Nurses’ Information Management and Use of Electronic Tools During Acute Care Handoffs

Abstract

Little evidence is available about nurses' use of electronic tools during handoffs. This qualitative study explored information management and use of electronic tools during nursing handoffs. The sample included 93 handoffs by 26 nurses on 5 medical/surgical units in 2 western hospitals with a robust electronic health record (EHR). Data collection included audiotaping handoffs, semi-structured interviews, observations, and fieldnotes. The dataset was inductively coded into 33 categories and 5 themes: good nurse expectations for handoffs, paper forms are best, information at a glance, only pertinent information please, and information tools that work. Two-thirds of the nurses abandoned use of the leadership-endorsed electronic handoff form, preferring personal paper forms. The findings suggest effective electronic solutions will require extensive contextually-based information, information integrated across EHR modules and portable, electronic support throughout shifts. This is a call to action for leaders and informaticists as they select and design future electronic tools.

Research on nursing handoffs for medical and surgical settings: an integrative review

“…Most studies did not address the impact of existing care models; while this might impact generalizability, the authors' current research (Staggers et al . , ) indicates that the defining factors include tailoring for patient‐centred and nurse‐centred aspects. Handoff context has not been sufficiently considered, until very recently (Mayor et al .…”

The clinician in the driver’s seat: Part 2 – Intelligent uses of space in a drag/drop user-composable electronic health record

“…Perhaps the most similar and illuminating studies were done by Staggers et al, examining nurses’ use of user-created paper ‘brains’ – summary sheets, each designed by the nurse, which are carried throughout the day and consulted and amended frequently [30–32]. Staggers reports that most nurses eschewed the computerized summaries made available for handoff, preferring their own for several reasons, with customizability and ‘fit to their way of thinking’ being the most important.…”

“…Staggers reports that most nurses eschewed the computerized summaries made available for handoff, preferring their own for several reasons, with customizability and ‘fit to their way of thinking’ being the most important. Other reasons included incompleteness, excessive density, poor layout, lack of changeability, and design not fitted to the way nurses were used to finding or processing information or the way they worked [30–32]. Ability to tailor the report form and take notes was deemed critical by nurses.…”

“…Therefore, they created personalized paper forms that better matched the way they do work and the way they think about patient care. Tailoring was important to fit the individual user - one who had already cared for the patient just needed updates, whereas more information was needed if the patient was new to the nurse[30–32]. Moreover, while not tested in this study, the act of organizing information can itself foster memorability [30–32]; nurses stated that the act of creating these ‘brains’ was itself helpful in promoting appropriate action and decision-making.…”

Nurse Perceptions of Electronic Handoff

“…Through this study nurses expressed a need to continue to use paper handoff tools because they are portable, easily accessible, and a means to write down important notes and cross off completed tasks throughout the shift. (Staggers et al, 2012).…”