3 years ago

Patient participation in nursing bedside handover: a systematic mixed-methods review

Numerous reviews of nursing handover have been undertaken, but none have focused on the patients’ role. Objectives To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Design Systematic mixed- methods review. Data sources Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Review methods Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Results Segregated synthesis of research of patients’ perceptions revealed two contrasting categories; (Kitson et al., 2014) patient-centred handover and (The Joint Commission, 2013) nurse-centred handover. Segregated synthesis of research of nurses’ perceptions included three categories: (Kitson et al., 2014) viewing the patient as an information resource; (The Joint Commission, 2013) dealing with confidential and sensitive information; and (Australian Commission on Safety and Quality in Health Care, 2012) enabling patient participation. The segregated synthesis of QI projects included two categories: (Kitson et al., 2014) nurse barrier to enacting patient participation in bedside handover; and (The Joint Commission, 2013) involving patients in beside handover. Once segregated findings were configured, we discovered that the patients’ role in bedside handover involves contributing clinical information related to their care or progress, which may affect patient safety. Barriers relate to nurses’ concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. Conclusions Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and ensure patients’ viewpoint is captured. Many barriers and strategies identified QI projects were from the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure improved quality of QI projects.

Publisher URL: www.sciencedirect.com/science

DOI: S0020748917302468

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