...CHAPTER 1 INTRODUCTION 1.0 INTRODUCTION A handover is defined as “the act of moving power or responsibility from one person or group to another (Oxford Advanced Learner’s Dictionary of Current English 2005)”. In healthcare and clinical context, the term “handover” applies to the transferring of a patient’s information between two health care providers, when the patient receives care in a different location, or when another healthcare provider is responsible of the patient (ACSQHC 2005). The American word “handoff” also signifies the same meaning. Nursing handovers are often being described as a ritual, which stemmed from the medical concept preliminarily in the 1880s, whereby the nursing sister would direct the nurses on duty after hearing reports from the night shift nurses and the doctors’ rounds (Walsh and Ford 1989). The repetitive characteristic of the traditional handover does not encourage nurses to think critically or share different views, therefore depicted as a “ritual” (Kerr et al 2011). 1.1 BACKGROUND OFTHE STUDY The aim of a nursing shift handover is to precisely inform the patient’s general condition, care plan, treatment and expectations in a timely manner (Runy 2008). The process, if made without a systematic standardized method, would lead to errors and jeopardizes patient’s safety (ACSQHC 2010). Reported adverse events from handovers include unnecessary procedure and investigations, delayed diagnosis or treatments, prolonged hospitalization...
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...Evidence Based Practice Task 1 Western Governors University Evidence Based Practice and Applied Nursing Research The nursing topic of interest is bedside handover, which is the concept of conducting shift handover at the patient’s bed instead of doing it at the front desk. Part A The article being analysed is: Tobiano, G., Chaboyer, W. & Murray, A. (2012). Family Members’ Perceptions of the Nursing Bedside Handover. Journal of Clinical Nursing, 22, 192-200. The analysis of the primary research report is done in the form of a graph (figure 1). Each of the four analysis areas is rated within a scale of 1-10; 1 denotes extremely weak while 10 denotes very strong. Table 1 then gives justifications for the rating by explaining why each area of analysis was rated that way in the analysis chart. [pic] Figure 1 Table 1 |A1 Article: Tobiano, G., Chaboyer, W. & Murray, A. (2012). Family Members’ Perceptions of the Nursing Bedside Handover. Journal | |of Clinical Nursing, 22, 192-200. | |A2 Background or introduction |The researchers provided an in depth introduction of the research topic outlining | | |important issues, previous research on the topic and their findings. The introduction | | ...
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...3.3 CHARACTERISTICS OF HANDOVER Laxmisan et al (2007) conducted an ethnographic study involving analysis of emergency department handover in a US hospital. The study found that interruptions within the emergency department were prevalent and diverse in nature and that there were gaps in information flow due to multi-tasking and shift changes. The communication process is complex and cognitively taxing during and after team handover, that can compromise patient safety. The study also discusses the need to tailor generic electronic tools to support adaptive processes like multi-tasking and handoffs in time constrained environments. Arora et al (2005) conducted interviews using the critical incident technique to handover failures between inpatient physicians in a US hospital. The study interviewed 26 interns and found 25 discrete incidents. The 21 worst events are described. Omitted contents and failure prone communication processes were identified as a major category of failure in communication. These may result in inefficient or sub-optimal care, leading to patient harm....
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...Bedside nursing handover: A case study 1. Purpose of the study: The purpose of this study was to identify and describe the structures, processes, and perceptions of the outcomes of bedside handovers in nursing practice. 2. Research design: The authors used a descriptive case study which is a methodological approach that can use a number of different methods to conduct an instrumental investigation that is bounded by place and time. Case study research asks questions of ‘what’, ‘why’, and ‘how’ in a non controlled or non artificial environment to analyse existing, real life situations with all their complexity 3. Sampling technique and characteristics of the sample: The study involved three wards in two hospitals in Australia, thus six wards where ultimately included. Wards that where included where medical, surgical and rehabilitation wards. Team leaders, shift coordinators, nursing managers, and educators where the focus of the study in which all participants gave their consent. A total of 32 female participants where interviewed from both hospitals. No male participants where included. From these participants seven where under the age of 30, ten between the age of 30 and 40, eleven between the age of 40 and 50 and six where aged over 50. with regards to nursing classifications, from the 32 participants, 7 where enrolled nurses, 15 where level 1 registered nurses, 7 where level 2 registered nurses and 5 where level three nurses. Only 16 out of the 32 participants...
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...purpose of this article was to identify patient perceptions of bedside handover through directly asking patients about their care. The study was done on a two in-patient medical-surgical departments at Borgess Medical Center in Michigan. They had implemented bedside handoff at shift change 18 months prior to this study. Then a sample of patient participants was chosen from the two nursing departments for the study. They had to meet certain criteria to be a participant and they had to experience three handoffs. Then they were given a survey to fill out after the beside handovers. Participants were positive about the RN bedside handoff process. The overall mean from the survey was 3.32 on a scale of 1 (strongly disagree) to a 4 (highly agree). | Review of Literature | There were multiple references that provided statistics and facts during this study. Most of these studies have focused on implementing bedside handoffs and nurse perceptions of the handoff. Published studies that focused on patients’ perceptions of beside handoff have been mainly qualitative. Recently, researchers have published studies that seek to measure bedside handover quantitatively. Whether qualitative or quantitative, all studies report an increase in patient satisfaction with bedside handover. | Methodology | This quantitative study was to identify patients’ perceptions of the bedside handoff. This was a quantitative study because they used a survey with the patients and found a mean score...
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...safe handover : safe patients guidance on clinical handover for clinicians and managers diSclaimer This publication has been produced as a service to ama members. although every care has been taken to ensure its accuracy, this publication can in no way be regarded as a substitute for professional legal or financial advice and no responsibility is accepted for any errors or omissions. The ama does not warrant the accuracy or currency of any information in this publication. The australian medical association limited disclaims liability for all loss, damage, or injury, financial or otherwise, suffered by any persons acting upon or relying on this publication or the information contained in it, whether resulting from its negligence or from the negligence of employees, agents or advisers or from any cause whatsoever. cOPyriGhT This publication is the copyright of the australian medical association limited. Other than for bona fide study or research purposes, reproduction of the whole or part of it is not permitted under the copyright act 1968, without the written permission of the australian medical association limited. safe handover : safe patients guidance on clinical handover for clinicians and managers PREPARED BY THE AUSTRALIAN MEDICAL ASSOCIATION LIMITED ABN: 37 008 426 793 2006 Adapted from the British Medical Association’s resource ‘Safe Handover: Safe Patients.’ Dr Mukesh Haikerwal President, Australian Medical Association Dr Geoff Dobb Chair, AMA Coordinating...
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...older adults living in the community?) | 1) Chaboyer W, McMurray A, Wallis M. Bedside nursing handover: A case study, International Journal of Nursing Practice 2010: 16:27-34 | Level I: Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) or evidence-based clinical practice. | This research aimed to better understand the structures, processes and perceived outcomes of bedside nursing handover as a beginning step to facilitate its implementation. | Randomized control trial, clinical trial. | 532 bedside handovers, 34 interviews with nurses. Six wards in two hospitals in Austrailia. 3 medical, 1 surgical, 1 medsurge, 1 rehabilitation ward. Semistructured observation and interviews. | SBAR was used in 45-65% of handovers in 3 situations when: patients were new or condition changed, patients were unfamiliar to staff such as when staff had been off for a few days, or casual/agency staff were part of the team. On average each bedside handover took just over a minute. | Before handover patient handover was completed and handover sheet updated. Just before handover pts were informed that handover would shortly take place and were asked if they required any assistance in order to limit disruptions during handover, visitors were excused. Information was prompted by pts presence. Safety scan and medication review was done. Kept handover short and simple and to the point. Information found might be used as the basis for standard operating...
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...of transfer of care is inadequately undertaken risks to the patient are increased and may subsequently lead to harm (BMA, 2005; Joint Commission, 2007). The Network organised a series of patient safety road shows which were specifically designed to build consensus and concentrate activities on the key topic of transfer of care, to facilitate networking between members of the Network’s regional groups and a range of colleagues working across all care sectors, and to identify the actions required to improve the patients’ experience of transfer of care across all health and social settings. 1.1 Literature Review “A good…handover process is a crucial part of providing quality…care…The conservation of patient data during the handover process is vital to ensure good continuity of care and safe practice. Any errors or omissions made during the handover process may have dangerous consequences…” (Pothier, et al., 2005) Delays in transferring or discharging patients can result in a range of problems for both patients and organisations (Bryan, et al., 2005). For patients these problems include: increased dependency; depression; loss of choice, control and confidence; and being placed at risk of exposure to hospital acquired infection. For organisations delays in the transfer or discharge of patients may result in bed blocking, leading to the possibility of greater waiting times for patients needing hospital care and treatment. In addition,...
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...Leadership Commentary Introduction Leadership is an important quality in all nurses. It is relevant to all levels of nursing and increases the quality of care we are able to give to our patients (James P. Smith, 2006). Leadership in nursing is not necessarily about being in charge but more about being able to make confident and competent decisions and influence the behaviour of others to ensure the best patient care is delivered. Throughout a community placement I endeavoured to improve my leadership skills and made use of an action plan to do this. I will make use of Gibbs (1988) reflective cycle to evaluate and reflect on this process. Gibbs is a simple and effective method of reflection and will allow a focus on the event and give a clear structure to the commentary and will also allow an action plan to be formulated to ensure the process is ongoing. Description During a placement with the district nursing team I identified leadership skills which I felt I needed to improve, which were achievable and relevant to nursing practice. I also took into consideration the leadership qualities framework from the NHS institute of innovation and improvement ( NHS institute for innovation and improvement,2005) this highlights a number a important aspects of leadership such as empowering others, collaborating with others and leading change through people. I felt that these were important and the skills which I would develop should be based around these concepts. The skills...
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...and the place to which the patient is discharged, reduce length of stay in hospital, and minimise unplanned readmission to hospital.1 Discharge planning is an established part of hospital care, but the process varies and is not entirely evidenced based. A Cochrane review analysed 11 randomised controlled trials looking at discharge planning in over 5000 patients and failed to show a reduction in mortality among elderly medical patients, lower readmission rates, or a shorter length of hospital stay.1 However, two trials in the review did report greater satisfaction of patients and carers when discharge planning was used.2 3 The Cochrane review concluded that discharge planning remains important as a small improvement, not detected by the studies performed so far, could still yield highly significant gains in health care with huge resource implications and better use of acute hospital beds.1 Unfortunately, none of the included trials assessed communication with primary care staff about patient transfer of care. This is an important aspect of discharge planning and another potentially important advantage for patients. On a patient’s initial contact with health services, discharge planning should be started.4 This is often difficult to achieve when acutely unwell patients are admitted as a thorough social history may not be immediately available without a collateral history from a relative or primary healthcare provider (who may be difficult to contact). Taking a comprehensive social...
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...from taped report to a bedside report is essential to increasing patient safety and satisfaction, nursing satisfaction, physician satisfaction, and a savings to the health-care facility. The Joint Commission found that the breakdown in communication during the shift report is a leading cause of sentinel events in the United States (Laws & Amato, 2010). We will explore benefits to the patient, nurse, facility and physician. The patient and family benefit by becoming a part of their own treatment. They will participate in decisions and know at all times the plan for their care. This autonomy helps the patient to have a confidence in the health-care facility and staff. They provide essential information that is not available otherwise to assist in providing the best care possible for the patient. With the family and patient being informed about the plan of care, they are less anxious. This promotes more compliance with care and willingness to start treatments earlier. These patients have a higher level of satisfaction and are less likely to litigate (Anderson & Mangino, 2006). In a study at Sharp Grossmont Hospital in San Diego County, a 481-bed community hospital, the patient benefits included a reduction of unanswered call lights and a reduction in patient falls. With the bedside report, patients are able to have needs met when bedside reporting is taking place. Before the change to bedside reporting, the Progressive Care Unit of this hospital experienced about six call lights...
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...The aim of this essay is to explore an aspect of clinical practice that I have experienced whilst working as a first year student midwife in hospital. The clinical aspect I will examine will be the handover of care. The reflective model I will be using is Stephenson’s, 1993 cited in Benbow et al (2013). Stephenson’s model of reflection will enable me to use a framework specifically targeted at health professionals; this will enable me to link theory to practice and given up to date evidenced based care. The purpose of reflection is to explore the science and art of Midwifery, it is essential for decision making (Raynor, 2010). The essay will examine the psychosocial and communication surrounding handover. Midwives are faced with handover of care on every working day. Handover is a summary of details regarding the woman’s physical condition, personality, relationship, capability and overall judgement from one midwife to another midwife (Wickham, 2008). Midwives are placed to be with woman supporting, informing and educating at a vulnerable time of their lives which can result in emotional instability; midwives need to be effective at taking care of woman’s emotional needs as well as their physical ones (Raynor, 2010.) The sociology aspect of handover has been affected by the government as there are less midwives working, the birth rate is rising and there is a shortage of beds so it is in the agenda to discharge women when it is possible to (Deery et al, 2015). In accordance...
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...health care assistant. I will use a reflective tool to assist in the reflective cycle using Gibbs (1988) ref – university of cumbria www.cumbria .ac.uk/public /liss/document/skills sat cumbria/reflective cycle) I will ensure that I comply with the Nursing and Midwifery council (NMC) in order to achieve this I will write in first person and all names and locations will be changed to protect identity. Ref (NMC 2015). Description My normal day started at 7.30 I was allocated to work in a bay alongside my colleague within my clinical area. An accurate handover of the clinical information was given in relevance to the patient’s continuity and safety of care. (Adams 2012). (Ref- Adams JM, Osbourne-Mckenzie T Advancing the evidence base for a standardized provider handover structure: using staff nurse description of information to deliver competent care. Journal of continuing Education in nursing 2012;43(6):261-6.) My case study is on a 59-year old lady( Appendix 1)who recently had been discharged after surgery on her left neck of femur fracture. This lady had been readmitted to our clinical area following her discharge due to signs of a UTI, fever and the wound site being very red and inflamed. Pam was showing all the signs and symptoms of a severe infection with a temperature ranging from 38.5 to 40 Celsius, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute and a white blood cell count greater than 12,000. These combined symptoms...
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...Therapeutic communication in its fundamental concept is providing a best treatment for patient based on patient-centre service. On the video case scenario, it is known that the woman is experiencing cerebrovascular attack. CVA or popularly known as stroke, needs a complex care as it involves plenty of communication barriers between patient and healthcare professionals, such as weakness, numbness, vision, and particularly, speech abnormalities (Grear & Bushnell, 2013). As stroke involves difficult communication, healthcare professionals need advanced skills of communication. For the purpose of the essay requirement, I will review how healthcare professional is conducting session with a patient from the therapeutic communication perspective. A patient is recently assigned to a hospital through emergency department. When paramedic team performs clinical handover to a nurse, he describes that the patient is 35 years old, 28 weeks pregnant and has history of hypertension. The nurse learns that she has difficulty in communication and gives a simple guideline. This is where the essence of therapeutic communication plays a great role. Anytime she shakes her head means affirmation and nodding means negation. Afterward, the nurse describes that there will be some other healthcare professionals visiting her. The first healthcare worker coming in after nurse is the radiographer. His intention is to inform and ask a consensual agreement of CT scan to the patient’s brain. The scanning procedure...
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...INTRODUCTION I am a 43 year old mother of two teenage daughters and have been taking stock of what I have achieved and where my career may take me. Hence my partaking in this module to assist the journey I hope to pursue. I have been working in my current position as a band 5 registered nurse for 6 years since I completed a returned to nursing course in September 2005 facilitated by the trust where I am now employed on a full time basis. I have enclosed a current job description at Appendix 1 (attached). For the purpose of this study I have chosen to reflect on 3 learning events that have impacted on me to provide positive outcomes and enrich my working practice. Within the main body of the study I will expand on each individual learning experience based on Gibbs’ cycle of reflection (1988) combined with influence from Johns’ cycle of reflection (1994). See Appendix 2 - 2a (attached). I have chosen to incorporate Gibbs model of reflection as I feel it is quite straight forward and clearly outlines a framework to help me logically describe the event, discuss feelings, evaluate the experience and how it impacted on me and my practice. It leads to a final conclusion with considerations for improvement that I will refer to as my action plan. I have incorporated aspects of Johns’ model of reflection as it quite usefully prompts more detailed consideration of the processes of analysing a situation e.g. influencing factors within an experience. I will explore the implications...
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