The function of this piece is to put forward a new proposal for the handing over process at the trust I was established at this past placement. I will not be mentioning staff or service users by name in order to adhere to the NMC’s guidelines on confidentiality,(The Nursing and Midwifery Council, 2015) I will also not be mentioning the name of the hospital I was placed at. If successful, this model could easily be adapted and used in other trusts providing uniformity and consistency in this area across the NHS.
At the hospital in question, different methods of handing over were used between wards which, allegedly could hinder bank or cover staff if they were encumbered by their lack of knowledge concerning the process being used. It could be suggested that this may cause inaccuracies in information received or delivered assuming they do not use the same handover method. In nursing, the communication of accurate information is paramount.
The Code (NMC, 2015) makes It clear that nurses must protect and promote the health and wellbeing of patients by working with others. This includes the communication of their details and treatment information both clearly and effectively to ensure continuity of care. The hospital has already begun to drive the idea of a situation, background, assessment, recommendation (SBAR) style of handover. The key concepts in my proposal are firstly, to adhere to that course of action; my reasons will be explained subsequently.
Secondly, to streamline the bay handover by ensuring nurses are allocated patients after receiving initial patient information both written and verbal by the nurse in charge, but before commencing handover in the bay. This would mean that all nurses in the bay would have the essential information on all the patients present but would only have to listen to the full handover of their allocated service users therefore saving time. The third and final key concept of this new handover would involve both nurses finishing at the bedside for the last stage of handover ‘recommendation’ where possible.
This would involve the service user and their family as recommended by the World Health Organization (WHO) (2007), giving them greater autonomy, strengthen the nurse-family partnership and as far as the law allows us to and in accordance with the code (NMC, 2015) share with them information about their ongoing treatment, health and care in a manner they can understand. This also allows an opportunity for the patient or family to ask any questions and to discuss the plans for the day including any requests the family have like an evening bath for the child or to let mum attempt the feed today.
Lastly, this also gives the opportunity for the nurses to introduce themselves and say goodbye to the family giving a more person-centred and compassionate approach to their care, promoting continuity and building a relationship of trust and following in the footsteps of the ‘Hello My Name is’ campaign (Granger and Pointon, 2014). Whilst at the trust mentioned it was observed that on one particular ward (Ward A), nurses were being handed over every patient in the bay and finishing their shift 15-60 minutes late on average. This was unpaid as there is no clock in, clock out system in place and appeared to be a regular occurrence.
It also goes against the guidelines given by the WHO (2007) which suggest that time should be sufficiently allocated for handover. Whereas other wards in the hospital were having an initial general handover with the nurse in charge, allocated their patients and then having received their allocation proceeding to receive handover for those service users only. On these wards, it was observed that the nurses tended to leave their shifts on time. If you add these figures up it could be suggested that some nurses are potentially working 40. 5 hours a week when being paid for 37. 5 in a three shift week.
This is not only unfair to the nurses; expecting them to work outside their normal hours without recompense but is also dangerous. There is a proven link with working over 40 hours to having an increased likelihood of medication errors, needle stick injuries, musculoskeletal injuries and other adverse events (Olds and Clarke, 2010). This link has been verified by a multitude of studies (Dean et al. , 2006; Jagsi et al. , 2005; Scott et al. , 2006). One could suggest the nurses simply left at the scheduled end of their shift as it is the fault of their leadership team for structuring their handover this way.
However, doing that would violate the code of conduct (NMC, 2015) in multiple ways as not performing a handover means you are not communicating the necessary information to the multidisciplinary team, therefore, putting your patient at risk meaning you could be found as being negligent. Unfortunately, this seems to be a regular occurrence for nurses (Scovell, 2010) but that does not mean it should continue. This method of handover also removes a large portion of the staff from being able to perform patient care for longer.
Though there has been no proven correlation with nurses being more likely to leave the profession due to unpaid overtime (Zeytinoglu et al. , 2006), stress is a definite contributing factor, which could be diminished if the nurses had more personal time and a suitable amount of sleep. It could be suggested that time for both of these are inhibited by having to stay at the hospital and work after the required time. The alternative suggested method should ensure nurses leave at the correct time in line with the other wards in the hospital.
This method of handing over every single patient could be presented as being more thorough, especially when nurses need to go on break, however, money would be needed to pay the extra staff. This is not feasible as it is one of the constraints which leads to our possible choices (Stewart, 1982). This problem can be reconciled by nurses handing over to the member of staff in question before their break and the nurse reading up the patient’s medical summary and previous notes if necessary. The nurse will have also received a written handover sheet to ensure data integrity and minimal loss of data (Pothier et al. 2005).
The third part of the proposed handover change involves performing the last stage ‘recommendation’ at the bedside involving the service user and their family. It was initially believed that the presence of family would inhibit care and visiting was, in essence, a way to restrict parents from spending time with their children (Smith and Coleman, 2010). It is now expected for an inclusion policy to be adopted meaning families are seen as a sign of stability for the child and are involved in their care (Coleman et al. , 2007). Family-centred care has been refined constantly and is still evolving.
It is a social construct shaped by our actions, values, and beliefs, which have come a long way from the 1950’s. Children have moved away from being cared for at home by their parents to being cared for by health care professionals in hospital and excluding the parents. Children’s healthcare needs were being met but not their psychological ones (Smith and Coleman, 2010). An emphasis was put on physical care and asepsis to prevent cross-contamination and the spread of infectious diseases; a significant concern in the 19th and early twentieth century.
Care was mechanistic, dependant on routine and lacking in emotional interaction which accurately reflected the behaviourist ideologies adopted at that time to raising children (Darbyshire, 1993). In was only in the 1950s that family centred care as a social construct began to emerge thanks to Bowlby (1953) who’s findings concerning maternal deprivation and separation regarding hospitalized children were instrumental in changing the way care of their child was viewed.
This was further compounded by the release of the att Report (Ministry of Health and Central Health Services Council, 1959) which recognised the importance of the psychological welfare of the child and not just the physical and recommended that parents should be allowed to visit at ant reasonable hour. The Court Report (Department of Health and Social Security, 1976) recognised that nurses and parents should work in partnership as children’s have different needs than adults and guidelines published by the Department of health (1991) stated that good quality care for children was both child and family centred.
More recently the World Gealth Organization (2007) has stated the importance of involving parebts and families in the delivery of care. Though concrete definitions of Family Centred care are hard to find since it is a social construct and depends on the society it comes from, it is assumed in this piece the meaning is nurses and families working in partnership for the best interests of the child. Though it is logical that family centered care also has its drawbacks. Evidently, people can sopmetimes disagree on what is ‘best’ for the child as that is a personal conviction, sometimes even the child themselves.
This could lead to decisions being made against the chil pr parent’s will if it is deemed as in their best interests medically, for example in the case of blood transfusion ina jehova’s witness (Woolley, 2005). Visitors to the ward, including parents, increases the risk of infection and cross contamination, especially to patients In intensive care. A study was performed in 2015 in which 35 out of 55 visitors entering an intensive care unit did not perform hand hygiene and all tested positive for bacterial growth (Birnbach et al. , 2015).
It has also been founf that even though appropriate signage increases the likelihood of visitors using hand cleaning facilities, the number of people observed doing so is still alarmingly low (Birnbach et al. , 2012). on the values and actions of the society within which that care has been practised. However, even when considering these factors Familt Centred Care has become such an ingrained facet of nursing culture that health care professionals would find it unthinkable to use an approach that woul not advocate the involvement of families and the service users in their care.
The location of the handover is also vital for protecting sensitive information. Hence why the initial part of the handover is conducted at the nurses station, meaning sensitive information canoot be overheard through and nurses won’t be tempted to avoid discussing sensitive information in case it is overheard and the protection of data is violated (Cahill, 1998). A study into bedside handovers found that this method and location made parents and patients feel more involved, their care was personalised and that they were a person first, this was especially true for when they were introduced at handover.
This gave them an indication of who would be looking after them at eh next shift and the opportunity to assure accuracy of information. It was however stated that these feelings also depended on the person conducting the handover, whether they were actively engaging them or treating them as passive listeners (McMurray et al. , 2011). The use of an SBAR format in handover is out of convenience and practically in this case.
Though there here is insufficient evidence for best practive regarding handover (Riesenberg et al. 2010) including the use of SBAR (Chaboyer et al. , 2010; Randmaa et al. , 2016Smeulers et al. , 2014;) it is still an essential aspect of nursing care as poor communication can result in errors and adverse incidents harming the patient (World Health Organization, 2007). The WHO also suggest using the SBAR technique for handover. Streamlining and standardizing the handover process prevents confusion, supports cohesion and ensures the nurses only discuss the relevant information guided by the standardised handover.
