By Mandeep Lally. Registered Nurse Adults, Patient Safety Support Nurse, University Hospitals of Derby and Burton NHS Foundation Trust, Florence Nightingale Travel Scholar; Twitter: @Mandeep_Lally @FNightingaleF
Nursing shift handovers may seem like such a basic and simple task which is embedded in the skills of every nurse. Yet the importance of the implications a nursing handover has, can be overlooked, as it is not an embedded nursing communication skill that all nurses possess. I have over the years come across many methods of the delivery of handover, and the information shared is only as accurate and reliable as the methods utilised and information shared, in ensuring a continuity of care is provided.
My first experience of nursing handover as student nurse was one, I will never forget, it felt like a wave of information had been splashed over me. The handover of 25 patients provided in the span of thirty minutes, where the nurse handing over, felt like she was talking at a speed of a 100 miles per hour. There was about 10 of us, all crammed into a small office space, where we all had our daily pre-shift huddles in the morning grasping on to our cups of tea, like it was the last cup of tea we would see that day, and just soaking up all the information that the previous shift nurse had just given us. My first thoughts after listening to these highlights from the previous shift were, “I’m so glad I’m just a student nurse”. My second thoughts looking over at the nurse’s expression and who I was to work with for the rest of the shift was, “that would be me in 3 years’ time!” It was from that moment I realised the immense pressure that nurses face daily, when having to rely on a nursing shift handover to provide the best care to their patients.
Over the years, my interest in how I could have an impact in some way and improve this overwhelming and stressful nursing handover process grew. It finally led me to ultimately exploring handovers further as a Florence Nightingale Foundation Travel Scholar in 2021. I had the opportunity to travel to acute hospitals nationally, and observe nursing shift handovers and compare the processes utilised, or see whether there was a more efficient solution to this stressful yet important nursing skill we were responsible for doing daily.
In my experience as a student nurse, and a registered nurse having to provide and receive nursing handovers, I experienced many different styles of handovers being used. Handovers are delivered in many places such as: behind closed office doors; standing outside patient bay areas; at the patient’s bedside, and in corridors. There is tremendous amount of literature detailing the need for a universal nursing handover tool (Bruton et al. 2016; Cornell et al. 2014; Poot et al. 2013; Street et al. 2011), however a tool to improve the process and efficiency is yet to be identified. Even more literature exists which details when standardised tools for handover are utilised, it improves communication and reduces errors (Bukoh and Siah 2019; Forde, Coffey and Hegarty 2020). Through this literature, application of tools like SBAR being utilised were compared, and whether there is a need for patients themselves to be involved (Spooner et al. 2016; Bruton et al 2016; Kerr, Lu, and McKinlay 2014; Poot et al. 2013).
I have recently travelled across England and Scotland as a Florence Nightingale Foundation Scholar and had insight visits on both medical and surgical inpatient wards across acute Trusts in London, Edinburgh, and Derbyshire. My aim was to explore best practices in nursing shift handovers and identify whether there was a specific tool utilised during nursing shift handovers. I concentrated on understanding how the tools used impacted the care provided and whether the processes followed for handover constituted an efficient process, or whether there was a need for a universal handover tool.
I witnessed multiple handovers, and I found benefits to delivering bedside handovers. When a structured approach to handovers was utilised it improved communication, was inclusive of the patient. These observations were made more than once and collaboratively from all the hospitals I had the opportunity of visiting and from practice and policy observed. Particularly useful and what was being implemented in a hospital in Scotland on my visit, was implementation of bedside handovers and the methods utilised from a Standard Operating Procedure (SOP) developed from previous studies conducted in hospitals in Australia (Chaboyer et al. 2009; McMurray et al. 2010). My observations made from the nursing handovers I witnessed, were that they followed a structured approach, and the content of handover provided were inclusive of the patient, when happening at the bedside. However, the process of handing over continued throughout the day, with mid-shift huddles and pre-shift safety briefings at both the morning and evening, with the whole team. The SBAR tool was mostly utilised, but was adapted by the nurse’s perspective, which provided not only a guide to follow but also ensured that all important information required to be handed over, was done so and not missed. This method also meant that information transferred during handover was succinct, relevant, and inclusive of the patient. Bedside handover therefore benefited not only the nurse, by improving communication, but ensured that their patients could participate in this process which improved the patients experience (McMurray et al. 2010).
There are many benefits of the bedside handover, including some that are unseen. I observed during bedside handovers, that the incoming nursing team would introduce themselves to the patients and it is at that time the outgoing nurse would hand over any tasks that are outstanding from their shift, as well as any other important information regarding the patients care. There’s also opportunity at this time to check that the nursing documentation and assessment are up to date, such as fluid balance charts, pressure area charts etc. and to do a safety scan at the bedside if the patient has any other equipment or attachments that needed checking.
There are still some differences in the specific processes utilised when handing over, and this is due to a lack of a universal structured handover tool and process adopted. In addition to this, the specific content to be included when handing over, should be inclusive of the patient, when done at the bedside so to ensure that both patient, and staff are engaged in the handover. When bedside handovers are adopted, it impacts on the patient’s wellbeing and their hospital experience, as well as providing them with the assurance that the information exchanged is reliable, thus providing a person-centred approach to care (Hu 2019; Bruton et al. 2016; Forde, Coffey and Hegarty 2020). Thus, the SBAR handover tool can be adapted to act as efficient, reliable, and safe tool to utilise for handing over (Forde, Coffey and Hegarty 2020; Malfait et al. 2018; Poot et al. 2013). Therefore, embedding bedside handover in practice would lead to a more beneficial way to deliver nurse to nurse shift handovers, and improve communication while promoting patient safety and the delivery of person-centred care.
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