Critique of Systematic Research Review (SRR): Nursing Handoffs Essay
Nursing handoffs is a type of report between two clinicians that are responsible for patients care and is an important part of transferring patient information (what, how, who and where) from one healthcare provider to another in clinical practice (Smith and Schub, 2014). Ineffective, inconsistent and incongruent communication during these handoffs continues to be a problem and a threat to patient safety. Effective handoffs are instrumental in providing for the successful quality of care that the patient is to receive (Holly and Poletick 2014). Medical errors, treatment delays, inappropriate treatment and/or care omissions can happen as a result of miscommunication during handoffs which could potentially lead to patient harm, longer stays, readmissions and/or increased costs. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.
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Search Process
The authors of this article performed a search looking for only qualitative research articles that were based on the nurse’s experiences at the time of shift change/nursing handoffs. One hundred and twenty-five qualitative articles between 1988 and 2012 met the initial inclusion criteria and 50 articles were evaluated and a final sample of 29 qualitative articles was analyzed and utilized for this study and included (Holly and Poletick 2014). Only articles that described nurse to nurse shift reporting was used.
Articles
The articles chosen are as follows (Holly and Poletick 2014):
- 21 ethnographic studies – study of people and cultures
- 2 qualitative descriptive studies – subjective research that studies the characteristics of a population. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.
- 3 case studies – a detailed, up close and in depth research method of a subject
- 1 phenomenological study – study of experiences
- 1 appreciative enquiry study – involves bringing large, diverse groups of people together to study
- 1 action research study – research initiated to solve a problem
The data collection methods in the research articles included observations, interviews, document reviews and questionnaires.
Search Terms
The terms that were used for their search included (Holly and Poletick 2014):
- Communication
- Nurse’s report(s)
- Intershift report(s)
- Shift report
- Nursing shift report
- Handoff(s)
- Sign-off
- Signoff
- Handoff report
- Handoff communication
- Information transfer
- Handover
- Handover communication
- Handover report
- Qualitative research
Databases
The following databases were used for their search (Holly and Poletick 2014):
- CINAHL
- Pre-CINAHL
- Healthstar
- ScienceDirect
- Dissertation Abstracts International
- Theses Canada
- DARE
- PyschINFO
- BioMed Central
- TRIP
- SI Current Contents
- Web of Science/Web of Knowledge
- Scirus
- gov
Findings
The articles were retrieved using the Qualitative Assessment Review Instrument (QARI) (www.joannabriggs.edu.au) which allows the authors to aggregate their findings with relation to their study (Holly and Poletick 2014). One hundred and seventeen findings were identified and these were then grouped into sixteen categories that were based on commonality and relevance to the nursing handoff report (Holly and Poletick 2014) and these findings were further subjected to a metasynthesis that produced these two findings that can thus be used as a basis for future evidenced-based practice:
- ‘Individual nurses influence patient care nurse as the gatekeeper if information handed off that is used for subsequent care decisions’ (Holly and Poletick 2014)
- ‘There is an embedded hierarchy in relation to the handy over of information that serves as a method of enculturation to the nursing unit’ (Holly and Poletick 2014) Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.
In reference to item number one: the authors found evidence to suggest incongruence among the nurses reports (written, oral and patient observation) with an overall congruence rate of 70% and the most common deficit was omission (Holly and Poletick 2014). It was also discovered that relevant information was omitted and irrelevant information as often conveyed.
In reference to number two: shift report is when information and responsibility is passed on to the next shift. It is a great time to facilitate staff cohesion and for support. It can also be a forum for team building. The authors noticed that the quality of information exchanged during shift report was unpredictable – few questions asked and dialogue between staff was often vague and lacked precision (Holly and Poletick 2014).
On a positive note, shift reporting provides a place where new nurses can be oriented to the culture, language and rituals of the unit being worked on. This time helps to increase the cohesiveness of the teams with increased consistency. As a result this can help to increase information being given during report time. Little approval is given verbally and often nonverbal cues or gestures (i.e. head nods, eye contact) are used.
Recommendations
The final results of this study showed the need for a more improved handoff technique. The authors state that the nurse is the gatekeeper for clinicians versus patients and the research showed that nurses are very ineffective in this area. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay. The key recommendation for improving nursing handoffs would be the improvement of communication which would include a reduction of omission, improved written report and a better communication between nurses and physicians. Other options of improving nursing shift reports would be to institute a written report to go along with a verbal report that can be passed down from shift to shift. A reliable handoff should include 3 important elements: (1) face to face, 2-way communication, (2) a universal structured written form or template and (3) the handoff needs to share the problem of the patient’s clinical situation (Halm, 2013). As sated previously a simple suggestion to improving shift change handoffs is to institute a universal structured from. One could use mnemonic devices to help in making sure that important information is transferred from one clinician to the next. A few examples are SBAR (situation, background, assessment, recommendation) or I PASS the BATON (Introduction, patient, assessment, situation, safety concerns, background, actions, timing, ownership, next) (Halm, 2013). Halm (2013) states that ‘consistently discussing information in a standardized sequence can also aid pattern recognition for clinicians’. In other words, if we all consistently use the same methods for shift change reports then, ideally, information should not be missed. Holly and Poletick (2014) states that ‘the role of a nurse as decision-make of what information is chosen to be acted up and/or handed off’ is a major finding of their research article. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay. Technology allows customized reports to be created and it would be a benefit for institutions to take advantage of this ability to create a standardized form to use during nursing handoffs.
Conclusion
Effective communication among healthcare clinicians is critical for an effective handoff to provide safe high quality care. The result of a better shift change report would include improved patient satisfaction, better patient outcomes and improved financial outcomes. The author’s goal in this research article was to improve our understanding of the shift change handoff report process. It was discovered that it is very important for standardization to be implemented in order for improvement to be made. It is the responsibility of nurses to provide proper care to their patients and it is of utmost importance to relay information to the following shifts in order for proper care to be given. Holly and Poletick (2014) states that ‘handoffs allow nurses the opportunity to exchange information that will be used to make subsequent care decisions about their patients’. This results in improved satisfaction, shorter inpatient stays and reduced cost to all.
References
Halm, M.A. (2013). Nursing handoffs: ensuring safe passage for patients. American Journal Of Critical Care 22(2), 158-162. doi:10.4037/ajcc2013454
Holly, C., & Poletick, E. B. (2014). A systematic review on the transfer of information during nurse transitions in care. Journal Of Clinical Nursing, (17-18), 2387.
Smith, N., & Schub, E. (2014). Nursing report: patient hand-off. CINAHL Nursing Guide. Critique of Systematic Research Review (SRR): Nursing Handoffs Essay.