Patient, family and nurse experiences with patient presence during handovers in acute care hospital settings: a systematic review of qualitative evidence

Abstract

Objective: The objective of this systematic review was to synthesize the best available evidence on patients’, family members’ and nurses’ experiences with bedside handovers in acute care settings. Introduction: The transfer of patient information between nurses represents a critical component of safety within health care. Conducting handover at the bedside allows patients and families to participate in information exchanges. Studies that address bedside handover highlight benefits and concerns with their implementation. Insight into patients’, families’ and nurses’ experiences with bedside handovers can help to identify the most appropriate and safest approach to handovers. Inclusion criteria: The current review considered patients, family members and nurses in the acute care hospital setting. Nurses included licensed nurses, registered nurses, practical nurses, nursing assistants, nurse researchers, and advanced practice nurses. Methods: A three-step search strategy was used to identify English language qualitative primary research studies. Two reviewers independently appraised the included studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative studies that considered attitudes, beliefs and experiences of patients, families and nurses on patient presence during bedside handover were considered for this review. Papers included in the review were from 1998 to 2017. Results: The review included 12 qualitative publications. Key findings were extracted and classified as unequivocal (U) or credible (C). A total of 96 findings were extracted and aggregated into 14 categories. From the 14 categories, five synthesized findings were developed: i) becoming more informed; ii) upholding confidentiality and privacy; iii) varying desire and ability to participate; iv) individualizing patient care; and v) challenges in conducting bedside handovers can be overcome with adaptive practices. Conclusions: This review captured the experiences of patients, families and nurses with patient presence during bedside handovers in a hospital setting. For the most part, patients and families describe bedside handover positively, reporting feeling more informed and engaged in care. This review highlights areas where patients’ and nurses’ views on bedside reporting may differ, particularly in the areas of desire to participate and the need for confidentiality. Although hospital environments can create challenges in sharing personal patient information at the bedside, these may be overcome through education and by the adoption of a flexible and individualized approach.

Information concerning ICU patients’ families in the handover—The clinicians’ «game of whispers»: A qualitative study

“…In many clinicians´ opinion, presence of family members during handover can be too time consuming, lead to more interruptions and disturb medical discussion and reflection (Davidson et al, 2017;Ervin et al, 2018;Manias et al, 2016). Consideration for other patients and the need for medical confidentiality are also important factors in determining whether the family can be present during handovers (Davidson et al, 2017;McCloskey et al, 2019). This also concurs with the findings in the present study.…”

“…Lost or inaccurate information is a well-known problem in clinical handovers both within ICU and during transfers between ICU and other hospital ward units (Blum & Tremper, 2009;Dutra et al, 2018;Enger & Andershed, 2018;Ganz et al, 2015;Zakrison et al, 2016). Incomplete handover is associated with medical errors and inadequate care (McCloskey et al, 2019;Smeulers et al, 2014). Our findings indicate that when the information handover within the ICU was lacking about family issues, family members were less likely to receive consistent information from the ICU team.…”

“…Even if improvements in handover have received increased attention in recent times, these findings indicate that routines for how information about the family should be included in the ICU teams' handover are missing, leaving scope for improvement. Earlier research shows the importance of effective and safe handover (Hoskote et al, 2017;McCloskey et al, 2019), which is associated with good workflow, increased focus on patient safety and efficient use of healthcare resources (Abraham et al, 2012;McCloskey et al, 2019).…”

“…In line with the principles for patient-and family-centred care, it is recommended that members of the patient's family are present during bedside handovers (Manias, Geddes, Watson, Jones, & Della, 2016;McCloskey et al, 2019) and during rounds (Davidson et al, 2017;Mørk, Krupp, Hankwitz, & Malec, 2018). This can enhance information flow between the clinicians and the family (Davidson et al, 2017;Ervin et al, 2018) and increase patient and family satisfaction (McCloskey et al, 2019).…”

“…ICU handovers generally take place at the bedside or in the clinicians' daily meetings (Ervin et al, 2018). To enhance collaboration and information flow between clinicians and family, it is recommended that family members are present during the bedside handover (Ervin et al, 2018;McCloskey, Furlong, & Hansen, 2019). This is in line with the principles and approach of patient-and family-centred care (PFCC) which recommends that health care be respectful and responsive to patients' and families' values and needs (Davidson et al, 2017;IPFCC, 2010).…”