A Descriptive Study to assess the practices related to end of shift handover among staff nurses working in selected hospitals of district Mohali, Punjab with a view to develop handover giving sheets

 

Rajinder Kaur¹, Rashmi Choudhary², Poonam Sharma³

¹Mata Sahib Kaur College of Nursing, Mohali

²Associate Professor, Mata Sahib Kaur College of Nursing, Mohali

³Assistant Professor, Mata Sahib Kaur College of Nursing, Mohali

 

ABSTRACT:

The end of shift handover is most important ritual at end of nursing shift. Patient handover between nurses at shift change has been an important process in clinical nursing practice, allowing nurses to exchange necessary patient information to ensure continuity of care and patient safety. Handover report increases client safety and satisfaction; creates trust between the nurse and client; reduces communication errors and promotes accountability, teamwork, and respect among staff. The aim of present study is to assess the practices related to end of shift handover among staff nurses working in selected hospitals of District Mohali, Punjab with a view to develop handover giving sheets. A quantitative research approach with descriptive research design was adopted. 100 staff nurses were selected through non probability convenient sampling technique for the study. Practices related to end of shift handover were assessed by observational checklist. Results showed that 33 staff nurses were having fair practices and majority of staff nurses i.e.67 were having good practices related to the end of shift handover. There was significant association of age, area of work and working experiences with practices related to the end of shift handover and no significant association of gender and educational qualification with practices related to the end of shift handover (p<0.05).

 

INTRODUCTION:

Clinical handover is an important aspect of safe patient care. The definition of clinical handover is ‘the transfer of professional responsibility and accountability for all aspects of care for a patient, or groups of patients, to another person or professional group on a temporary or permanent basis. Shift-to-shift handover between nurses normally occurs 2–3 times a day in most hospitals and is an opportunity to promote a patient-centered approach to care.¹

 

Bedside handover allows the patient to contribute to his or her plan of care. It also allows the oncoming nurse an opportunity to visualize the patient and ask questions. This is critical in meeting the Joint Commission's 2009 National Patient Safety Goals. It encourages patients to be involved actively in their care and it implements standardized handover communication between nursing shifts. Bedside handover allows an opportunity for patients to correct misconceptions.²

 

There are many methods of formal nursing handover including verbal, tape recorded and written. The information handed over include patient name, age, diagnosis and then a variety of information pertaining to the patient and their care.³ For the description of nursing tasks, the documents that are usually consulted are admission, referral, discharge documents, progress notes, medication charts, observations charts, nursing care plans and documents between health disciplines. Nursing shift handovers present variation from ward to ward and among hospital settings.⁴

 

There are also a variety of environments for handover delivery to take place, these being bedside, and office or staff room.³ Location of handovers varied depending on the needs of each specialty and impacted on what information was transferred. Namely, in a medical/surgical unit, handovers were at the bedside; avoid discussing patient diagnosis that moment. Contrarily, in mental health specialties, handovers were given in a room where access to patients was not allowed (Johnson et al, 2012a).⁵

 

Evidence shows that ineffective shift handover increases the risk of medication error and sentinel events, delays the course of treatment, decreases patient satisfaction, and prolongs the length of hospital stay.⁶ Reader et al. reported that ineffective intra-shift and inter-shift verbal and written communications are responsible for 57% and 37% of all the healthcare errors respectlively.⁷

 

Objectives:

·       To assess the practices related to end of shift handover among staff nurses.

·       To develop and distribute end of shift handover giving sheets to the staff nurses.

·       To associate the findings with selected socio demographic variables.

 

MATERIAL AND METHODS:

Research Approach:

Quantitative research approach has been used in present study.

 

Research Design:

Descriptive research design has been used in present study.

 

Research Setting:

The study was conducted in a multispecialty private hospital at Mohali. 

 

Target Population:

The target population of the study consisted of all staff nurses of multispecialty private hospital Mohali, who fulfill the inclusion criteria. In this study, inclusion criteria stated as:

·       Both male and female staff nurses.

·       Staff nurses who were willing to participate in the study

 

Sample size and Sampling technique:

Non probability convenience sampling technique was used to draw sample from the target population. Sample for the present study was 100 staff nurses who fulfill the inclusion criteria.

 

Ethical consideration:

·       Written permission was obtained from the Medical Officer of multispecialty private hospital at Mohali.

·       All respondents were assured about their confidentiality and anonymity.

 

Description of the tool:

Section I: Socio – demographic data:

It consists of socio- demographic variables which give baseline information such as age, gender, educational qualification, experience, and area of work.

 

Section II: Checklist for assessing end of shift handover:

Observational checklist consisted of 51 items on end of shift handover practices.

 

Data collection:

Main study was conducted in multispecialty private hospital at Mohali (Punjab). 100 staff nurses were selected by non probability convenient sampling technique. The practices of staff nurses were observed by researcher using observational checklist.

 

RESULTS:

Table 1: Frequency and percentage of staff nurses according to socio- demographic data                         N=100

S. No.	Socio - demographic data	Frequency     f	Percentage      %
1.	Age (in years)
	22 – 24	30	30.0
	25 – 27	36	36.0
	28 – 30	23	23.0
	> 30	11	11.0
2.	Gender
	Male	4	4.0
	Female	96	96.0
3.	Educational qualification
	GNM	42	42.0
	Basic B.Sc. Nursing	30	30.0
	Post Basic B.Sc. Nursing	28	28.0
4.	Area of work
	ICU	15	15.0
	Emergency ward	21	21.0
	General ward	49	49.0
	Private  ward	15	15.0
5.	Work experience (in years)
	0 – 2	38	38.0
	2 – 4	35	35.0
	4 – 6	14	14.0
	> 6	13	13.0

 

Table 1: Depicts majority of staff nurses i.e. 36% were in the age group of 25-27 years. Gender distribution of sample revealed that majority of sample i.e.96% were females, 42% staff nurses did GNM, 49% staff nurses were working in general ward and 38.0% staff nurses having 0-2 years of working experience.

 

Table 2: Frequency and percentage distribution of practices of staff nurses for patient related data during end of shift handover                                                                                             N=100

S. No	Patient related data	YESfy (%)	NOfn (%)	Not Applicablefna (%)
1.	Name	100(100.0)	0(0.0)	0(0.0)
2.	Age	100(100.0)	0(0.0)	0(0.0)
3.	Gender	100(100.0)	0(0.0)	0(0.0)
4.	Date of admission	100(100.0)	0(0.0)	0(0.0)
5.	Diagnosis	100(100.0)	0(0.0)	0(0.0)
6.	Consultant name	100(100.0)	0(0.0)	0(0.0)

 

Table 2: Depicts that all the staff nurses i.e. 100% gave information to next shift’s staff nurse related to patient’s name, age, gender, date of admission, diagnosis and consultant’s name.

 

Table 3: Frequency and percentage distribution of practices of staff nurses for care related data during end of shift handover                                                                                                 N=100

S. No	Care related data	YES fy (%)	NO fn (%)	NOT APPLICABLE fna (%)
1	Date of surgery	42(42.0)	0(0.0)	58(58.0)
2	Chief complaints	77(77.0)	11(11.0)	12(12.0)
3	Vital sign recorded	100(100.0)	0(0.0)	0(0.0)
4	Consciousness level	83(83.0)	17(17.0)	0(0.0)
5	Intravenous  infusion	68(68.0)	6(6.0)	26(26.0)
6	Blood transfusion	18(18.0)	3(3.0)	79(79.0)
7	Intake	100(100.0)	0(0.0)	0(0.0)
8	Output	100(100.00	0(0.0)	0(0.0)
9	Pain level	83(83.0)	9(9.0)	8(8.0)
10	Pressure ulcers	16(16.0)	0(0.0)	84(84.0)
11	Oxygen therapy	67(67.0)	3(3.0)	30(30.0)
12	Mechanical ventilation	16(16.0)	0(0.0)	84(84.0)
13	Personal Hygiene	100(100.0)	0(0.0)	0(0.0)
14	Dressing change	54(54.0)	0(0.0)	46(46.0)
15	Tracheotomy Care	19(19.0)	3(3.0)	78(78.0)
16	Intravenous canula care	33(33.0)	0(0.0)	67(67.0)
17	Central venous care	68(68.0)	0(0.0)	32(32.0)
18	Medication administered of patient	100(100.0)	0(0.0)	0(0.0)
19	Informed consent for any procedures	100(100.0)	0(0.0)	0(0.0)

Table 3: Depicts that 100% staff nurses have given handover of recorded vital sign, intake-output chart and medication administered.

 

Table 4: Frequency and percentage distribution of practices of staff nurses for investigations related data during end of shift handover                                                                       N=100

S. No	Investigations related data	YES fy (%)	NO fn (%)	NOT APPLICABLE fna (%)
1	Lab Sample sent	100(100.0)	0(0.0)	0(0.0)
2	Lab Report received	91(91.0)	9(9.0)	0(0.0)
3	Lab Report upkeep	25(25.0)	8(8.0)	67(67.0)
4	X-Ray report	64(64.0)	2(2.0)	34(34.0)
5	C.T Scan	54(54.0)	3(3.0)	43(43.0)
6	MRI	65(65.0)	3(3.0)	32(31.0)
7	Endoscopy	12(12.0)	0(0.0)	88(88.0)

 

Table 4: Depicts that 100% and 91% staff nurses gave handover regarding lab sample sent and lab reports received.

 

Table 5: Frequency and percentage distribution of practices of staff nurses for doctor’s round or instructions and nursing care notes related data during end of shift handover                   N=100

S. No	Doctor’s round or instructions and nursing care notes	YES fy (%)	NO fn (%)	NOT APPLICABLE fna (%)
1	Doctor round or instruction	100(100.0)	0(0.0)	0(0.0)
2	Nursing care notes	100(100.0)	0(0.0)	0(0.0)

 

Table 5: Depicts that 100% staff nurses gave handover of doctor’s round or instructions and nursing care notes.

 

Table 6: Frequency and percentage distribution of practices of staff nurses for inventory related data during end of shift handover                                                                                       N=100

S. No	Inventory related data	YES fy (%)	NO fn (%)	NOT APPLICABLE fna (%)
1	Medicine trolley	100(100.0)	0(0.0)	0(0.0)
2	Intravenous stand	64(64.0)	36(36.0)	0(0.0)
3	Cardiac monitor with ECG leads	55(55.0)	0(0.0)	45(45.0)
4	Suction jar	63(63.0)	37(37.0)	0(0.0)
5	O2 flow meter	65(65.0)	35(35.0)	0(0.0)
6	Cardiac tables	100(100.0)	0(0.0)	0(0.0)
7	Inventory handing over as per assignment	100(100.0)	0(0.0)	0(0.0)

 

 

Table 6: Depicts that 100% staff nurses have given handover of medicine trolley, cardiac table and inventory handling as per assignment. All staff nurses i.e. 55% gave handover of cardiac monitor with ECG leads in applicable cases

 

Table 7: Criteria for distribution of level of practices according to percentage of total score for practices of staff nurses

Level of Practices	Percentage of total score
Poor	(0-33.3%)
Fair	(33.4-66.6%)
Good	(66.7-100%)

 

Table 7: Depicts the distribution of level of practices according to percentage of total score of practices related to end of shift handover among staff nurses.

 

 

Figure 1: Distribution according to level of practices among staff nurses

 

Figure 1 depicts that majority of the staff nurses (67%) were having good practices and 33% staff nurses fall into category of fair practices. None of them fall into poor category of practices.

 

Table 8: Association of level of practices among staff nurses with selected socio-demographic data     N=100

(NS= Non significant at level of p<0.05          and       * significant at level of p< 0.05)

 

Tables 8: Depicts that there is significant association of practices with age, area of work and work experience.

 

Table 9: Development of end of shift handover giving sheets for the staff nurses

S. No	Items	Detailed Information
1	Name of patient
2	Age of patient
3	Gender of patient
4	Date of admission
5	Diagnosis
6	Consultant name
7	Date of surgery
8	Chief complaints
9	Vital sign recorded
10	Consciousness level
11	Intravenous infusion
12	Blood transfusion
13	Intake
14	Output
15	Pain level
16	Pressure ulcers
17	Oxygen therapy
18	Mechanical ventilation
19	Personal Hygiene
20	Dressing change
21	Tracheotomy Care
22	Intravenous cannula care
23	Central venous care
24.	Medication administered of patient
25.	Informed consent for any procedures
26	Lab Sample send
27	Lab Report received
28	Lab Report upkeep
29	X-Ray report
30	C.T Scan
31	MRI
32	Endoscopy
33	Doctor round or instruction
34	Nursing care notes
35	Medicine trolley
36	Intravenous stand
37	Cardiac monitor with ECG leads
38	Suction jar
39	Oxygen flow meter
40	Cardiac tables
41	Inventory handover as per assignment
42	Admission register
43	Discharge register
44	Stock register
45	Referral register
46	Patient shift report register
47	Investigation record register
48	Round register
49	Laundry register
50	Death register
51	Blood Sugar register
52	Any other relevant handover giving information

 

DISCUSSION:

A systematic review of English-language articles, published between January 1, 1987, and August 4, 2008, that focused on nursing handoffs in the United States was conducted. Search strategy yielded 2,649 articles. After title review, 460 of these were obtained for further review by trained abstractors. Ninety-five articles met the inclusion criteria; of these, 55 (58%) were published between January 1, 2006 and August 4, 2008. Content analysis yielded identification of barriers to effective handoffs in eight major categories and strategies for effective handoffs in seven major categories. Twenty articles involved research on nursing handoffs. Quality assessment scores for the research studies ranged from 2 to 12 (possible range, 1 to 16). The majority of the research studies on nursing handoffs (17 studies; 85%) received quality scores at or below 8 and only three achieved scores above 10. Ten (50%) of the studies included measures of handoff effectiveness. ⁸

 

Street et al. (2011) conducted a study to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross‐sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part‐time compared with full‐time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation‐Background‐Assessment‐Recommendation,active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care.⁹

 

CONCLUSION:

The end of shift handover is highly important to have better practice and to provide effective care to the patients admitted in hospital ward/ units. Shift handover is a regular process that is done three times a day. The present study concluded that 67% staff nurses had good level of practices and 33% were having fair level of practices regarding end of shift handover.

 

REFERENCES:

1.        Maxson PM et al. Bedside nurse to-nurse handoff promotes patient safety. Medsurg Nurs. 21 (3); 2012: 140-144. PMID:22866433. Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/22866433

2.        Chaboyer W, Mc Murray A, Wallis M. Bedside nursing handover: a case study. International Journal of Nursing Practice. 16 (1); 2010: 27-34. Available from: URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1440-172X.2009.01809.x/abstract

3.        O’Connell B, MacDonald K, Kelly C. Nursing handover: Its time for a change. Contemporary Nurse. 30 (1); 2008: 2-11. Available from : URL: http://www.curationis.org.za/index.php/curationis/article/view/1126/1611

4.        Nancy Boaro et al. Using SBAR to improve communication in inter-professional rehabilitation teams. Journal of inter-professional care. 24 (1); 2010: 111-114. Available from: URL: http://www.uhn.ca/TorontoRehab/Education/SBAR/Documents/SBAR_Toolkit.pdf

5.        Johnson M, Jefferies D, Nicholls D. Developing a minimum data set for electronic nursing handover. Journal of Clinical Nursing. 21; 2012: 331-343. Available from: URL: https://s3.amazonaws.com/EliteCME_WebSite_2013/f/pdf/NNM02MEI13.pdf .

6.        Hansten R. Streamline change-of-shift report. Nursing Management. 34 (8) ; 2003: 58–59. Available from: URL:.http://www​.ahrq.gov/qual​/qsummit/qsummit4.htm

7.        Reader TW, Flin R, Cuthbertson BH. Communication skills and error in the intensive care unit. Curr Opin Crit Care. 13 (6); 2007: 732–736. Available from:  URL: http://www​.macoalition​.org/Initiatives/RecMeds/SafePractices

8.        Riesenberg Lee Ann, Leisch Jessica, Cunningham  Janet M. Nursing handoffs: A systematic review of the literature. American Journal of Nursing. 110 (4); 2010: 24-34.

9.        Street M et al. Communication at the bedside to enhance patient care: A survey of nurses' experience and perspective of handover. International Journal of Nursing Practice. 17(2);  2011: 133–140. Available from:  URL : https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-172x.2011.01918.x?journalCode=1440172x

 

 

 

Received on 10.09.2018         Modified on 18.10.2018

Accepted on 02.11.2018      ©A&V Publications All right reserved