CNA153 Aspect Of Nursing Practice Based On Given Case Study Assessment 4 Answer

Introduction

Handover is one of the ways of communication in the hospital setting, which helps nurses in rendering their services more effectively. It is not only a matter of transferring a patient's information but also the transformation of their responsibilities and accountabilities as well. Moreover, it is beneficial to use handover method as it serves as a platform and gives opportunity where views, expressions and learning among nurses can be exchange (Kerr, Lu, and McKinlay, 2014). There are various factors which affect the handover process, like lack of time which leads to incomplete handover. Due to this incomplete handover, quality of care plan for patients gets hampered. 

Analysis of the given Case Study

In the given case study, a new handover tool was introduced so that the process of handover can be standardized and appropriate information is transferred. To assess the satisfaction with the handover process and to evaluate the efficacy of the tool, a pre-implementation survey was conducted among 33 nurses and again three months later post-implementation survey done among 18 nurses.

In this study, the outcomes of the survey have been discussed based on satisfaction and quality of data transferred. The efficacy of handover tool is accessed by four parameters, after analyzing the all the parameter that it can be stated that only one parameter that is improved by the implementation of the tool is that reduction of interruption. However, due to the smaller sample size, this should not be the basis of selection of efficacy of handover tool; thus, this tool does not see to be effective. 

Quantitative Research Question: Evaluation of efficacy of standardized handover tool in order to improve the quality of care among patients?

Quantitative research questions focus on systematic investigation by collecting data. It includes a mathematical, statistical, or computational method for data analysis. The data is collected from the users by surveys or polls. The data is analyzed to get a conclusive result about the product or method.

In the given case study, there are various factors which impact the quality of handovers such as frequent disturbances in between, shortage of time and many organizational factors. These factors can be improved by the use of standardized handover tool, which has to be particular enough and covers all the aspects so that patients need could be achieved. Moreover, it should contain all the relevant detail about physical, spiritual, psychological needs, information of medical as well as nursing care and also at the same time it covers the demands of the family too.

Literature that contributes to the question and its outcome 

Various research articles and studies have been conducted to analyze various aspects of handover. With a qualitative content analysis approach, a descriptive exploratory study was conducted, and data of nursing handovers were recorded (Sarvestani, 2015). Some other relevant literature considered are by Ayse et al. in 2016, & Pearse et al., in 2018.  These studies will impart light on our research question and will help us to understand the importance of handover tool.  

Relevant material from the literature

In the study by Sarvestani in 2015, after each session of data gathering by four modes: oral shift report taped- handovers, observations, field notes and interviews were recorded. It has been found that nursing handovers were not holistic by mean of oral shift report as the handover was centred on physical dimensions and medical plans. Moreover, tape records evaluation reflects a lack of structured content in nursing handover. Hence the analysis of data revealed that the handover process faces many hurdles which required modification. Unstructured handover practices may give rise to various problems like lack of complete information, deficit concentrations, whereas standardized reports contain meaningful, organized data. Hence, the quality, correctness and rate of handover can be enhanced by providing standard criteria for representing patient-related information (Sarvestani, 2015). Another study was conducted in Turkey with 136 nurses. The efficiency of the handover evaluation tool was assessed on different parameters (Ayse et al., 2016). The data suggest that in the present scenario, such tools can be of great help in evaluating the process of handover.   

An accurate communication while handover process is the vital element for delivering quality care and providing safety to the patient. In some studies, it has been found that oral shift report has no importance as most of the information is documented in nurse records. As a result, this is time taking practice. Literature recommended that due to non-holistic and unstructured reports, handover practice is non-holistic. Conversely, it has been observed that gossiping and locating each other can be done by the mode of handover. The value of a guide to nursing handover is recommended by the American Nurse Association code of ethics for nurses (American Nurse Association, 2001). Patient-centred care is also a vital aspect of the holistic approach in nursing handover. It has also been noticed that oral report for an extended period results in nurse incapability of prioritizing the demands of the patient. Consideration of patient's privacy and confidentiality, location of an area away from interruption is a necessary feature of handover as interruptions may result in the low quality and accuracy of handovers (Pearce, 2018).

For improving patient safety, standardizing handover has been introduced by JCAHO (The Joint Commission on Accreditation of Health Care Organizations) since 2006 (Chaboyer, 2011; Schroeder, 2006). While performing the handover process, a structured approach is used by the nurses as a priority. They use an acronym during this process is RIMMS (respect, introduction, medications, management and safety).

Qualitative research question: Is the bedside handover the best way to reduce the time duration and complexity of handover?

Qualitative research focuses on collecting information based on experiences, opinions, and thoughts. It does not depend upon the numbers. Hence qualitative research questions are limited to explaining new theories, concept and reasoning.

Bedside handover is a necessary process and involves the interaction among patient, nurses and family members, which is found to be more effective than the other area (Raeisi et al., 2019). The main objective of this method is to promote nurse to nurse interaction and patients nurse as well (Gregory et al., 2014). By getting involved in planning their care plans, they feel more empowered and involved with the nurse.

Literature that contributes to the question and its outcome

Handover in every change shift in another area may lead to the occurrence of adverse events due to lack of patients involvement, but the use of structured standardize format not only reduces the time duration of the handover but also prevents the confusion state of nurses about the information that needs to be transferred. Errors in patient's documentation, the significant interpersonal relationship among nurse and patient, improved patient safety can be obtained by bedside handover, which is illustrated by giving research evidence for the same. Various studies were done by Malfait et al., in 2018; Anderson et al., in 2015; Bae and Fabry, in 2014); Johnson & Cowin, in 2013 & (Kullberg et al., in 2018 are discussed here. These are the detailed studies which discuss various aspects of bedside handover. Henceforth, they would substantiate our discussion about bedside handover. 

Relevant material from the literature

Malfait et al. (2018) conducted an observational study with implications for evidence-based practice to evaluate the effectiveness of bedside handover. It has been found that handover at the bedside not only manipulate the duration of time whereas time duration can be manipulative by the changes made by an organization which are required to execute handover at the bedside. Anderson et al., (2015) suggested that patient participation while handover process increases its time duration. It has been observed that decentralized handover and structured content are the two critical factors which not only allow the bedside handover possible but also promotes effective implementation of bedside handover at assigned time duration. Utilization of time has great importance in nursing practice (Bae and Fabry, 2014), data focusing comprehensive study on the handover duration is required.

Due to the importance of time use in nursing practice (Bae & Fabry, 2014), a more comprehensive and specific study on the data concerning the handover duration is needed (Malfait et al., 2018).

Suppose any one of the factors is deficit before implementation increased time duration may be anticipated. The importance of assessing the nursing care delivery model beforehand was also found effective (Johnson & Cowin, 2013). Most of the studies suggested that bedside handover plays a significant role in decreasing over time and also helps in doing financial saving at the time of shift handover (Kullberg et al., 2018).  

Conclusion 

For the patient, safety handover is one of the essential elements, and any incorrect information may give rise to adverse impact. In the above discussion, two aspects are discussed. The quantitative research question focuses on the analysis of various important factors required for efficient handover like time, quality and satisfaction. Various studies have shown that handover tool will help the nurses in several ways. However, more such studies should be conducted to develop an efficient tool which covers all the essential aspects of handover (NSQHSS, 2018).   Whereas in the qualitative research question importance of bedside handover is discussed on the basis of various research studies. However, bedside handover can also be a right choice. Prior to the implementation, both the qualitative and quantitative elements has to be investigated for making the correct choice. To substantiate an option, it is essential to conduct various studies with a large sample size, so that the handover process could be made accessible. 

The analysis of the mentioned case study shows that challenges of handover process can be solved by implementing some modification in the process such as the location of particular time and area, finding of job responsibilities, and focusing on a holistic approach in which participation of nurses is encouraged and also patient's role is identified and anticipated. In future, it is suggested to have the structured handover so that adverse impact can be reduced and also for promoting documentation and interpersonal relationship which not only enhance the nursing handover quality but also it improve the work satisfaction level among nurses which in turn helpful in attaining an optimum level of quality care with patients safety.