PATIENT’S STORIES

It’s warm in the handover room.

Too many bodies squashed into too small a space.

Handover is droning on.

Each patient is being presented to the next shift of nurses.

Some of the patients you will not see at all that shift.

But you need to know what is going on … in case.

But one nurse forgets to pass on an important piece of information.

And the consequences has the potential to be disastrous to the patient.

The one thing that was needed to keep the patient safe was missed.

Because the room was hot …  Because the nurse handing over was not getting to the point … Because the handover was interrupted by someone wanting the keys … Because …

Nurses are the glue that keeps hospitalised patients safe.

They provide the round the clock bedside care that keeps patient care safe and seamless.

The nursing shift report (NSR) is a critical process by which nurses “hand off” information about and responsibility for patients to the next shift of nurses.

The information that is imparted at NSR is important in protecting patient safety.

Poor communication is a root cause in patient safety incidents.

Effective communication at NSR can lead to greater clarity between members, promote collaboration and reduce the risk of errors.

And should be the focus of all in improving patient safety in hospitals.

During NSR, nurses communicate patient status, needs and plan of care between the nurses providing care at the bedside.

The nurses at the bedside are at the “sharp” end ofcare delivery as without that care and coordination patient stays would inevitability be longer.

The complexity of patient care requires frequent handover of information.

Because patient careis complex and dynamic, the chances of failure to communicate important information are potentially catastrophic for the patient.

Despite the importance of NSR, there is not much written about the most effective ways ofconducting a NSR.

One paper has reviewed nursing bedside shift report (NSBR) as a way of keeping patients safe and making sure important information is not missed out.

The NSBR is where the outgoing nurse hands off to the incoming nurse at the bedside. 

Groves et al. investigated how nurses gave handover at the bedside.

As they wrote

“However, a review of current literature revealed no theoretical work explaining how NBSR supports patient safety, and little research focusing on safety-oriented outcomes of NSBR”

What Groves et al. found was that nurses value‘conveying the patient story’ from shift to shift in NSBR.

The same applies to handovers not provided at the bedside.

Most nurse desire the ‘story’ behind why the patient is in the circumstances that they find themselves in.

The medical record does not tell the nurse everything they need to know about the patient.

The ‘story’ fills in the critical missing information that is not provided in the medical record.

When you think about the volume of information that is exchanged, the ‘story’ is the means by which nurses pull all the information together.

It creates a shared mental ‘model’ of the patient.

Even if the nurse has had the patient before, it does help to hear the ‘story’ again to assimilate any new information into the ‘model’.

In the case of NSBR, being present in the room provides the full ‘story’ to be told.

The nurse can assess, visualize and focus on the patient which provides a foundation to the ‘story’.

But the benefits are wider than that, NSBR improves patient safety because it creates an opportunity for an early assessment of the patient.

An early assessment of the patient allows immediate action to occur if a safety risk is detected.

This becomes really important when the patients condition changes. 

Having seen the patient early provides a baseline against which any change can be initiated.

If you have not seen the patient, you just don’t know if there is a change.

No one wants to be asked what is different and not be able to say.

It is better and safer to say “At the start of the shift the patient condition was…”

The ‘story’ about the patient gives you the confidence to say what has changed and why it is important.

To learn more about patient’s stories:

Groves, Patricia S., Kirstin A. Manges, and Jill Scott-Cawiezell. “Handing Off Safety at the Bedside.” Clinical nursing research 25.5 (2016): 473-493.