilitator). Overall, nurses working in decentralized nursing care systems report fewer barriers against and more facilitators in favor of using bedside handovers than nurses in two-tier or centralized systems.Linking Evidence to Action: Before implementing bedside handovers, the context of the nursing care system may be considered to determine the most effective process to implement change. Based on these study findings, implementing bedside handovers could be more challenging on wards with a two-tier or centralized care system.

Barriers to and Facilitators of Bedside Nursing Handover

“…28 The head nurse was a fundamental reference point, ensuring that the data were processed and forwarded by all staff members. 38 Through BNH, patients reported that they became aware of the organizational patterns in the hospital. 25,27,35 They would call nurses less because they were more aware of the nurses' schedules and did not want to risk…”

“…28,33,35 They were particularly concerned about the privacy violations that could occur due to the presence of other patients or caregivers. 27,28,31,35,38,44 The greatest challenge was to pass relevant information to incoming colleagues while maintaining confidentiality. 41,45 Patients perceived their medical data as sensitive and considered information about sexually transmitted diseases or addiction problems to be discriminatory.…”

“…42 Nurses described that BNH facilitated communication between professionals because it is a structured method. 31,38 BNH promoted the use of specialized language, which in turn reassured patients of nurses' competence. 28,29 The structure of BNH also facilitated its execution and provided a guide for less experienced colleagues and students.…”

Influencing Factors of Nurses’ Practice during the Bedside Handover: A Qualitative Evidence Synthesis Protocol

“…In 2007, the World Health Organization, in its report, “Communication During Patient Hand-Overs”, recommended healthcare workers adopt a set of strategies to increase handover safety, among which included patient participation [ 3 ]. Since then, several studies and experiences about the change to the Nursing Bedside Handover (NBH) have been reported [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. This type of clinical handover is distinguished by the patient-centered [ 11 , 12 ] and family [ 13 , 14 ] approach, by the direct involvement of patients [ 6 , 15 , 16 ], care givers, and relatives [ 17 , 18 , 19 ], and by inciting nurses to ask questions [ 10 , 20 ] and to express their opinions or comments in the handover [ 21 , 22 ].…”

An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study

“…Unfortunately, the world's countries were not universally proactive in addressing this recommendation and implementing structured, evidence-based handovers to improve patient safety and the continuity of care. Countries such as Australia, Belgium, China, Spain, the United Kingdom of Great Britain and Northern Ireland, the United States, and the Netherlands developed national and regional standards for nursing and interprofessional handovers [4,[10][11][12][13][14][15][16]. Despite a recent systematic review by Bukoh and Siah, which demonstrated that structured handovers reduced incidences of patient complications, medication errors, and general adverse events, none of the handover standards examined had been designed using a robust evidence-based methodology.…”