Nurses’ perceptions on the role of “end-of-shift” verbal handover: mixed method research

Aim To examine the perspectives of nurses in contemporary Australian clinical settings on the role of “end-of-shift” verbal handover practices; and to further identify the theoretical elements associated with this practice. The study also sought to examine what nurses considered as essentials of handover and their perspectives on the expectations of this ritualistic practice. Background There has been significant research on the topic of handover as a means of communication between clinicians. Verbal handover is a routine practice that assumes the transfer clinical responsibility between nurses, with a further intent of providing focus and direction for the oncoming nursing at the end of shift. Despite this, there continues to be gaps in the clear understanding of the verbal handover practice and its purpose amongst nurses. The following thesis sought to explore and provide a richer insight on the Australian nurses’ perspectives of “end-of-shift” verbal handover. Research Design The following study was a Mixed Methods Research that was conducted in two phases. Phase 1 used Grounded Theory methodology. The participants included 41 Registered Nurses from acute care backgrounds in a metropolitan hospital in Melbourne Australia. Purposive sampling was employed, and data was collected using intensive interviewing techniques in 6 focus groups. The data was then coded and analysed concurrently allowing the categorisation of core concepts. Phase 2 of the research was undertaken using an online questionnaire. The questionnaire was developed from the findings of Phase 1, containing a total of 70 items with each item providing a Likert scale measurement for respondents to select a response. There was a total of 239 respondents who were Registered Nurses. The data gathered from the questionnaire was used to validate the findings of Phase 1. During this phase, Exploratory Factor Analysis was performed, a technique where variables are grouped into factors to validate empirically each of the individual items on the questionnaire and to conceptualise these items into meaningful factors. Findings The current research provided details on the role of “end-of-shift” verbal handover from a nursing perspective. Whilst communication and transfer of responsibility had previously been identified as key reasons for nursing handover practices, this research delved into how these aspects further assisted the nurses in preparing for a shift. The nurses indicated the need for “being in the know” from the perspectives of discussing relevant patient care content, various dimensions and understanding of transferring responsibility; and the different modes of handover that supported the information transfer. Additionally, nurses discussed the dynamics of human interactions which included nurse to nurse and nurse to patient interactions; and their inherent influence on the preparation of the nurse coming onto a shift. These features further build on the mutual understanding of shared care responsibilities between clinicians and their role as a team to maintain continuity of care. The communication shared during “end-of-shift” verbal handover provided the information nurses sought to execute patient care as it allowed for identification and verification of care needs. The “end-of-shift” verbal handover was further perceived to inform the plan of care for the impending shift. The next most notable finding was the “sense of time” that was conveyed through the process of verbal handover as nurses suggested that this information also assisted in the nurses feeling prepared to deliver patient care. Conclusion Communication during handover must be tailored to support the oncoming nurse in preparing for the shift ahead. Nurses felt the need of “being in the know”; and developing a mutual and shared understanding of the patient care requirements amongst clinicians. Information shared must be relevant and fashioned such that the oncoming nurse can prioritise patient care needs in a timely manner. The additional roles of verbal handover as a means of informal learning and sharing of knowledge; and a platform for informal debriefing must be formerly acknowledged. It is envisaged that the findings generated from this Mixed Method Research study will assist healthcare providers to expand and enhance current handover practices.