The need for handoff education in pre-licensure nursing programs is certainly recognized by research findings that handoff failures have been implicated in seven out of eight novice nurses’ near miss and adverse events1. Current literature reviews indicate that nursing students reported limited opportunities to develop and enhance handoff communication.2-6 The process of learning handoff communication in pre-licensure nursing programs is often unpredictable and dependent on clinical experiences7. Students need opportunities to practice the handoff process to increase their confidence, promote teamwork, and enhance critical thinking skills. This study hypothesized that the use of the mObile Nursing Synergy HAndoff REporting (ON-SHARE) provides a solution to these challenges in handoff education in a pre-license nursing program. This study examined the feasibility of a mobile nursing handoff reporting app (ON-SHARE) as an educational tool for baccalaureate senior nursing students to enhance handoff communication skills and clinical judgment skills.
Methods:
The study used mixed-methods, incorporating a randomized pretest-posttest design. The ON-SHARE app was developed by integrating the American Association of Critical-Care Nurses’ Synergy Model8 into the interface design. A convenience sample of 32 senior nursing students was randomly assigned to experimental (n=18) and control groups (n=14). With four simulated patient scenarios, the experimental group used the ON-SHARE app for handoff practices; the control group experienced standard handoff procedures using a paper-based template. Before and after handoff education and practice, students in both groups completed the confidence in handoff communication skill questionnaire. The duration of handoff reporting in both groups was also measured. Students’ clinical judgment skills were measured with a checklist to examine if students correctly responded to 25 items that corresponded to changed patient conditions in the standardized scenarios. The accuracy score was measured by checking if 25 items that corresponded to patient condition changes were updated and reported in students’ handoff reports. The quantity and quality of care plans created by students were also measured.
Results:
The following findings are reported: 1) significant differences in the accuracy scores associated with capturing several patient conditions (e.g., updates for the latest temperature, IV site dressing status, urinary elimination conditions, etc.) on handoff reports between the students in the experimental group and the control group, 2) significant improvement in confidence in handoff communication skills of the students within the experimental group between pre- and post-handoff practices, 3) no significant differences in duration of handoff reporting between two groups, and 4) a significantly larger number of nursing care plans and higher quality of care plans created by students in the experimental group than students in the control group.
Conclusion:
The senior students' clinical practices require well-thought-out assessments and syntheses of the care rendered to patients. The handoff training via the ON-SHARE app helps students learn how to collect/synthesize patient data, promote an understanding of patient problems and situations, plan interventions, and communicate patient condition information. Strategies for an adoption/implementation of the ON-SHARE app for handoff and clinical judgment education in a nursing program will be planned considering lessons learned from the process of this study.