Correlating Nursing Staff's Contribution to Improved Patient Outcomes: Videotaping Shift Reports and Developing Behavioral Interventions

Monday, 13 July 2009: 3:05 PM

Mary M. Hays, DSN, RN
Rita W. Ferguson, MSN
College of Nursing, University of Alabama in Huntsville, Huntsville, AL

Learning Objective 1: describe how nurses interacting with each other at shift reports and patient handoffs influence clinical outcomes.

Learning Objective 2: apply the identified behavioral interventions in varied clinical venues in a variety of global settings.

Suboptimal communication during shift change in clinical units is a source of patient-care instability (Dracup & Morris, 2008; Australian Council for Health Care, 2005; Meifsner et al, 2007). Stone et al. (2006) stated that a supportive environment improves the hospital climate for nurses, patient outcomes and staff retention. The 2009 Joint Commission’s report still stresses the need to improve caregiver interactions in handoffs; yet to date, there is no measure of how those interactions affect outcomes. Helmreich and Sexton (2004) found among aviation crews that pilots talk more about their task related problems and solutions. This collaborative research, conducted in a southeastern hospital analyzed nurse-nurse interactions, conducted behavioral interventions, and linked them with quality indicators. Subjects were 26 RNs in a medical-surgical unit. Using Gordon’s (1967) Survey of Interpersonal Goals and a 2-item Survey of Goals showed their priority was conformity, not individual recognition. We scored 52 video recordings of leader-follower dyad handoffs over 3-weeks, using the investigator-developed Target Behavior Instrument (Hays, 2006). The principal investigator and research assistant independently scored the interactions. Interobserver agreement was established at >80% on 10 second intervals. The reports were informative with few questioning behaviors. Participants demonstrated a paucity of collegiality and supportiveness. Behavioral interventions were developed in collaboration with the clinical coordinators to identify nurse-centered behaviors that affect outcomes. Pre-post quality indicators were the markers used to obtain input, throughput, and output findings as predictors of nursing effectiveness. Findings were derived through statistical analysis and modeling. Interventions were linked to two frameworks: King’s Interacting Systems (1981) and Hersey and Keilty’s (1980) situational leadership to understand the complexities and intermediaries of behavioral change. The desired outcome is to empower staff to identify high performing nurses and replicate their behaviors. Positive effects for these measures help establish nursing’s influence on improving clinical outcomes.