HLT54115 Nursing

Introduction:

Clinical Handover is a healthcare convention on transference of clinical care among health professionals such as nurses for superior and efficacious treatment. Handing over of patient is undertaken for continual treatment of a patient (Abdurrahman & Garcia, 2016). Approximately seven million cases arise annually related to clinical handover in hospitals and twenty six million cases in community settings in Australia. Change of Shift Report (CoSR) constitutes archives on the transference of clinical care including incoming or outgoing of patient and handover procedures followed for an interminable reporting based on flexibility and trustworthiness towards content (Ortega & Parsh, 2016). National safety and quality health service standard determines the effectual implementation and regulation of framework for better practices. Framework requires regular reporting, appraisal and reorientation for enhanced resultants (Boyd & Sheen, 2014).

Ineffectual communication is one of the predominant issues related to upgraded clinical handover in Australia. Nursing beside and other general meeting rooms are the target areas for the undertaking of communication on patient care. Good communication fulfills the treatment, supervision, time constraint and methodical viewpoint leading to cardinal clinical abode. Inefficacy in it leads to haphazard transfer of clinical care and underdeveloped care. Deplorable communications undertakes abortive transference of the required information on the patient during critical conditions and can lead to severe implications on the patient (Eggins & Slade, 2015).

The literature review is an attempt to determine the reasons and fallacies of ineffective communication and ramification of prevailing conditions in the workplace among the nursing professionals. Further undertaking required diagnosis on the effective measurements, such as conventional strategies, instrument and electronic systems, to ameliorate such prevailing conditions. The outline of this literature review determines the importance and existing themes and trends of clinical handover in professional arena. Furthermore, review undertakes the discussion on the resultant of existing complexities in practicing optimal clinical handover and its importance in the healthcare profession.

Importance of Clinical Handover:

According to the study conducted by Sonntag et al. (2016) effective handover of clinical care is essential for enhanced treatment of patients of all age group. For effectual treatment, patient is regularly transferred for diagnosis, remediation and vigilance, among different care units of hospital, such as basic care, secondary or specialized care, rehabilitation unit, emergency unit and intensive unit. The handover communication is critically important for the smooth transfer of treatment undertakings between the nurses and between nursing professional and patient (Sonntag, et al., 2016).

Theme and Procedures:

Handover of treatment through effective communication constitutes transferring of patient related information on diagnosis, medication, alteration and impediments, from one associated health professional or organization to another. Further, this is conducted to maintain the continuum of treatment. Examples of transfer of care constitutes admitting patient for primary or secondary care by hospital nurses, relocation from general physician to other health professional, transfer of Change of Shift Report (CoSR) prepared by health professionals to different units. Further, emergency unit and intensive care unit, critical handling of patient as nursing bedside and discharging of patient from one unit to another or home (Grimshaw, Hatch, Willard, & Abraham, 2016).

According to the research conducted by Amin (2015) effective communication for clinical handover among nurses requires five crucial steps include legislation, contributor, patient, transfer communication and communication discharge. Legislation undertakes implementation of appropriate policy and procedures for effective transfer of responsibilities between nursing professionals. Contributor must provide appropriate information in accordance with change of shift report. Palliative care must be provided to patient and family members in accordance with optimum medication. Transfer communication must be undertaken in adequate time by conventional speaking to reduce confusion. Communication discharge requires handover of the information related to diagnosis and treatment of patient, to family members and other nurses before final discharge from a hospital (Amin, 2015).

Barriers of Clinical Handover:

Nurses instilled with effective communication provide required information leading to increase in patient satisfaction. Psychologically, patients adjust better in the novice environment of critical situation and responds better to the treatment provided. Methods of handover incorporate face-to-face communication, telephonic communication, hardcopy drafting and assistance with electronic tools. Furthermore, the locations of handover are bedside of patient, general room for staff and the hospital reception (Johnson, Jefferies, & Nicholls, 2012).

According to the study conducted by Croos (2014) attainment of feasible refinement in clinical handover is extremely important and requisites homogenize and systematize procedures and statistical data. The solutions as the resultant of followed procedures and data must provide appropriate treatment leading to effective clinical handover by nurses. Disintegration in optimal information transfer is the issue that ushers unpropitious effects on patient condition. Prime clinical handover undertakes optimal treatment and safety of patient care leading to better results (Croos, 2014).

NSQHS Standards:

National Safety and Quality Health Service Standards are formulated by Australian Commission on Safety and Quality in Healthcare (ACSQHC) that propounds corroboration of protocols and policies to undertake the loopholes in current practices by appropriate legislature of Australia, as it is necessary for the formulation and implementation of efficacious clinical handover systems. Such legislation requires developing an organizational structure with the help of appropriate policies, procedures and tools. Policies and procedures must regulate the implementation of handover and tools must regularly monitor and evaluate the effectiveness. Further, execution of rugged reporting is essential for further appraisal and reorganizing supervision for optimal treatment. The staff must be trained enough to undertake handover by appropriate reporting to another health professional. Furthermore, such system must reduce the likelihood of any adverse eventuality and prevent any such incident for future as well. Besides this, patient with their family members and other health carers must be involved during the handing over process for optimum palliative care and augmented apprehension on the information related to the patient (Birks, Davis, Smithson, & Cant, 2016).

Relation of Clinical Handover with other NSQHS standards:

Clinical handover standard of National Safety and Quality Health Service Standards plays an important role in the optimal establishment and regulation of other standards in Australia. The protocols, strategies and policies required for implementation and regulation of clinical handover coincides with the regulation of other standards. With the help of structured communication, strategies regulating the safety and quality of treatment are exercised. This can be seen during minimization in the syndicate with infectious diseases is achieved with proper handover of responsibilities and hygiene practices between the nurses. Handover affirms patient oriented systems for enhanced and productive treatment by sanctioning appropriate prescription and regulation of required medication. This renders provision of administering appropriate treatment to the patient, and is achieved by potent communication between doctor, nurse, pharmacist and patient. During critical conditions, clinical handover plays an important role of reestablishment of the remedial procedures, according to specific demand of treatment and is undertaken by appropriate communications between the staff members and nurses (Flanigan, 2016).

Importance of efficacious communication has been acknowledged since past but certain obstacles make it a complicated tool for effective clinical handover. Some of the associated obstacles are exclusion of cardinal information related to diagnosis and treatment of patient and probable source, leading to deterioration in the condition of the patient. Some other factors responsible are inappropriate communication related to poor diagnostic measures, substandard analysis of the critical condition, antique laboratory equipments and practices, excessive patient grievances, anxiety among patient leading to chaos and increased expenditure (Dawson, King, & Grantham, 2013).

Barriers of Effective Communication:

Poor communication is the prevailing reason for ineffective communications and occurs due to multifarious handovers leading to misplace of the information. Further, unhealthy professional relationships due to inappropriate behavior, indolent observance, impartiality and obstruction among nurses also lead to ineffective communications. Further barriers that affect the capability of nurses are increased stress, lack of infrastructure and staff prowess. Beside this, clinical handover usually undertaken by temporary carers and professionals, authorizing the permanent staff to leave on or before scheduled time. This leads to pivoting extraneous information eventually loss in valuable time of treatment and medication (BScRRT, 2010).

Human factors also play an important role in affecting the efficacious communication. Clairvoyance, prowess, anticipation and prediction determine the haphazard decision-making. Such decision-making is undertaken without full analysis of the critical situation, ambiguity and large data for reporting, forging of communication and ineffective prognosis leading to bottleneck systematic clinical handover (BScRRT, 2010).

Remedial Actions for effective clinical handover targeting communication and legislation:

The resultant of the review determines that clinical profession requires a complex of procedures and protocols to be undertaken with utmost care to culminate effective and persistent handover practices of remediation. Besides this, senior professionals and legislations must perpetuate equilibrium between the effectiveness and meticulousness of the handover by managing Efficiency – Thoroughness Tradeoffs (ETTO). This determines the discrepancies between stipulation and magnitude of the handover in a specific period leading to the failure or success of the handover procedures. Certain time is required for apprehension, decision-making and implementation of decision. This can affect implementation of the handover through optimal communications. Further, interventions from other critical situations can increase the time for decision-making (Spranzi, 2014).

As a remedial action for misleading and unsecured human factors, resilience and reliability are two important terms playing important role of rectifying the psychological errors. This leads to enhancement in the clinical handover procedure. Resilience Engineering (RE) is an essential technique based on increasing the resilience and reliability of the existing practices for better reporting. This concept compels to catechize the intricacies of clinical handover.

ISBAR is a mnemonic for Identify, Situation, Background, Assessment and Recommendation and furnishes a framework for safe and healthy handover of clinical aid, provided to a patient for optimum treatment. Identify determines the identity of the allotted nurse and patient or both (Blyth, Bost, & Shiels, 2016). This further determines the role and responsibilities of the nurse, and age, sex and other family details of the patient. Situation determines the diagnosis and rationale of the condition of patient. Background determines the clinical history of patient undertaking the previous critical conditions. This step is important for the future remediation and medication. Assessment undertakes the contemporary condition of the patient and formulation of therapeutic treatment as a remedy. Recommendation undertakes the procedural guidelines required as the precautionary methods to be implemented by patient, for the reduction in prevailing conditions (McKechnie, 2015). Handing over is an important measure for effective treatment of the patient. Proper reporting in terms of Change of Shift Report (CoSR) must be documented for optimal resultants. Furthermore, involvement of patient family and carers except from the hospital staff is important for better reporting and therapeutic treatment. Legislation must undertake required steps for optimal implementation of the practices.

Conclusion:

Clinical handover is a crucial aspect of healthcare industry. This bears a great authority and liability towards optimal remediation of patient under critical condition. Addressing and reporting a team rather than individual nurse is a preferable method for solving the issue of misplaced required information for further treatment. Furthermore, being certitude and amenable towards each other, nurses can strengthen unity for optimum results. Clinical handover can be enhanced with strengthening team enterprising, critical analysis, enhanced clinical skills and updated tools and systems. Professionals on duty must contain a copy of updated Change of Shift Report (CoSR) in order to imply any therapeutic procedures to the patient (Kapadia & Addison, 2012).

Besides this, the key aspect of effective handover is communication that is the most complex issue related to inefficacious implementation in healthcare profession. Verbal communication alone is insufficient and requires optimal documentation in the form of Change of Shift Report (CoSR) to be formulated by nurses themselves. Managers and appropriate legislative practitioners must undertake this responsibility of skill development and leadership qualities for enhanced communication leading to effective handover (Silverman, Kurtz, & Draper, 2016).

The hierarchical distribution of healthcare professionals makes extremely difficult for professionals for effective communications. Juniors discerns in communications with their senior leading to the breakage of optimal flow of information. Further, due to handover among different professional leakage of information occurs at every level due to existing inappropriate reporting measures. Furthermore, optimal usage of tool like ISBAR is essential to target the existing leakage and loopholes in the flow of effective communication. This tool provides a systematic approach to reporting and implementation of clinical handover among different nurses (Shah, Alinier, & Pillay, 2016).

Besides this, time taken for the formulation and implementation of the remedial procedures should be less. The nurses must have imbricate schedules to perceive enough time for the effective communications. Further, hospitals must initiates in removal of hierarchical barrier between the professionals to achieve much friendlier environment. Updated technology, equipment and training on implementation must be provided to enhance the handover. Lastly, optimal formulation of Change of Shift Report must be undertaken for enhanced handover (Vines, Dupler, Van Son, & Guido, 2014).

Bibliography:

Abdurrahman, M., & Garcia, C. (2016). Safe Clinical Handover,In On-Call Geriatric Psychiatry (pp. 87-97). Springer International Publishing.

Amin, S. (2015). Clinical Handovers. Springer International Publishing.

Birks, M., Davis, J., Smithson, J., & Cant, R. (2016). Registered nurse scope of practice in Australia: an integrative review of the literature. Contemporary Nurse, 522-543.

Blyth, C., Bost, N., & Shiels, S. (2016). Impact of an education session on clinical handover between medical shifts in an emergency department. A pilot study. Emergency Medicine Australasia.

Boyd, L., & Sheen, J. (2014). The national safety and quality health service standards requirements for orientation and induction within Australian Healthcare: A review of the literature. Asia Pacific journal of health management, 31-37.

BScRRT, W. H. (2010). Human Factors in Clinical Shift Handover Communication: Review of reliability and resilience principles applied to Change of Shift Report. Canadian Journal of Respiratory Therapy, 44.

Croos, S. (2014). The practice of clinical handover: a respite perspective. British Journal of Nursing.

Dawson, S., King, L., & Grantham, H. (2013). Review article: improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient. Emergency Medicine Australasia, 393-405.

Eggins, S., & Slade, D. (2015). Communication in clinical handover: improving the safety and quality of the patient experience. Journal of public health research.

Flanigan, K. (2016). NSQHS standard-patient identification. ACORN: The Journal of Perioperative Nursing in Australia, 23.

Grimshaw, J., Hatch, D., Willard, M., & Abraham, S. (2016). A Qualitative Study of the Change-of-Shift Report at the Patients’ Bedside. The Health Care Manager.

Johnson, M., Jefferies, D., & Nicholls, D. (2012). Exploring the structure and organization of information within nursing clinical handovers. International journal of nursing practice, 462-470.

Kapadia, S. A., & Addison, C. E. (2012). Developing clinical handover: what does the literature suggest? The International Journal of Clinical Leadership, 119-122.

McKechnie, A. (2015). Clinical handover: the importance, problems and educational interventions to improve its practice. British journal of hospital medicine (London, England: 2005), 353.

Ortega, L., & Parsh, B. (2016). Improving change-of-shift report. 

Shah, Y., Alinier, G., & Pillay, Y. (2016). Clinical handover between paramedics and emergency department staff: SBAR and IMIST-AMBO acronyms. International Paramedic Practice, 37-44.

Silverman, J., Kurtz, S., & Draper, J. (2016). Skills for communicating with patients. CRC Press. 

Sonntag, O., Plebani, M., Della, P., Jones, D., Steward-Wynne, E., Walsh, J., & Lee, M. (2016). Effective communication in clinical handover: From research to practice . Walter de Gruyter GmbH & Co KG.

Spranzi, F. (2014). Clinical handover on the labour ward: A narrative synthesis of the literature. British Journal of Midwifery.

Vines, M. M., Dupler, A. E., Van Son, C. R., & Guido, G. W. (2014). Improving client and nurse satisfaction through the utilization of bedside report. Journal for nurses in professional development, 166-173.