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Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover—A qualitative study
Chien, Laura J. Slade, Diana Goncharov, Liza Taylor, Joanne Dahm, Maria R. Brady, Bernadette McMahon, Jake Raine, Suzanne Eggins Thornton, Anna
Chien, Laura J.
Slade, Diana
Goncharov, Liza
Taylor, Joanne
Dahm, Maria R.
Brady, Bernadette
McMahon, Jake
Raine, Suzanne Eggins
Thornton, Anna
Abstract
Aim
To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention.
Design
A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions.
Methods
We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact.
Results
Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information.
Conclusion
Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists.
Relevance to Clinical Practice
Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change.
Reporting Method
We adhered to the COREQ guidelines.
Patient or Public Contribution
We interviewed patients on study wards pre and post intervention.
Keywords
clinical handover, communication, discourse analysis, ethnography, nursing, organisational change, patient involvement, patient safety, patient-centred care, qualitative research
Date
2024
Type
Journal article
Journal
Journal of Clinical Nursing
Book
Volume
33
Issue
7
Page Range
2688-2706
Article Number
ACU Department
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY-NC-ND 4.0
File Access
Open
Notes
© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.