Nursing Handover Research Project - Wintec Research Archive

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A key element to person centred care is patient engagement, so their inclusion in the handover process could be advantageous. Alvarado et al. (2006) discuss a transfer of accountability (TOA) model that introduces a bedside patient safety check which encompasses checking the patient’s wrist band, intravenous (IV) medications in line with medication chart, allergy status, monitor alarms set, and any risk concerns. This process engages the patient into communication around their care and also fulfils a safety element reducing risk. This process the TOA handover approach also includes a face to face handover and a handover sheet (Alvarado et al.). Recommendations Change to nursing handover requires more than linear thinking around its process and content. Looking at the constructs that create handover has given me greater understanding of nursing handover. From this recommendations have been made to acknowledge the significance of handover, the activities that relate to it and the identities that occur within the process. 1. Value the significance of handover. Nurses are attached to and value the significance of handover. Within this patient safety is paramount but also equally as important is nurse safety. Resilience is required to move away from a blame culture to a focus on handover accomplishments that reflect quality care and mistake prevention. Handover allows time for nurses to develop their professional identity through education and discussion. 2. Protect the activities in handover. In valuing nursing handover there needs to be consideration to the other functions it serves other than just the communication of information. This includes the protection of significant aspects of handover such as ritual and psychosocial elements. To allow time and space for handover is crucial so that nurses have a place to debrief and reflect on the nursing shift. This creates a professional space to give away their workload free from outsider comment. 3. Honour the identities within handover. Nursing handover should not be seen as pulling nurses away from patient care. The patient and the nurses are both central identities in nursing handover. Person centred care incorporates both in the relationship and encourages their identities to flourish. There can be professional anxiety associated with nursing care and acknowledgement of these identities ensures that the need for emotional support is not devalued. Flexible standardisation would 29
meet the needs of nurse, patient and the institution. It would also recognise the importance of the different nurse relationships and culture that exist from area to area. This project has the potential to inform practice by implementing these recommendations. Globally there is much work being done around handover with a focus to implementing standardisation of practice. In considering changes to current practice there needs to be attention given to the reasons for change and valuing the time nurses spend together. This avoids the application of superficial solutions to perceived challenges associated with handover as it is not just the communication of information to the next shift and has psychosocial implications that need to be respected. Nurses deal with very unusual elements in their day to day jobs that need to be expressed to relieve some professional anxiety. Challenges Handover discourse affects how nurses practice and this ultimately affects the patients’ experience of being cared for (Crowe, 2005). Discourse analysis is abstract in that there is no recipe to follow and this created difficulty. As a novice researcher it was extremely challenging to analyse language in use using text without a strict framework. However to over simplify the method would detract from the process and what can be gained by looking at nursing handover constructs. I used discourse analysis to give another viewpoint analysing how nursing handover text is constructed and what is gained by such a construction. Discourse analysis was a good fit as it takes into account the text, context and discourse. It connected the social, cultural and institutional components with the process. Gee’s (2005) approach provided the ideal support in particular the first three steps; significance, activities and identities to answer the research questions. Summary This chapter discussed patient safety and risk management as one of the main constructs in handover. As patient safety and risk management consume the institution in the effort to 30
Page 1 and 2: Nursing Handover Research Project H
Page 3 and 4: Acknowledgements I would like to ac
Page 5 and 6: Chapter Four ......................
Page 7 and 8: Questions The research questions ar
Page 9 and 10: Sexton et al., 2004). There are als
Page 11 and 12: Summary The aim of this project is
Page 13 and 14: Chapter Two Methodology Introductio
Page 15 and 16: contemporary nursing world. This ma
Page 17 and 18: experiences, thoughts and feelings
Page 19 and 20: Following these studies was an arti
Page 21 and 22: Sentinel events “When information
Page 23 and 24: “While nurses had difficulty writ
Page 25 and 26: notes (Meibner et al., 2007; Sexton
Page 27 and 28: the value in handover and construct
Page 29 and 30: shares “values, norms and rules o
Page 31 and 32: Chapter Four Discussion and recomme
Page 33: are visible and well talked about.
Page 37 and 38: References Alvardo, K., Lee, R., Ch
Page 39 and 40: Engesmo, J., & Tjora, A. (2006). Do
Page 41 and 42: McCann, L., McHardy, K & Child, S.
Page 43 and 44: Potter, J., & Wetherell, M. (1987).
Page 45: Wynne-Jones, J. (2009). The develop

Nursing Handover Research Project - Wintec Research Archive

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