Qualitative Research Assignment

The nursing change of shift report or handover is a valuable opportunity to transfer responsibility and accountability from one nurse to another in most hospital wards (Lamond, 2000). It is actually a substantial part of a nurse’s duty, and each nurse should allocate 38% of his or her working hours in a hospital ward every day to fulfill the handover process (Spanke & Thomas, 2010). Therefore, handover is a fundamental component of nursing care for a nurse to pass on patients’ care plan, practices, information, and priorities to the next (Rushton, 2010). Moreover, handover is an opportunity for nurses’ group cohesion, professional socialization, education, interaction, and emo- tional support (Griffin, 2010; Payne, Hardey, & Coleman, 2000). Thus, handover should be accurate, complete, specific, relevant, timely, up to date, subjective, and objective. However, cases of handover that are inaccurate, incomplete, and biased may lead to many errors, mislead nursing practices, and increase patient complications (Rushton, 2010; Strople & Ottani, 2006).

A key component in patient safety and care quality is accurate communi- cation during handover (Chaboyer, 2011). The Joint Commission on Accreditation of Health Care Organizations (JCAHO) has established stan- dardizing handover as a priority for improving patient safety since 2006 (Chaboyer, 2011; Schroeder, 2006). However, a review of literature reflects limited research and articles addressing handover, while most of them high- lighted the importance of nursing handover and prioritized it for patient safety (Baker, 2010; Blouin, 2011; Schroeder, 2006; Scott, 2012; Welsh, Flanagan, & Ebright, 2010).

Although there are controversies about the efficacy of handover practices, some articles highlight the importance of oral shift report that could not be substituted by any other method because handover is the only place where different aspects of professional nursing care are identified (Gordon & Findley, 2011; Manias & Street, 2000; Scovell, 2010); otherwise, other stud- ies question its efficacy and report that there is no need to have an oral shift report because most of the discussed information could be located within nursing documentation, and, therefore, such a practice is time-consuming (Manias & Street, 2000; Sexton et al., 2004).

In practice, the complexity of patients’ conditions, lack of organization, and different interruptions during handover prolong the reporting process (Spanke & Thomas, 2010). In a large scale study of 10 European countries, Meiβner et al. (2007) explored the nurses’ perception of handover and the reason for dissatisfaction among them. She found that 22% to 61% of nurses were dissatisfied due to “too many disturbances,” “lack of time,” and “work organizational factors” (Meiβner et al., 2007).

Qualitative Research Assignment

236 Clinical Nursing Research 24(3)

In general, the goal of nursing handover is the transfer of relevant infor- mation and continuity of patient care; however, there is no agreement about its content and the related literature recommends different templates for pre- senting data (Johnson, Jefferies, & Nicholls, 2012). According to Schroeder (2006), the specific component of shift report should include PACE (Patient problems, Assessment/Action, Continuing/Changes, Evaluation; Schroeder, 2006), and other researchers have suggested other templates such as SBAR (Situation, Background, Assessment, and Recommendations; Raines & Mull, 2007). Regarding all such guidelines, the content of handover must contain short- and long-term goals. It should also be broad and specific enough to meet the patients’ needs. Furthermore, it should contain information such as medical and nursing care and physical, psychosocial, spiritual, and family needs at the same time (Rushton, 2010).

A body of literature reflects four modes of handover: the verbal handover in station, tape recording, written handover, and handover at bedside. In prac- tice, the method of handover depends on the patient, the shift (day, evening, or night shift), and the model of service delivery (team vs. case method; Johnson & Cowin, 2012). Nevertheless, many studies have confirmed the efficacy of bedside handovers. (Chaboyer, 2011; Chaboyer, Johnson, & Wallis, 2009; Mott & Bradley, 2010; Webster, 1999) For example, Mott and Bradley (2010) conducted an action research in three rural South Australian hospitals and incorporated bedside handover reports. She found that bedside handover was better than office reports in terms of ease and time efficiency. Interestingly, level of satisfaction increased among nurses and patients, and patients were more involved in their care; it also decreased the rate of errors (Mott & Bradley, 2010).

The role of nurses and families has changed recently in pediatric wards; previously, all responsibilities were done by professional nurses, but now, complete involvement of family is highly supported (Hutchfield, 1999; Mikkelsen & Frederiksen, 2011). The words nurses use in describing a family during shift report can affect how other nurses approach a family. Although the goal of shift report is to exchange objective data, value judgments and labels often accompany these data. These labels can limit the opportunity of families to learn the skills needed to manage the problems and meet their essential needs and decrease their involvement. So, applying a standard handover is essential in pediatric wards (Ryan & Steinmiller, 2004).

The first step in standardizing handover and introduction of an alternative model is to improve our understanding of current practices. Although some studies have been conducted in several countries, the handover practices have not been well studied in the Iranian health system because the context is dif- ferent. Because situational analysis is the first step in changing the program,Qualitative Research Assignment