The quality of intensive care unit nurse handover related to end of life: a descriptive comparative international study

Effective nursing shift handover in critical care: A concept analysis

To explore the concept of effective shift handover in critical care settings. Ineffective handover is one of the leading causes of adverse events in healthcare settings. Nursing shift handover in the intensive care unit (ICU) is more complex and detailed than in other in-patient wards due to the complexity of medical issues experienced by ICU patients. It is, therefore, critical that nurses be able to conduct handover effectively. Despite the importance of handover, the definition and attributes of effective handover are not clearly understood. Walker and Avant's eight-step approach to concept analysis. Effective handover in nursing is an interactive process between two nurses, resulting in the direct transfer of adequate patient-specific recent information in a manner that creates a shared understanding of information. Its defining attributes are (1) content-related and (2) process-related attributes. The antecedents of effective handover are organizational support, interpersonal relationship, and work environment. Its consequences include patient and nurse satisfaction, improved care, and continuity of care. Empirical referents include several tools developed to measure some of the effective handover attributes. The definition provides a connotative meaning and is the first step toward concept validation and instrument development to measure effective handover practice in the ICU.

Quality of collaboration and information handovers in palliative care: a survey study on the perspectives of nurses in the Southwest Region of the Netherlands

Background

When patients receiving palliative care are transferred between care settings, adequate collaboration and information exchange between health care professionals is necessary to ensure continuity, efficiency and safety of care. Several studies identified deficits in communication and information exchange between care settings. Aim of this study was to get insight in the quality of collaboration and information exchange in palliative care from the perspectives of nurses.

Methods

We performed a cross-sectional regional survey study among nurses working in different care settings. Nurses were approached via professional networks and media. Respondents were asked questions about collaboration in palliative care in general and about their last deceased patient. Potential associations between quality scores for collaboration and information handovers and characteristics of respondents or patients were tested with Pearson’s chi-square test.

Results

A total of 933 nurses filled in the questionnaire. Nurses working in nursing homes were least positive about inter-organizational collaboration. Forty-six per cent of all nurses had actively searched for such collaboration in the last year. For their last deceased patient, 10% of all nurses had not received the information handover in time, 33% missed information they needed. An adequate information handover was positively associated with timeliness and completeness of the information and the patient being well-informed, not with procedural characteristics.

Conclusion

Nurses report that collaboration between care settings and information exchange in palliative care is suboptimal. This study suggests that health care organizations should give more attention to shared professionalization towards inter-organizational collaboration among nurses in order to facilitate high-quality palliative care.

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

AIMS AND OBJECTIVES

To explore how information concerning ICU patients´ families is included in the ICU clinicians' daily handover.

BACKGROUND

Handover refers to the transfer of information and care responsibility between clinicians. An effective and precise handover are of great importance to ensure quality of care. Although improvements in handovers have received increasing attention in recent decades, little is known about how information about ICU patients' family members is included in handovers.

DESIGN

A qualitative study using Charmaz' constructivist grounded theory approach.

METHODS

Data were gathered through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. The data consist of 270 observation hours, seven focus groups, three dyadic interviews and two individual interviews. Field notes and transcribed interview data were analysed using constructivist grounded theory approach. COREQ checklist was applied as reporting guideline for this study.

FINDINGS

"A game of whispers" emerged as the core category, representing missing information about the patient's family during the handover. Together with three subcategories: "documentation dilemmas," "being updated" and "talking together," the core category explains how transfer of family-related information between clinicians is continually processed and resolved.

CONCLUSIONS

This study indicates challenges related to appropriate and high-quality handover concerning ICU patients´ families. Oral handovers are essential in terms of clinicians' need to elaborate on written information and update each other. However, oral transmission involves a high risk of information loss during the handover. Written documentation about the family seems to be inadequate and poorly structured.

RELEVANCE TO CLINICAL PRACTICE

The study findings suggest a need for increased awareness in practice and research of the importance of transferring appropriate and reliable information about patients' families between ICU clinicians. User-friendly handover tools and patient records that include information on patients' family members should be developed.

Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey

INTRODUCTION

There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited.

OBJECTIVES

The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation.

METHODS

The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results.

RESULTS AND DISCUSSION

A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings.

CONCLUSION

Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover.

Nursing team leader handover in the intensive care unit contains diverse and inconsistent content: An observational study

BACKGROUND

Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited.

OBJECTIVE

The study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover.

DESIGN

A prospective observational study.

SETTING

A 21-bed medical/surgical adult intensive care unit specialising in cardiothoracic surgery at a tertiary referral hospital in Queensland, Australia.

PARTICIPANTS

Senior nurses (Grade 5 and 6 Registered nurses) working in team leader roles, employed in the intensive care unit were sampled.

METHOD

After obtaining consent from nursing staff, team leader handovers were audiotaped over 20 days. Audio recordings were transcribed and analysed using deductive and inductive content analysis. The frequency of content discussed at handover that fell within the a priori categories of the ISBAR schema (Identify-Situation-Background-Assessment-Recommendation) was calculated.

RESULTS

Forty nursing team leader handovers were recorded resulting in 277 patient handovers and a median of 7 (IQR 2) patients discussed at each handover. The majority of nurses discussed the Identity (99%), Situation (96%) and Background (88%) of the patient, however Assessment (69%) content was varied and patient Recommendations (60%) were discussed less frequently. A diverse range of additional information was discussed that did not fit into the ISBAR schema.

CONCLUSIONS

Despite universal acknowledgement of the importance of nursing team leader handover, there are no previous studies assessing its content. Study findings indicate that nursing team leader handovers contain diverse and inconsistent content, which could lead to inadequate handovers that compromise patient safety. Further work is required to develop structured handover processes for nursing team leader handovers.