Patient Participation in Change-of-Shift Procedures

Abstract

In the Italian health system, the most common handover model is that of a meeting between nurses at the shift change in the nurses' staff room. The information dealt with at the handover tends to cover patients' medical diagnoses, physical symptoms, and clinical events. Information tends to be omitted however, relating to patients' needs and their care plan, all elements that might benefit from involvement of the patient. This research, using Lewin's 3-Step Model for Change, tracks the change at an Italian hospice from verbal reporting in an isolated room to bedside handover with the patient present. An assessment of the hospice bedside handover was made by means of a questionnaire in collaboration with management and training staff. One questionnaire was drawn up for patients and family members and another for nurses and healthcare assistants. The universally positive reaction of patients, appreciating the handover model proposed and obtaining benefit from it, confirmed that bedside handovers represent an increase in quality for patients. The bedside handover can help to humanize relations and indeed, as at the hospice, to humanize dying itself. This result is consistent with findings of other research confirming increases in patients' sense of safety. KEY WORDSbedside handover, change of shift, hospice, patient participation, safety N urse handovers represent a fundamental part of professional activities generally and of the daily communication process in particular. 1,2 Communication between shifts of nurses requires written documentation and a verbal element. The purpose of the handover is to transfer responsibility from one nursing shift to the other, providing precise details of the patients' state of health and current physical condition. The information included in the verbal part of the handover tends to cover patients' personal details, medical diagnoses, medications, physical symptoms, and clinical events. On the other hand, it tends to omit information relating to patients' needs, their care plan, and the effectiveness of nurse interventions and planning of discharge, all elements that might benefit from an involvement of the patient.The handover seeks to ensure nursing continuity and guarantee sufficient individual care. 1-3 Given that it takes the form of a meeting between professionals, it also functions as an occasion for teaching and learning, an emotional debriefing, and as a source of support and cohesion within the group. 4 The handover provides an opportunity for socializing and fostering professional relations. 5,6 In the Italian context, the most common handover model is that of a meeting between nurses at the shift changeover in the nurses' staff room.Chaboyer and colleagues 7 reported that the bedside handover system improved safety, efficiency, and teamwork. Bedside handovers can be used to increase patients' collaboration in the drawing up of their care plan. 8 The nurse is able to give the patient the opportunity to participate, but it is the latter who decides the level of such involv...

A systematic review of patient participation during bedside handovers on wards with older patients indicates evidence is urgently needed

“…Nurses often just assume that this type of patients cannot or will not participate in their care (Lyttle & Ryan, 2010), therefore designating the bedside handover as not possible for patients of older age. The single study we identified (Wildner & Ferri, 2012) confirms this typical idea about elderly and the fact that patient participation was not mentioned in the other studies is perhaps a symptom of the same misunderstanding. As emphasised by Anderson and Mangino, patient participation is a crucial aspect of the bedside handover in order to achieve the beneficial effects.…”

“…After systematic screening of 154 hits (Appendices 1 and 2), 22 articles were considered eligible or needed full-text screening to determine eligibility. Of these 22 articles, nine discussed the use of the bedside handover on a ward with an (partially) older population, of which only one study (Wildner & Ferri, 2012) addressed the issue of patient participation. This study (Wildner & Ferri, 2012) had a small sample of both nurses (n = 12) and patients (n = 15), used a non-validated questionnaire, and mainly looked at the issue from the nurses perspective.…”

“…Of these 22 articles, nine discussed the use of the bedside handover on a ward with an (partially) older population, of which only one study (Wildner & Ferri, 2012) addressed the issue of patient participation. This study (Wildner & Ferri, 2012) had a small sample of both nurses (n = 12) and patients (n = 15), used a non-validated questionnaire, and mainly looked at the issue from the nurses perspective. Moreover, the responses of nurses indicate "that a significant part of the patients did not participate.…”

Paso de guardia en enfermería: Una revisión sistemática

“…Categoría I: Características de la entrega A la cabecera del paciente Algunos autores mencionan como una parte esencial para el recibo y entrega de turno, también identificado como paso de guardia, que este se debe realizar a la cabecera del paciente y con la participación del mismo, dicha entrega de turno consiste en una relación establecida enfermera(o)-paciente, donde el paciente comprende, busca y mantiene un sentido de control y reconocimiento de su propia responsabilidad frente a su estado de salud, mientras que enfermería actúa para facilitar este papel y proporciona información ajustada a las necesidades de cada individuo. La metodología que plantean estos autores para la entrega de turno comprende a los dos equipos de enfermería (el turno de salida y el turno de entrada), quienes en conjunto pasan por las habitaciones de los pacientes, se detienen en sus camas e intercambian la información vital relacionada con su cuidado [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”