Patient, family and nurse experiences with patient presence during handovers in acute care hospital settings: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this systematic review was to synthesize the best available evidence on patients', family members' and nurses' experiences with bedside handovers in acute care settings. INTRODUCTION: The transfer of patient information between nurses represents a critical component of safety within health care. Conducting handover at the bedside allows patients and families to participate in information exchanges. Studies that address bedside handover highlight benefits and concerns with their implementation. Insight into patients', families' and nurses' experiences with bedside handovers can help to identify the most appropriate and safest approach to handovers. INCLUSION CRITERIA: The current review considered patients, family members and nurses in the acute care hospital setting. Nurses included licensed nurses, registered nurses, practical nurses, nursing assistants, nurse researchers, and advanced practice nurses. METHODS: A three-step search strategy was used to identify English language qualitative primary research studies. Two reviewers independently appraised the included studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative studies that considered attitudes, beliefs and experiences of patients, families and nurses on patient presence during bedside handover were considered for this review. Papers included in the review were from 1998 to 2017. RESULTS: The review included 12 qualitative publications. Key findings were extracted and classified as unequivocal (U) or credible (C). A total of 96 findings were extracted and aggregated into 14 categories. From the 14 categories, five synthesized findings were developed: i) becoming more informed; ii) upholding confidentiality and privacy; iii) varying desire and ability to participate; iv) individualizing patient care; and v) challenges in conducting bedside handovers can be overcome with adaptive practices. CONCLUSIONS: This review captured the experiences of patients, families and nurses with patient presence during bedside handovers in a hospital setting. For the most part, patients and families describe bedside handover positively, reporting feeling more informed and engaged in care. This review highlights areas where patients' and nurses' views on bedside reporting may differ, particularly in the areas of desire to participate and the need for confidentiality. Although hospital environments can create challenges in sharing personal patient information at the bedside, these may be overcome through education and by the adoption of a flexible and individualized approach.

A qualitative study on the transfer of residents between a nursing home and an emergency department.

Nursing home (NH) residents who have exacerbations of chronic health conditions or new illnesses must generally go the emergency department (ED) for health care, later returning to the nursing home when it is felt that they are no longer require acute care. Transfers between settings of care are referred to as transitions, and research has shown that residents are at risk of experiencing negative health outcomes during these periods. This article reports on a qualitative study of resident transfers between one NH and one ED in Canada. Data were collected using interviews, participant observation, and examination of institutional policies and standard practices. Three themes emerged from the data: (1) work of executing transfers; (2) creating and exchanging resident information; and (3) feelings of guilt but not being responsible about how residents' transfers occurred. Although completion of organization-specific forms consumed a considerable amount of practitioners' time, they contributed little to resident transfers or to the sharing of information. There is a need for integrated models of care that transcend settings and promote an understanding of the roles and responsibilities of practitioners working along the entire continuum of care.

Caring for patients with dementia in an acute care environment.

Although hospital nurses are skilled in meeting the acute health needs of the elderly, they may not have the expertise required to manage the behavioral disturbances typically seen in this population. Using the Progressively Lowered Stress Threshold Model (PLST), this article helps identify factors that may precipitate undesirable behaviors in the acute care setting and suggests strategies to help nurses prevent or control them.