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Aim To describe an integrative review protocol to analyse and synthesize peer-reviewed research evidence in relation to engagement of patients and their families in communication during transitions of care to, in and from acute care settings. Background Communication at transitions of care in acute care settings can be complex and challenging, with important information about patients not always clearly transferred between responsible healthcare providers. Involving patients and their families in communication during transitions of care may improve the transfer of clinical information and patient outcomes and prevent adverse events during hospitalization and following discharge. Recently, optimizing patient and family participation during care transitions has been acknowledged as central to the implementation of patient-centred care. Design Integrative review with potential for meta-analysis and application of framework synthesis. Review method The review will evaluate and synthesize qualitative and quantitative research evidence identified through a systematic search. Primary studies will be selected according to inclusion criteria. Data collection, quality appraisal and analysis of the evidence will be conducted by at least two authors. Nine electronic databases (including CINAHL and Medline) will be searched. The search will be restricted to 10 years up to December 2013. Data analysis will include content and thematic analysis. Discussion The review will seek to identify all types of patient engagement activities employed during transitions of care communication. The review will identify enablers for and barriers to engagement for patients, families and health professionals. Key strategies and tools for improving patient engagement, clinical communication and promoting patient-centred care will be recommended based on findings. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore families' perceptions of shift-to-shift bedside handover. Background. The potential role families can play in bedside handover is unknown. Understanding family members' perceptions can provide a foundation for nurses to tailor their bedside handover to family members' perceptions, encouraging their involvement and potentially improving patient care. Design. Qualitative study, using case study methodology. Methods. The study was conducted with eight family members in one rehabilitation ward in Queensland, Australia, in 2009. Data included observations of bedside handover, field notes and in-depth interviews. Thematic analysis of data was conducted to identify unique and common themes indicative of family perceptions. Results. Three major themes emerged. The first, understanding the situation, consisted of three subthemes: feeling informed, understanding the patient's condition and understanding patient's treatment. The second theme was interacting with nursing staff, with five subthemes, including sharing information, clarifying information, assisting in care, asking questions and interpreting for the patient. The final subtheme was finding value, which contained five subthemes: feeling at ease, feeling included, valuing individualisation, preparing for the future and maintaining patient privacy. Conclusions. Bedside handover provides an opportunity to involve family members in patient care and promote family-centred care core concepts. Family members value the chance to participate and can ultimately improve the accuracy of handover communication. Relevance to clinical practice. Bedside handover is beneficial for nurses, patients and family members and embodies patient and family-centred care. Managers should consider its implementation in hospitals, developing strategies such as standard operating protocols for a more family inclusive approach to communication. Nurses may require further training to best undertake bedside handover and involve family members in care. The study suggests expansion of research into this important area of family-centred care. [ABSTRACT FROM AUTHOR]

stubbings l., chaboyer w. & mcmurray a. (2012) Nurses' use of situation awareness in decision-making: an integrative review. Journal of Advanced Nursing 68(7), 1443-1453. Abstract Aim. To critically review the literature related to situation awareness and clinical decision-making by nurses. Background. International recognition that situation awareness positively contributes to clinical decision-making has led to a growing body of healthcare literature. To date, research has predominately focused on anaesthetists and surgeons using measurement frameworks from the aviation industry. The evidence focussing directly on situation awareness in decision-making by nurses remains limited. Data sources. Databases: PROQUEST, Web of Science, CINAHL, and PUBMED. Review methods. An integrative review was undertaken following an extensive literature search with the date range January 1965 - March 2011. English language literature reviews, primary qualitative, quantitative and mixed method studies describing situation awareness in decision-making by or including nurses were included. Results. Five empirical studies of nurses' situation awareness were reviewed. Of these, three included decision-making and situation awareness by nurses in inter-professional teams; two related solely to situation awareness and decision-making by nurses. Findings from the five studies could be grouped under three themes: individual factors influencing situation awareness, interpersonal behaviours influencing situation awareness and situation awareness improving working relationships and patient care. Conclusion. Further investigation is needed to identify the situation awareness skills that are vital to decision-making by nurses. Elucidating essential skills sets associated with situation awareness may inform the development of education and training to enhance clinical decision-making by nurses. [ABSTRACT FROM AUTHOR]

Aims and objectives. To identify factors influencing change in two hospitals that moved from taped and verbal nursing handover to bedside handover. Background. Bedside handover is based on patient-centred care, where patients participate in communicating relevant and timely information for care planning. Patient input reduces care fragmentation, miscommunication-related adverse events, readmissions, duplication of services and enhances satisfaction and continuity of care. Design. Analysing change management was a component of a study aimed at developing a standard operating protocol for bedside handover communication. The research was undertaken in two regional acute care hospitals in two different states of Australia. Method. Data collection included 532 semi-structured observations in six wards in the two hospitals and 34 in-depth interviews conducted with a purposive sample of nursing staff involved in the handovers. Observation and interview data were analysed separately then combined to generate thematic analysis of factors influencing the change process in the transition to bedside handover. Results and conclusion. Themes included embedding the change as part of the big picture, the need to link the project to standardisation initiatives, providing reassurance on safety and quality, smoothing out logistical difficulties and learning to listen. We conclude that change is more likely to be successful when it is part of a broader initiative such as a quality improvement strategy. Relevance to clinical practice. Nurses are generally supportive of quality improvement initiatives, particularly those aimed at standardising care. For successful implementation, change managers should be mindful of clinicians’ attitudes, motivation and concerns and their need for reassurance when changing their practice. This is particularly important when change is dramatic, as in moving from verbal handover, conducted in the safety of the nursing office, to bedside handover where there is greater transparency and accountability for the accuracy and appropriateness of communication content and processes. [ABSTRACT FROM AUTHOR]

Chaboyer W, McMurray A, Wallis M. International Journal of Nursing Practice 2010; 16: 27–34 Bedside nursing handover: A case study A case study of six wards in two hospitals was undertaken to describe the structures, processes and perceptions of outcomes of bedside handover in nursing. A total of 532 bedside handovers were observed and 34 interviews with nurses were conducted. Important structural elements related to the staff, patients, the handover sheet and the bedside chart. A number of processes before, during and after the handover were implemented. They included processes for managing patients and their visitors, sensitive information, and the flow of communication for variable shift starting times. Other key processes identified were the implementation of a safety scan and medication check. The situation, background, assessment and recommendations approach was used only in specific circumstances. Perceived outcomes were categorized as improving accuracy and service delivery, and promoting patient-centred care. Although the move to bedside handover is not the norm, it reflects a patient-centred approach. [ABSTRACT FROM AUTHOR]