Introduction
A nursing handover is a type of communication that occurs between nurses as a part of nursing rounds in hospitals. It is an obligatory activity with multiple goals every incoming shift has to know. It includes a report on all patients’ statuses before providing care and evaluating the conditions. Sometimes, nurses do not want to communicate with patients until they get a formal handover and read all information about recent changes. Handover communication is an important concept that has to be properly understood by every nurse.
My practice shows that not all nurses are usually aware of how to carry on a handover in the emergency department. The content of handover may vary between the departments, and it is hard to develop one general plan for nurses to follow. Some nurses do not make official notes about patients, their conditions, and their families. Recent research proves that several critical incidents in health care occurred because of poor communication between nurses and the inabilities to prevent patient harm (Slade et al. 2015). A handover is a pivotal step that creates an opportunity for a nurse to know what has been happening to a patient during the last several hours or minutes when another nurse was on duty. Handover communication requires the development of critical skills and knowledge to observe what care changes occur (Riley 2015). ED handover is very different in comparison to handover in the clinical environment due to significant patient turnover and unpredictable patient flow. Communication should be fast and clear. Nurses have to divide necessary and unnecessary facts and use clear language.
Effective communication between nurses is an important factor for providing safe and high-quality health care, and nursing rounds depend a lot on how well nurses can share information at handover. It is a process when information about one patient or the whole department has to be transferred. The purpose of this paper is to develop a handover communication process analysis, evaluate the worth of nursing communication in the emergency department, identify the main elements of nursing handover, and introduce possible improvements of handover communication.
Description of a Communication Process
A nursing handover is an activity that helps to identify and solve some patients’ problems and needs (Negarandeh, Bahabadi & Mamaghani 2014). All clinicians have to know the purpose of a handover and the information that has to be communicated. ED handover is also a high-risk activity for both a patient and a nurse. Multiple tasks may mislead and confuse nurses, promote informative gaps, and interrupt a working process. Handover communication is a crucial process because it aims at obtaining information, understanding the facts, and evaluating the general situation.
In the emergency department where I have been working for the last nine years, the system of work is rather simple and clear. There are three shifts of nurses that have to work at different periods for 8 hours. Three regular nursing rounds occur at 8 am, 4 pm, and 12 am. Handovers occur at 7 am 3 pm and 11 pm. Handover communication is usually short but informative. Therefore, it is better to choose an appropriate area for handover where privacy, confidentiality, and the use of IT systems may be supported. As a rule, there are not many patients at the moment of a handover because nurses try to accept all critical patients, gather the main information about patients, including their names, birth years, and past medical history or present allergies that may influence the current treatment, and transform them to a waiting room or pass them to doctors.
Verbal communication at handover should not last more than 30 minutes. Nurses may focus on cultural preferences, religious backgrounds, and personal concerns. However, the task of nurses is to minimize the amount of information for exchange. The most important aspects of the discussion include a current bed issue, waiting times, deaths, and technical problems during a shift. If there are some personnel changes, it is necessary to report on staff sickness. In our department, three different nurses work at their shifts. Their work is divided into areas, and they know the nurses from other shifts who have to complete the same duties. If there are no force-major cases, staff nurses should follow a brief plan with the issues to be covered during each nursing handover. First, nurses inform about the number of patients accepted and their current status. Then, nurses give information about each patient, including their names, birth dates, complaints, insurance details, and statuses. If there are some significant personal issues, family history, or religious beliefs that may play a role in treatment, they should be mentioned. Finally, technical details must be discussed, including the number of beds, the presence/absence of doctors, and IT errors.
Issues, Questions, and Problems
Handover communication in the ED setting is characterized by certain issues, elements, and skills to be recognized and critically evaluated by a nurse. One of the main problems of this process is a necessity to introduce crucial information about patients in short statements (Slade et al. 2015). Nurses have to understand all the challenges patients may go through in case they fail to give the details to another shift. Nurses may use empathy and rapport during their communication with patients to gather the information for another shift and continue care (Pun et al. 2015). During handovers, these qualities may be neglected. It is enough to provide other nurses with actual information. In the chosen workplace, all ED communication processes usually lack the required level of empathy because nurses have to be focused on their primary tasks and make sure that other nurses obtain all necessary information about patients, recent health changes, and the effects of the already offered treatment. Nurses do not spend much time on handover. As a result, not all information may be given, cultural or social points are not properly explained, and new shifts cannot understand why their communication with patients is not as successful as it was during the previous shift.
To overcome these challenges and find solutions to these problems, some changes in the workplace are required. For example, Klim et al. (2013) suggest promoting handover that is specific for every patient and conducted at the bedside. One of the weak aspects of handover communication is missing information about medications used by or assigned to a patient and vital signs that can influence a care plan. The employees of our emergency department can identify their strong and weak aspects and understand what kind of work should be done to promote positive care outcomes.
Literature Review
Importance of Communication in Emergency Departments
Handover communication is a frequently discussed topic in many hospitals. Despite the existing cultural diversities and social norms, the fact that this nursing communication process plays an important role cannot be ignored. Good communication between nurses is a step forward in achieving successful outcomes in nursing care (Kourkouta & Papathanasiou 2014). In addition to clinician-patient communication, clinician-clinician communication helps to avoid misunderstandings and critical mistakes in further care (Pun et al. 2015). The success of handovers in ED depends on how well nurses understand the purposes of the process, combine their duties, and develop a system of signs and concepts to shorten the exchange of information from one shift to another and report to their colleagues in a clear, consistent way (Klim et al. 2013). Nurses should have similar understandings of the tasks and focus on the same duties and responsibilities.
Handover Communication Process
Increased overcrowding in the ED is a challenge that staff nurses may face and have to find an effective and working solution (Hearld & Alexander 2012). It is not enough to develop respectful relations with their patients during nursing rounds, but also to think about what kind of information should be transferred to another shift, and what details may influence the quality of care and the development of a new treatment plan. In my practice, I observe how nurses help people who have certain expectations. As a rule, nurses do not think about nursing handover communication all the time. They focus on one problem at a time and search for its solution. Nurses have their shifts and understand that they need to complete their duties, examine patients, and learn the recent changes. They expect the hospital provides them with a comfortable environment, including space where nurses gather information about patents, talk to each other, and share the details about patients and the results of their examinations (Hearld & Alexander 2012; Martin & Ciurzynski 2015). However, they fail to understand that they are also responsible for the promotion of this appropriate environment. Nursing handover is an important process, and a single misstep or omission of some information may negatively influence nursing care and treatment (Reimer & Herbener 2014). In my hospital, there is usually no time to think about personal comfort or satisfaction. We have to work hard to have enough information to share during a nursing handover because, as a rule, nurses have about 30 minutes (maximum one hour) for this type of communication.
Documentation during Communication
Nursing handover communication is of a verbal type. Nurses should know that additional notes and written reports have to be included in a handover to make sure that all information is mentioned (Limpahan et al. 2013). Documentation and specially developed models are necessary for any communication process in the ED (Bost et al. 2012; Morton et al. 2014). For example, in the hospital where I work, nurses are provided with special guides to be filled in for every handover. There are three main boxes in written reports, including patient information, organizational issues, and technical aspects. Nurses should develop their writing skills and critical thinking and present their reports orally.
In EDs, nurses expect to develop optimal handover with specific information about patients, health care, the number of occupied and free beds, and organizational details. Nurses admit that they pay attention to the information they receive at handover (Klim et al. 2013). Still, not all of them understand the level of their responsibility during this kind of communication.
Written and oral communication during handovers influences the quality of the work nurses to have to perform. Nurses are welcome to use such processes and behaviors as listening, empathy, and close-ended interviews to gather enough facts (O’Hagan et al. 2014). Considering these requirements, nurses should have a thorough knowledge to identify actual problems, develop good relationships with each other, and monitor the changes that occur in the department.
Non-Verbal Support
Handover communication may be improved in a variety of ways. Sometimes, communication may happen without words, and it is called as non-verbal communication expressed by eye-contact, gestures, posture, and physical barriers (Kourkouta & Papathanasiou 2014). In some hospitals, it is normal to start nursing rounds every hour, address all basic needs of patients, and enhance safety to present a good portion of information at handover (Mitchell et al. 2014). Nurses may gain a better understanding of patients’ needs and demands. However, such practice can hardly improve the outcomes of nursing handover. In our hospital, nursing rounds are equal to nursing handover with the only difference in one hour. As soon as a new shift comes to the department, they exchange the information with the previous shift, evaluate all facts, and begin around to check the appropriateness of the information given at handover.
Comparison of Practices
Hospitals develop their guidelines and steps to meet local requirements and improve the quality of health care. The experience of a staff nurse at the emergency department in a general hospital is an opportunity to understand what kind of work should be done at handover. In our workplace, nurses never neglect handover communication because they share the necessary information about patients and describe the current condition in the department. We use personal notes and special toolkits to make sure that all facts are mentioned.
Similar ideas and models are observed in other hospitals. For example, Klim et al. (2013) introduced the Sunshine Hospital ED structured nursing handover framework in terms of which nurses had to identify all patients, present problems, explain backgrounds, and check the signs and other parameters of patient condition. However, the main difference between these two practices is the attention of the Sunshine Hospital to nursing care needs. In our hospital, ED nurses do not have to analyze their needs and think about possible improvements in care at handover. Therefore, Klim et al.’s approach can be a significant change in our nursing practice.
Another handover practice was described by Bost et al. (2012) who underlined that ED personnel found it enough to use memory and neglect electronic or written documentation during handover. It is possible to question the importance of toolkits in our work and focus on the development of nurses’ memory and the ability to share information clearly and briefly. Finally, the approach offered by Hearld and Alexander (2012) about the importance of an appropriate environment for a communication process at handover. Handover is a process that does not take much time and has several important purposes. Nurses should not be challenged by the necessity to find a place, time, and an opportunity to share the information between the shifts. In our hospital, there is a special room for nurses to communicate at handover. Still, not all ED departments have such room, and the quality of the information shared between nurses may be questioned.
Communication Improvements
The results of this research can be used to improve the communication process during nursing handover. Three main aspects of the work of ED nurses have to be discussed. First, the improvement of the environment where nurses from different shifts have to communicate and exchange information about patients and recent achievements made in the department. The environment means the conditions under which nurses have to work and communicate (Hearld & Alexander, 2012). Some hospitals have special rooms for nursing handover or other communication processes to be developed. In some hospitals, nurses may exchange information at any place they find comfortable at the moment. Though handover does not take much time, the quality of the information given has to be high and definite. Nurses should know how to evaluate the conditions of patients and what information is necessary for another shift. In case the environment is not appropriate, it may influence the results of communication. In our workplace, nurses have a cozy room for communication and try to use it during every shift change.
The second area of improvement is connected with the tools that nurses may use to document all necessary information during a communication process. The goal of any communication process is to gather enough credible information about patients and the setting. Lack of access to electronically documented information at handover may increase the risk of missed or wrong information (Bost et al., 2012). There is a threat that nurses may confuse facts or fail to give all the necessary data. To avoid such situations, nurses have to be provided with special technologies. In our workplace, nurses are free to use toolkits and personal notes. However, written information may be as not effective and concrete as electronically made notes. It is possible to use this new approach in our hospital.
Finally, in our workplace, many nurses focus on their duties and do not find it necessary to develop new approaches to their work and communication. Handover communication can and has to be improved. For example, it is possible to add new expressions, emotions, and behaviors with the help of which nurses can save their time and prepare another shift for a certain portion of information (O’Hagan et al. 2014). Eye-contact has to be developed during a communication process (Kourkouta & Papathanasiou 2014). Special training programs can be offered as a part of the program for nursing handover improvement.
Importance of Change and Reasoning
To be effective, any organizational or personal change should be developed according to a plan or a model, and nurses should participate in the improvement process voluntarily. In the chosen general hospital where I have been working during the last nine years, many nurses are ready for changes and share their reasons and ideas on how to improve their communication at handover. Nursing handover is a process when nurses have to demonstrate the results of their work and share the information they gather during their shifts, including physical and mental conditions of patients, the progress and changes in the department, statuses of patients and the medical staff, and the details that may influence treatment. Nurses have to understand that they have responsibilities for different people. They are the main communicators between patients and other nurses. The way of how they cooperate with patients determines the quality of information nurses shares at handover. Patients are free to choose any communication method regarding their abilities, needs, and preferences. Hospitals offer different conditions for handover communication, and our hospital is a good example for nurses to rely on.
Conclusion
In general, the evaluation of handover communication in EDs is a unique opportunity to investigate the peculiarities of nursing practice and the factors that determine the quality of information nurses have to exchange. Many nurses are ready for communication during handover. Some nurses lack knowledge and experience in communication, and additional training may be required. Nurses may be challenged by different external factors, human emotions, and the changes in the hospital environment. It is necessary for nurses to get prepared for new tasks, as well as to remember about their regular duties and responsibilities during handover. Many hospitals ignore the importance of a handover, and nurses have to learn how to fit in the hospital culture, handover peculiarities, and their skills. In my workplace, handover is defined as a significant process of communication between nurses, and its improvement is a requirement that cannot be neglected but has to be improved by new practices and recommendations.
Reference List
Bost, N, Crilly, J, Patterson, E & Chaboyer, W 2012, ‘Clinical handover of patients arriving by ambulance to a hospital emergency department: a qualitative study’, International Emergency Nursing, vol. 20, no. 3, pp. 133-141.
Hearld, LR & Alexander, JA 2012, ‘Patient-centered care and emergency department utilisation: a path analysis of the mediating effects of care coordination and delays in care’, Medical Care Research and Review, vol. 69, no. 5, pp. 560-580.
Klim, S, Kelly, AM, Kerr, D, Wood, S & McCann, T 2013, ‘Developing a framework for nursing handover in the emergency department: an individualised and systematic approach’, Journal of Clinical Nursing, vol. 22, no. 15-16, pp. 2233-2243.
Kourkouta, L & Papathanasiou, I 2014, ‘Communication in nursing practice’, Materia Socioamedica, vol. 26, no. 1, pp. 65-67.
Limpahan, LP, Baler, RR, Gravenstein, S, Leibmann, O & Gardner, RL 2013, ‘Closing the loop: best practices for cross-setting communication at ED discharge’, The American Journal of Emergency Medicine, vol. 31, no. 9, pp. 1297-1301.
Martin, HA & Ciurzynski, SM 2015, ‘Situation, background, assessment, and recommendation-guided huddles improve communication and teamwork in the emergency department’, Journal of Emergency Nursing, vol. 41, no. 6, pp. 484-488.
Mitchell, MD, Lavenberg, JG, Trotta, R, & Umscheid, CA 2014, ‘Hourly rounding to improve nursing responsiveness: a systematic review’, The Journal of Nursing Administration, vol. 44, no. 9, pp. 462-472.
Morton, J, Brekhus, J, Reynolds, M & Dykes, AK 2014, ‘Improving the patient experience through nurse leader rounds’, Patient Experience Journal, vol. 1, no. 2, pp. 53-61.
Negarandeh, R, Bahabadi, AH & Mamaghani, JA 2014, ‘Impact of regular nursing rounds on patient satisfaction with nursing care’, Asian Nursing Research, vol. 8, no. 4, pp. 282-285.
O’Hagan, S, Elder, C, Woodward-Kron, R & Webb, G 2014, ‘What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients’, Journal of Advanced Nursing, vol. 70, no. 6, pp. 1344-1355.
Pun, JKH, Matthiessen, CMIM, Murray, KA & Slade, D 2015, ‘Factors affecting communication in emergency departments: doctors and nurses’ perceptions of communication in a trilingual ED in Hong Kong’, International Journal of Emergency Medicine, vol. 8, no. 1, pp. 48-60.
Reimer, N & Herbener, L 2014, ‘Round and round we go: rounding strategies to impact exemplary professional practice’, Clinical Journal of Oncology Nursing, vol. 18, no. 6, pp. 654-660.
Riley, JB 2015, Communication in nursing, 8th edn, Elsevier Health Sciences, St. Louis, MO.
Slade, D, Manidis, M, McGregor, J, Scheeres, H, Chandler, E, Stein-Parbury, J, Dunston, R, Herke, M & Matthiessen, C 2015, Communicating in hospital emergency departments, Springer, New York.