As a rule, when we get into a hospital environment, whether it is a hospital, maternity ward, or a simple polyclinic, our psychological state changes noticeably. The patient immediately experiences anxiety and fear, sadness, and loneliness, not only because of the illness itself but also because of social isolation from the usual lifestyle. A medical mistake can be very costly for patients: at best, it will result in an extra week of treatment and money spent on unnecessary medication; at worst, it can lead to death. For this reason, it is essential to improve the systems of patient care continually. One of the foundations of nursing care prevention is the ability to understand and listen to the patient, which subsequently helps to diagnose the disease better and has a positive effect on the psychological contract between the health worker and the patient. This work aims to thoroughly analyze the model of the relationship between nurses and the patient, called Bedside Shift Reports, at the time of the change of duty officer It makes sense to start with a description of the classic schemes most commonly used by nurses to provide better care for patients before and after surgery.
Previously, a paternalistic model was prevalent in healthcare settings, which suggested that the views of the healthcare professional were superior to those of the patient himself. For example, the nurse herself established the most appropriate procedures for each specific situation, aimed at a full recovery. However, it is hard to ignore the fact that the world is undergoing continuous qualitative changes, which is also true for the patient/health worker relationship model. Today, the patient is actively interested in his or her health issues, reads different literature and often asks for a second opinion, demands that the doctor and nurse explain the goals and objectives of the procedures, and reserves the right to make a final decision on the consent to the treatment offered to him or her. From the point of view of fundamental civil rights, such a situation seems natural.
The second principle underlies the Bedside Shift Reports method, which explains how one nurse replaces the other in the workplace. This method will significantly reduce errors and inaccuracies in the diagnosis and the next treatment of a patient (Gregory et al., 2014). To determine the relevance of this principle, it is essential to understand how two nurses are usually linked during a shift. In many health care settings, the process of transferring nurses between nurses takes place in the nursing home or residential care settings, with one health care provider passing on patient information to the other, most often verbally. Obviously, in such an organization of the shift nursing facility, it is difficult to take into account the needs and requirements of a particular patient and to obtain feedback from him or her on the manipulations and procedures that took place the day before. Errors of all kinds are likely to occur: incomplete or inaccurate communication of information, loss of data that is important to the patient, and misunderstanding of oral information. Therefore, the organization of the transfer of the nursing shift should be based on the principles of effective communication and medical care, centralized around the patient.
Therefore, the organization of the transfer of the nursing shift should be based on the principles of effective communication and care, centralized around the patient. According to the BSR principles, it should be impossible for a patient to be alone while one nurse replaces the other (Ofori-Atta, Binienda, & Chalupka, 2015). Active patients are known to reduce the likelihood of various types of errors and to integrate into their treatment, resulting in positive health and psychosocial effects (Sand-Jecklin & Sherman, 2014). This type of communication between the two nurses should be based on the principles of timeliness, accuracy, and unambiguity of the information provided.
The implementation of the bedside shift report practice can be presented as follows. The first nurse’s shift report is completed in the patient’s ward, which includes a substitute nurse. A bedside space near the patient as a meeting place is a prerequisite so that the patient can hear the conversation and participate in the discussion (Gregory et al., 2014). Nurse-to-nurse talks are only businesslike, and topics that are directly related to the patient are discussed. For example, as specific questions for transfer from one nurse to another, the current state of the patient’s health, the review of prescriptions, and the monitoring of takeaway doses can be discussed. Relatively new is the positive trend to describe short-term goals, for the time being, to clarify how the patient’s affairs are not specific to treatment issues and the motivation for recovery.
The “triangular” communication between nurse, nurse, and the patient has a positive impact on future treatment and, ultimately, recovery. Preliminary research shows that the bedside shift report has excellent potential to lead to higher patient satisfaction, improved clinical outcomes, and teamwork (Gregory et al., 2014). The conclusion from the above is that such a conversation can take longer and take additional time for medical staff. Generally speaking, the main argument against this idea is that it is a waste of time. In the medical field, every minute can play an important role, and reckless waste of tens of minutes can cost the lives of other patients who are not currently under vigilance. It should be noted at once that such arguments are unfair: contrary to fear, a bedside shift report on an already tried-and-tested practice in several clinics takes no more than ten minutes (Dorvil, 2018). The time at which the shift takes place varies from clinic to clinic, so two nurses can meet in the morning or the evening.
It is worth keeping in mind the role of the nurse in the patient’s treatment. Previously, there was a widespread belief that nurses, nurses, and nurses, such as nurses, played only a secondary role and had no specific impact on the patient. Positive trends in the importance of nursing are observed today. The majority of people today believe that nurses (not including attending physicians) are the primary caregivers of any clinic that performs the primary functions of maintenance and prevention (Ofori-Atta et al., 2015). The surgeon performs a complex operation, but it is the nurse who prepares the patient for it. A medical assistant assists the surgeon during the process by providing the necessary instruments. The nurses perform the most critical functions of sterilization and disinfection of equipment and rooms.
In this regard, it is worth noting how the psycho-emotional state of the nurse affects the course of recovery of the patient. Like everyone else, nurses experience stress, fatigue, and fear. Depressive syndromes most often occur during the first years of practice, immediately after graduation from university. This period of activity is characterized by extra-curricular hours, the need to quickly assimilate large amounts of new information, subordinate position within the medical team, and a high level of responsibility. Of course, training should have developed their sustainability skills, but no one can be perfect. In an underdeveloped health care system where there is no reporting scheme for change of doctor, nurses have to process the reports for several hours due to, for example, a shortage of staff (Gregory et al., 2014). Sleep fatigue and lack of sleep are known to lead to emotional, social, and cognitive impairments that tend to reduce the ability of nurses to collaborate with both the doctor and the patient. In this way, the RMB contributes to a positive financial effect by reducing the overtime of nurses, as well as accelerating and deepening the care of patients.
A fantastic feature of the system is the flexibility to include additional parties. For example, the BSR provides the opportunity to include the patient’s family in the discussion of health and treatment (Ofori-Atta et al., 2015). Of course, it is up to the patient to decide on this issue. However, if an interested relative or close relative is involved in the discussion, they may have additional questions during the bedside shift report that is important. Still, the patient, for example, has forgotten to ask them (Sand-Jecklin & Sherman, 2014). In this way, each party will be more involved in the conversation and will receive all the necessary information. However, if the patient does not wish to do so, the BSR can only take place with his or her family or not at all.
In addition to time management, improving the quality of care, and involving the patient and family members in the treatment process, the bedside shift report also plays an essential role in monitoring the accountability of nurses. Without this system, it is assumed that nurses transmit all relevant information about the patient to the administrative office, where the patient’s health is discussed without the patient’s presence. Alternatively, the data can be transmitted in writing (Dorvil, 2018). One nurse makes all the necessary notes on the particular form, and then a second nurse who comes to replace her uses the information. Of course, the second option is in some ways better than the first, because it provides better accuracy of the medical data being broadcast.
But from the BSR point of view, both of these options are problematic. Firstly, the office conversation between the two nurses does not involve the patient, which brings some problems with subsequent communication. In addition, in the absence of a regulator, the conversation between medical staff can go beyond business discussions, leading to a reckless waste of time. Second, the written report option is good but excludes the personal element of the change process. Lack of live discussion can negatively affect the patient’s sense of self and lead to a lack of communication (Dorvil, 2018). For this reason, the BSR is more advanced: it provides all the crucial factors but also monitors the accountability of nurses. The patient waits for a nurse change process so they cannot forget or miss it because they are responsible for the patient.
The quality of the work performed has a direct impact on the effectiveness of preventive and supportive procedures. To become a nurse, you need to have at least a secondary medical education and a certificate, but this is not enough to participate in bedside shift reports. Such a system implies some additional qualities for the nursing staff. Firstly, it is the carefulness and tremor of the patient. An employee cannot demonstrate a lack of interest and apathy. Second, creating the right atmosphere in the working group is also essential. To achieve the best results, the team must be interdisciplinary and multi-disciplinary (Ofori-Atta et al., 2015). It is not a good idea to present two nurses who have the same views and use the same methods to the patient. It is essential to set the right short-term goals for yourself and the patient. You could say, “you need to get well today,” but it will be much more effective and understandable, “you need to take two pills today and take a walk outdoors.
At first, we need to train our staff, give them a vector of development, and motivate them to work. Only then can we use bedside shift reports (Dorvil, 2018). However, you should not introduce bedside shift reports for all patients at once. It is best to do this gradually and try it out on several patients. This is an excellent way to minimize possible errors and to consider problems in advance. There are several limitations where the use of BSR can be problematic. These include patients with impaired cognitive and motor function.
For maximum objectivity in the analysis of this system, it is necessary to discuss the disadvantages of bedside shift reports. A review of the literature on this topic shows that healthcare professionals may encounter some problems if they use BSR (Dorvil, 2018). The first thing that can harm the treatment process is excessive questions from the patient and their relatives. In addition to the fact that there are situations in which staff cannot answer any questions, there are also cases in which the patient should not know the answer. This applies to experimental treatments in which the patient should not see any control points. For example, if the patient is prescribed placebo pills for treatment and decides to ask what medications he or she is taking, the employee’s correct response may harm the effectiveness of the procedure. In addition, reducing the nurse’s working hours is an undeniable benefit because the employee does not have to stay in the workplace. But the reduction in working hours harms employee salaries. Moreover, many nurses who have already tried bedside shift reports have expressed concerns about the confidentiality of the data transmitted (Ofori-Atta et al., 2015). A room where one nurse on duty changes to another may be bugged, and intruders or outsiders may be able to obtain the necessary information about the patient’s health.
In conclusion, let us repeat that there are several approaches to medical care for the patient. One of the new directions is BSR, which implies bedside communication between two nurses and the patient. If the patient so wishes, relatives, or a surrogate may be involved in the discussion, or there may be no discussion at all if the patient is not interested in his or her health. This type of work during a nursing shift has a positive impact on teamwork, patient involvement in treatment, and recovery processes.
References
Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing Management, 49(6), 20-25.
Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside shift reports: what does the evidence say. JONA: The Journal of Nursing Administration, 44(10), 541-545
Ofori-Atta, J., Binienda, M., & Chalupka, S. (2015). Bedside shift report: Implications for patient safety and quality of care. Nursing2018, 45(8), 1-4.
Sand‐Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal Of Clinical Nursing, 23(19-20), 2854-2863.