Standardized Change-of-Shift Handoff: Nurses' Perspectives and Implications for Evidence-Based Practice.

BACKGROUND: Nursing handoff is a communication activity with a high risk for loss or omission of information. Efforts to improve handoffs include standardization of the processes and content of handoff communications. OBJECTIVES: To examine nurses' perspectives on the structure and organization of change-of-shift handoffs. METHODS: A qualitative descriptive approach was used to conduct a secondary analysis of focus group data. Thirty-four nurses from 4 critical care units participated in focus groups. RESULTS: Three themes emerged: handoff elements are defined by practice and culture; a clear, consistent, identified structure supports handoff; and personal preferences can disrupt handoff. CONCLUSIONS: A standardized approach to handoff based on unit and organizational needs will be more successful than a broad mandate of content and organization. Individual preference is prevalent and strongly influences the information conveyed and the structure of handoff communication.

Rapid Deployment of Team Nursing During a Pandemic: Implementation Strategies and Lessons Learned.

BACKGROUND: The COVID-19 pandemic increased the number of patients requiring intensive care nation-wide, leading to nurse staffing shortages in many units. LOCAL PROBLEM: At the beginning of the statewide COVID-19 surge, a tertiary teaching hospital in the upper Midwest experienced a sharp increase in patients needing intensive care. To relieve the resulting staffing shortage, it implemented a pilot program to bring general care nurses into its 21-bed mixed specialty intensive care unit to free intensive care unit nurses to help staff the hospital's COVID-designated units. METHODS: Using a team nursing model, the intensive care unit recruited, oriented, and incorporated 13 general care nurses within 4 days. Education and resources were developed to distinguish team nurses from intensive care unit nurses, introduce them to the intensive care unit environment, outline expectations, communicate between team nursing pairs, and guide charge nurses in making staffing decisions and assignments. Staff feedback identified additional resources, barriers, and successes. An adaptive process was used to improve and update tools and resources on the basis of staff needs. RESULTS: The pilot program ran for 6 weeks. Positive outcomes included a reduced need for float nurses and self-perceived reduction in nursing workload. The principal barrier was charge nurses' challenges involving staffing-to-workload balance based on the existing staffing model. This model identified productivity of a general care nurse and an intensive care unit nurse as equivalent, despite differences in their skill sets. CONCLUSION: Team nursing in the intensive care unit is an agile tactic easily replicated in dire staffing situations.

Change-of-Shift Nursing Handoff Interruptions: Implications for Evidence-Based Practice.

BACKGROUND: The importance of change-of-shift handoffs in maintaining patient safety has been well demonstrated. Change-of-shift handoff is an important source of data used in surveillance, a nursing intervention aimed at identifying and preventing complications. Surveillance requires the nurse to acquire, process, and synthesize information (cues) encountered during patient care. Interruptions in handoff have been observed but there is a gap in the evidence concerning how interruptions during nurse-to-nurse handoff impact the change-of-shift handoff process. AIMS: To describe registered nurses' perceptions of interruptions experienced during change-of-shift handoff at the bedside in critical care units and analyze the number, type, and source of interruptions during change-of-shift handoff at the bedside. METHODS: An exploratory descriptive design was used. One hundred nurse-to-nurse handoffs were observed, and four focus groups were conducted. Observation data were analyzed with descriptive statistics and quantitative content analysis. Focus group data were analyzed with qualitative content analysis. RESULTS AND FINDINGS: Of the 1,196 interruptions observed, 800 occurred in the communication between the two nurses involved in the handoff. Over 80% (645) of these interruptions were from the nurse receiving handoff and included questions or clarification of information received. About half of the nurses reported that interruptions occurred during handoff. Focus group findings revealed that whether or not something is an interruption is determined by the individual nurse's appraisal of value added to their knowledge of the patient and/or plan of care at the time of handoff. LINKING EVIDENCE TO ACTION: Interruptions during handoff are evaluated as useful or disruptive based on the value to the nurse at the time. Strict structuring or mandating of handoff elements may limit nurses' ability to communicate information deemed most relevant to the care of a specific unique patient.

Surveillance: A Nursing Intervention for Improving Patient Safety in Critical Care Environment.

BACKGROUND: Nursing surveillance has been identified as a key intervention in early recognition and prevention of errors/adverse events. Nursing Intervention Classification (NIC) defines surveillance as "the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making." Because nurses are the main staffing constant in the critical care environment, the importance of surveillance as an intervention is fundamental. OBJECTIVE: The aim of this study was to explore how surveillance is expressed by critical care nurses. METHODS: A descriptive exploratory research design was used. Think-aloud was used for data collection. Twenty-one registered nurses from 3 critical care units participated in the study. Participants were asked to say out loud whatever they were thinking as they performed patient care at 3 time points: during handoff, initial patient assessment, and after 4 hours of care. Think-aloud (saying aloud what one is thinking) represents the information (cues) that is attended to in short-term memory, before it has been processed and stored. Data were analyzed using content analysis with key concepts and themes identified. RESULTS: The expression of surveillance was through the main theme of finding meaning. Surveillance involved (a) knowing the patient, (b) shared understanding and decision making, and (c) thinking ahead. The outcomes of these activities were aimed at finding meaning in the cues that emerged as the overarching theme. DISCUSSION: Surveillance was expressed through nurses' gathering cues, reflecting on past knowledge, asking questions, verifying, and pulling it all together to find meaning. During handoff, surveillance involved collaborative cognitive work to find meaning in cues.