Improving patient‐centred care through a tailored intervention addressing nursing clinical handover communication in its organizational and cultural context

Abstract

Aims To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover. Design Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention. Methods Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data. Results Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications. Conclusions Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success. Impact Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals.

Using a simulation-based approach to promote structured and interactive nursing clinical handover: a pre- and post-evaluation pilot study in bilingual Hong Kong

“…Similarly, in a monolingual clinical environment, the implementation of ISBAR protocol with attention to authentic interactive and informational skills was argued to be helpful for handover communication by supporting outgoing nurses to structure their information [ 4 ]. Other observed benefits of adopting the protocol include, a reduced miscommunication frequency with other staff [ 14 ], junior staff having improved confidence in performing handovers with their seniors [ 29 ], and improved nursing culture (for staff to be productive, respected, and have an increased sense of professionalism) [ 30 ].…”

Nursing Handover: Experiences and Perspectives in the Critical Care Unit at Murang’a County Referral Hospital

“…Throughout the study, the study participants expressed the need for education on nursing handover across the nursing profession in form of CMEs to streamline handover process. Training combined with a redesigning of the local practices that inhibit handover process are effective interventions for optimal patient handover (Chien et al, 2022). Benchmarking in CCUs of private hospitals was borrowed from the nurses' handover experience in private hospitals and was deemed better.…”

Reaching consensus on the definition of person‐centred handover practices in emergency departments: A modified online Delphi

“…Person-centred handover practices have been shown to gradually increase patient and staff satisfaction, enhanced quality care and patient safety (Chien et al, 2022). Although person-centred handover practices are advocated for and preferred by patients, in many instances this does not happen (Kerr et al, 2013;Oxelmark et al, 2020).…”

“…Person‐centred handover practices that include patients and/or significant others may promote the delivery of person‐centred care (White‐Trevino & Dearmon, 2018). Person‐centred handover involves the handover of patient information between healthcare professionals together with the patient whilst performing the handover according to a set structure focussing on relevant clinical information and patient safety concerns (Chien et al., 2022; Kullberg et al., 2017). Furthermore, person‐centred handover involves more than just the transfer of information, it should be a process were both parts gain new insights (Kullberg et al., 2018).…”

“…Furthermore, person‐centred handover involves more than just the transfer of information, it should be a process were both parts gain new insights (Kullberg et al., 2018). Person‐centred handover practices have been shown to gradually increase patient and staff satisfaction, enhanced quality care and patient safety (Chien et al., 2022). Although person‐centred handover practices are advocated for and preferred by patients, in many instances this does not happen (Kerr et al., 2013; Oxelmark et al., 2020).…”