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Friday, April 12, 2013
Learning Objective 1: The learner will be able to identify three hidden functions exclusive of clinical data exchange included in nurse-to-nurse shift report.
Learning Objective 2: The learner will be able to discuss the prospective outcomes or tools provided by the hidden functions of nurse-to-nurse shift report.
JCAHO reported that communication errors were responsible for almost two-thirds of sentinel events in JCAHO accredited facilities. Ineffective transfers of care accounted for nearly half of communication breakdowns. Despite these findings, no consensus on best reporting practices exists. Current research is focused on report standardization, tools and technology to streamline and cue exchange of predetermined clinical data. Literature suggests nursing shift report may serve other functions such as providing emotional support, psychosocial rituals and formation of novices. The purpose of this study was to determine functions of nursing shift report beyond exchange of standard clinical data. Secondary data analysis was performed on transcripts of handoffs collected as part of a larger study identifying barriers and facilitators to high reliability handoffs. The study was guided by principles of human factors engineering and crew resource management. Mixed methods were used to collect data, including direct observation, audio and video recording. Criterion sampling of all shifts on two different medical-surgical units at a Midwestern medical facility was used. For this study purpose, nurse to nurse handoffs were analyzed using the same framework. Data from twelve handoff report transcripts was coded and analyzed through iterative discussion to reach final consensus on themes. Findings included three handoff mechanisms (Orientation, Interpersonal Interaction and Education) that resulted in three outcomes (Foresight, Ease and Power) gifted by the outgoing nurse to the incoming nurse in addition to the exchange of standard clinical data. An enabling function of nurse handoffs to enhance nursing care delivery was discovered by this study in the form of three mechanisms leading to three outcomes. Future studies are needed to determine: 1) structure of handoffs that support the three study mechanisms, 2) interventions and education to improve current handoff processes, and 3) impact of the handoff outcomes on quality and safety of patient care.