This book gives valuable insights into the features of effective and ineffective clinical handovers in a variety of common hospital context.
Pun, J, Chan, EA, Man, M, Eggins, S & Slade, D 2019, 'Pre- and post evaluations of the effects of the Connect, Ask, Respond and Empathise (CARE) protocol on nursing handover: A case study of a bilingual hospital in Hong Kong', Journal of Clinical Nursing.View/Download from: Publisher's site
© 2019 John Wiley & Sons Ltd Aims and objectives: To evaluate (a) the perceived effects of the training provided to nurses under a standardised Connect, Ask, Respond and Empathise (CARE) protocol; (b) the ability to enhance the effectiveness of the ISBAR checklist; (c) any increase in nurses' spoken interactions and/or improved comprehension of the patient conditions upon the transfer of responsibility. Background: Nursing handover is a pivotal act of communication with effects on both patient safety and risk management. Previous studies of critical incidents have highlighted ineffective communication, including a lack of interaction and incomplete and unstructured handovers, as a major contributor to patient harm. Design: A pre- and post evaluation study involving a questionnaire survey before and after the 3-hours training. Methods: Forty-nine randomly selected bilingual nurses with no previous professional development experience in handover communication were trained according to the CARE protocol, and their perceptions of nursing handovers were assessed before and after training using questionnaire. The STROBE checklist is used (See File S1). Results: Training of the CARE protocol improved key areas of the handover process. All participating nurses exhibited significant improvements in their perceptions of effective handover from before to after training. Particularly, improvements were observed in the interactive frequency and quality and completeness of the presented patient information per handover. Conclusions: The nurses reported a deeper understanding of their perceptions of handover after a patient-centred intervention, a better quality of interactions (e.g., querying and checking by incoming nurses), a greater focus when managing handovers and a more complete and comprehensive transfer of information between nurses. Relevance to clinical practice: CARE protocol-based training yielded significant improvements in nursing handover practice.
Slade, D, Murray, KA, Pun, JKH & Eggins, S 2019, 'Nurses' perceptions of mandatory bedside clinical handovers: An Australian hospital study', Journal of Nursing Management.View/Download from: Publisher's site
© 2018 John Wiley & Sons Ltd Aims: The research explores (a) nurses' views of the change to mandatory bedside handovers, and (b) these nurses' perceptions of their skills in managing this new practice in an Australian hospital. Background: In Australia, nursing bedside handovers are now considered essential in many hospitals, although most nurses received minimal training at the time this policy was instituted. This research establishes a unique quantitative tool to investigate nurses' views of, and self-reported actions related to, bedside handovers. Method: Prior to the implementation of mandatory bedside handovers in a hospital in Canberra, Australia, nurses in two wards (n = 66) were recruited to complete the new Bedside Handover Attitudes and Behaviours (BHAB) questionnaire. Results: Most nurses strongly value bedside handovers and have confidence in their ability to lead this clinical practice. Conclusions: Researchers identified a high level of alignment between the nurses' acceptance of bedside handovers and nurses' self-reported actions in conducting this communication process. Implications for Nursing Management: Future research should explore the links between nurses' views of, and skills in, the management of bedside handovers, as well as the effects of professional training for this practice. Furthermore, the BHAB questionnaire may be employed in different nursing contexts in future research.
Slade, D, Pun, J, Murray, KA & Eggins, S 2018, 'Benefits of Health Care Communication Training for Nurses Conducting Bedside Handovers: An Australian Hospital Case Study', JOURNAL OF CONTINUING EDUCATION IN NURSING, vol. 49, no. 7, pp. 329-+.View/Download from: UTS OPUS or Publisher's site
Slade, DM & Eggins, S 2016, 'Contrasting discourse styles and barriers to patient participation in bedside nursing handovers', Communication and Medicine, vol. 13, no. 1, pp. 71-83.View/Download from: UTS OPUS or Publisher's site
This paper applies qualitative discourse analysis to
'shift-change handovers', events in which nurses hand
over care for their patients to their colleagues. To
improve patient safety, satisfaction and inclusion,
hospitals increasingly require nursing staff to hand
over at the patient's bedside, rather than in staff-only
areas. However, bedside handover is for many a new
and challenging communicative practice. To evaluate
how effectively nurses achieve bedside handover,
we observed, audio-recorded and transcribed nursing
shift-change handovers in a short stay medical
ward at an Australian public hospital. Drawing on
discourse analysis influenced by systemic functional
linguistics we identify four handover styles: exclusive
vs inclusive and objectifying vs agentive. The styles
capture interactional/interpersonal meaning choices
associated with whether and how nurses include
patients during handover, and informational/ideational
meaning choices associated with whether or
not nurses select and organise clinical information
in ways that recognise patients' agency. We argue
that the co-occurrence of inclusive with agentive and
exclusive with objectifying styles demonstrates that
how nurses talk about their patients is powerfully influenced
by whether and how they also talk to them.
In noting the continued dominance of exclusive objectifying
styles in handover interactions, we suggest
that institutional change needs to be supported by
Eggins, S & Slade, D 2015, 'Communication in Clinical Handover: Improving the Safety and Quality of the Patient Experience.', Journal of public health research, vol. 4, no. 3, p. 666.View/Download from: UTS OPUS or Publisher's site
Rider, EA, Kurtz, S, Slade, D, Longmaid, HE, Ho, M-J, Pun, JK-H, Eggins, S & Branch, WT 2014, 'The International Charter for Human Values in Healthcare: An interprofessional global collaboration to enhance values and communication in healthcare', Patient Education and Counseling, vol. 96, no. 3, pp. 273-280.View/Download from: UTS OPUS or Publisher's site
Eggins, SE & Slade, DM 2012, 'Clinical handover as an interactive event: Informational and interactional communication strategies in effective shift-change handovers.', Communication and Medicine, vol. 9, no. 3, pp. 215-227.View/Download from: UTS OPUS or Publisher's site
Clinical handover - the transfer between clinicians of responsibility and accountability for patients and their care (AMA 2006) - is a pivotal and high-risk communicative event in hospital practice. Studies focusing on critical incidents, mortality, risk and patient harm in hospitals have highlighted ineffective communication - including incomplete and unstructured clinical handovers - as a major contributing factor (NSW Health 2005; ACSQHC 2010). In Australia, as internationally, Health Departments and hospital management have responded by introducing standardised handover communication protocols. This paper problematises one such protocol - the ISBAR tool - and argues that the narrow understanding of communication on which such protocols are based may seriously constrain their ability to shape effective handovers. Based on analysis of audio-recorded shift-change clinical handovers between medical staff, we argue that handover communication must be conceptualised as inherently interactive and that attempts to describe, model and teach handover practice must recognise both informational and interactive communication strategies. By comparing the communicative performance of participants in authentic handover events we identify communication strategies that are more and lesslikely to lead to an effective handover and demonstrate the importance of focusing close up on communication to improve the quality and safety of healthcare interactions.
Eggins, S & Slade, DM 2016, 'Clinical Handover in Context: Risks and Protections Across a Hospital Patient's Journey' in Eggins, Slade, DM & Geddes, F (eds), Effective Communication in Clinical Handover from Research to Practice, De Gruyter Mouton, Berlin, pp. 131-155.View/Download from: UTS OPUS or Publisher's site
One weekday afternoon an 18-year-old patient, we'll call her Belinda Page,1 arrives at
the emergency department of a busy tertiary teaching hospital, complaining of shortness
of breath and chest pain due to a flare-up of her asthma. During the six hours
Belinda spends in the emergency department she develops additional symptoms –
and numbness, particularly down her left side. She undergoes an emergency
MRI, x-rays and other tests but the emergency department night registrar, Dr Ken Lee –
a relatively junior non-English speaking background doctor – cannot reach a diagnosis.
Under pressure to move patients out of the emergency department as quickly as
possible, during the night he calls the senior neurology consultant, Dr Richard Lancer,
who declines to admit Belinda before reviewing her. Dr Lee then calls the Ward M consultant,
Dr Allenanda, who reluctantly agrees to admit Belinda to a general medical
assessment ward, until the neurology staff can review her the next day.
Over the next day we observed and recorded as many of the interactions with and
about Belinda as we could, including consultations and examinations, formal and
informal discussions about her case and nursing and medical handovers. The first
occurred at 8 am the next morning when, after working a 12-hour shift, Dr Lee fronted
up to a large auditorium to give the whole-of-hospital medical handover of all the
patients he had admitted overnight. He sat on a solitary chair placed front and center
of the auditorium, almost as if he were to be interrogated. In the tiered rows of seats
facing him sat those members of the hospital's day shift medical staff who had the
time and motivation to attend (attendance is not compulsory). On this morning, about
25 doctors were present, ranging from interns to senior consultants. They included
the two female registrars from Ward M (Dr Pantani and Dr Lingren) and a male cardiology
consultant (Dr Davidson). The neurology consultant Dr Lancer arrived about
Eggins, S & Slade, DM 2016, 'Communication in Bedside Nursing Handovers' in Eggins, S, Slade, DM & Geddes, F (eds), Effective Communication in Clinical Handover from Research to Practice, De Gruyter Mouton, Berlin, pp. 97-113.View/Download from: UTS OPUS or Publisher's site
The previous chapters have described the challenges of emergency department
clinical handovers when medical staff change. In this chapter the focus shifts to
nursing staff shift changes in a general medical ward. We describe and analyze
the practice of bedside handovers in a metropolitan teaching hospital, hospital B,
acknowledging the challenges but also the benefits of this semi-public clinical
handover mode for nurses and patients. In chapter 7 we then suggest strategies and
resources to improve patient safety and to increase nurse and patient satisfaction
with the practice.
Eggins, S & Slade, DM 2016, 'Resource: Communicating Effectively in Bedside Nursing Handovers' in Eggins, S, Slade, DM & Geddes, F (eds), Effective Communication in Clinical Handover from Research to Practice, De Gruyter Mouton, Berlin, pp. 115-125.View/Download from: UTS OPUS or Publisher's site
Chapter 6 described the challenges nurses faced at the research site when implementing
the mandated policy of bedside handovers. In response to our research findings,
and with the strong support of the local health department, we developed a twohour
training module 'Better Bedside Handovers', and a train-the-trainer package.
At time of writing we have delivered this training to more than 300 nurses and nurse-managers.
The training is described in full in Slade et al. (in preparation). In this
chapter we summarize the training module design and present the communication
protocols and tools that we developed.
Eggins, S, Geddes, F & Slade, DM 2016, 'iCARE: an Integrated Translational Model of Effective Clinical Handover Communication' in Eggins, S, Slade, DM & Geddes, F (eds), Effective Communication in Clinical Handover from Research to Practice, De Gruyter Mouton, Berlin, pp. 295-323.View/Download from: UTS OPUS or Publisher's site
Our final example of a handover event brings together many of the challenges with
clinical handover identified in earlier chapters.
Early one weekday evening, Sartaj1, a tall, strong man who speaks English as
a second language, brought his wife Indira to hospital B's emergency department.
Indira was 33-weeks pregnant and had suffered a miscarriage in the past. The couple
were of Indian background. Sartaj told the triage nurse that Indira was complaining
of nausea and vomiting and had headaches. Sartaj explained that he had taken Indira
to the other major public hospital in the city earlier in the day, but that she had been
discharged home after a few hours in their emergency department.
Several hours later, hospital B's emergency department night registrar examined
Indira. He found her unwell – still nauseous and complaining of severe headaches.
He was unable to reach a diagnosis but wanted to admit Indira for observation and
tests. However, no beds were available in the antenatal ward. He made several phone
calls to consultants and other wards, looking for a bed where Indira could be cared for
while she waited for a bed in antenatal. At around 3 am Indira was admitted to Ward M,
the hospital's general medical ward, where she stayed for 10 hours before being transferred
to a bed in the antenatal ward.
Throughout her admission and handover, Indira was accompanied by Sartaj.
With the consent of Sartaj and Indira, an ECCHo researcher observed and audiorecorded
the transfer from Ward M to the antenatal ward.
Geddes, F, Slade, DM, Eggins, S, Watson, B, Manias, E, Della, P & Jones, D 2016, 'Clinicians' Voices: What Healthcare Professionals Say About Handover Practice' in Eggins, S, Slade, DM & Geddes, F (eds), Effective Communication in Clinical Handover from Research to Practice, De Gruyter Mouton, Berlin, pp. 25-42.View/Download from: UTS OPUS or Publisher's site
The following patient story is taken verbatim from a junior doctor's recount of an adverse event submitted to the ECCHo handover survey
Slade, DM, Eggins, S, Geddes, F, Watson, B, Manias, E, Bear, J & Pirone, C 2016, 'Effective Communication in Clinical Handover: Challenges and Risks' in Eggins, S, Slade, DM & Geddes, F (eds), Effective Communication in Clinical Handover from Research to Practice, De Gruyter Mouton, Berlin, pp. 5-24.View/Download from: UTS OPUS
Slade, DM, Pun, J, Lock, G & Eggins, S 2016, 'Potential risk points In doctor–patient communication: An analysis of Hong Kong emergency department medical consultations' in de Silva Joyce, H (ed), Language at work: Analysing Language Use in Work, Education, Medical and Museum Contexts, Cambridge Scholars Publishing, Newcastle upon Tyne, pp. 146-165.View/Download from: UTS OPUS
Eggins, SE 2016, 'As A Doctor, You're Always Learning: Discourse Strategies SeniorClinicians Use To Teach Junior Clinicians On The Job' in De Silva Joyce, H (ed), Language at Work: Analysing Language Use in Work, Education, Medicaland Museum Contexts, Cambridge Scholars Publishing, UK, pp. 166-191.
Eggins, SE, Cominos, N & Walsh, J 2016, 'Disciplinary Discourses: Contrasting Representations of the Patientin Medical and Mental Health Handover Interactions' in de Silva Joyce, H (ed), Language at Work: Analysing Language Use in Work, Education, Medicaland Museum Contexts, Cambridge Scholars Publishing, UK, pp. 192-213.
Iedema, RA & Eggins, SE 1997, 'Difference Without Diversity: Semantic Orientation and Ideology in Competing Women's Magazines' in Wodak Ruth (ed), Gender and Discourse, Sage Publications Ltd., London, pp. 165-196.