Bedside handover at the change of nursing shift: A mixed‐methods study

Abstract

Aim To describe the structures, processes and content of bedside handover at the change of nursing shift in an acute‐care context. Background The handover of patient information and care at the change of nursing shift is an essential, albeit risk‐laden, time‐consuming activity in clinical practice. Design A convergent parallel mixed‐methods design was used. Methods Thirty episodes of bedside handover were concurrently audio‐recorded and observed using a researcher‐developed tool modelled on the five domains of the British Medical Association's Safe Handover–Safe Patients framework. The audio recordings were analysed using content analysis. Quantitative and qualitative data generated were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient's bedside during the change of nursing shift. This study followed Good Reporting of Mixed Methods Study guidelines. Results Bedside handover was observed to be mainly conducted at a fast pace. However, within these timeframe large volumes of complex information were shared and important nurse–patient interactions occurred. Analysis of the audio recordings provided evidence that the dialogue during handover was nurse‐dominated and the outgoing nurse appeared to influence the degree of patient participation. Conclusion Bedside handover at the change of nursing shift involves three key stakeholders: outgoing nurse, incoming nurse and the patient. A combination of intricate communication skills both verbal and nonverbal facilitates the rapid sharing of large volumes of complex information which is necessary for the continuity and safety of patient care across nursing shifts. Relevance to clinical practice The comprehensive description of the complexities of bedside handover in this study provides an insight into this frequently occurring, important nursing practice and can be used to support nurse education and practice development.

Effective nurse handoffs

“…5,10 Nurses who have tried NBSR felt they were more prepared to assume the care of their patients and appreciated that they were able to carry out a safety scan during the process. 5,11,12 Successful NBSR requires a flexible standardized reporting process to tailor it to individual patients; for example, to allow for a discussion of sensitive information outside the room to prevent harm to a patient who may have a terminal diagnosis. 5 Patients also need to be informed about this new process to make sure that the handoff is effective.…”

“…This practice has been shown to decrease staff overtime, increase patient and nurse satisfaction, enable the early assessment and direct visualization of the patient during report which reduces handoff errors, enhances patient safety, and reduces adverse events 5,10. Nurses who have tried NBSR felt they were more prepared to assume the care of their patients and appreciated that they were able to carry out a safety scan during the process 5,11,12. Successful NBSR requires a flexible standardized reporting process to tailor it to individual patients; for example, to allow for a discussion of sensitive information outside the room to prevent harm to a patient who may have a terminal diagnosis 5.…”

Shift‐to‐shift nursing handover interventions associated with improved inpatient outcomes—Falls, pressure injuries and medication administration errors: An integrative review

“…Interventions such as the implementation of bedside handover and adoption of standardized handover tools (SBAR, ISBAR) have demonstrated positive outcomes. These outcomes were reported as increased patient satisfaction with the newly adopted handover style (Forde et al, 2020;Hada et al, 2018;Sand-Jecklin & Sherman, 2014), increased nurse satisfaction (Athwal et al, 2009;Jukkala et al, 2012;Thomas & Donohue-Porter, 2012), decreased nursing workload (Bradley & Mott, 2012;Chung et al, 2011;Jukkala et al, 2012) and increased patient safety outcomes such as reduction in patient adverse events and complications (Bradley & Mott, 2012;Chaboyer et al, 2010;Hada et al, 2018).…”

Factors Affecting Nurses’ Experiences Related to Current Handover Process between Emergency Department and In-patient Units

“…Handover can take place in nursing station, conference room, or even at patient bedside that is viewed as the best place where recipient nurse has opportunity to assess patients' general condition. (3,4) Handovers occur in a multitude of environments and situations.It is carried out during times of transition, when nurses discuss the data for patients and plan the next steps for the care of the patient. This transition time often includes entry, therapy and discharge.…”