Purdue University, West Lafayette, IN, USA.
Anne Arundel Medical Center, Annapolis, MD, USA.
J Clin Nurs. 2018 Mar;27(5-6):e1189-e1201. doi: 10.1111/jocn.14254. Epub 2018 Jan 25.
To qualitatively investigate the medical-surgical nurse shift handoff as a process within the workflow of the exchanging nurses. Specifically, this study sought to identify the ideal handoff, ways the handoff deviated from ideal, and subsequent effect on nursing care.
The functions as well as information content of the handoff have been studied. However, typical studies look at the handoff as an isolated activity utilising nurse perceptions as the primary measure of quality.
Semi-structured focus groups were conducted to discuss nurses' perspectives on ideal handoffs, ways handoffs deviate from the ideal including frequent and significant deviations and the effects on subsequent care.
Twenty-one medical-surgical nurses participated in one of five audio-taped focus group sessions. Three sessions were conducted at hospital A; two sessions at unaffiliated hospital B. The general inductive approach was used to analyse verbatim transcripts. Transcript segments relevant for answering the research questions were coded as ideal or not ideal. Conceptual themes were then developed.
Two major themes were identified: teams/teamwork and constructing and communicating a shared understanding of the patients' conditions. The importance of nurse preparatory activities was revealed including the incoming nurses reading patients' health records and outgoing nurses rounding on patients. The impact of shared expectations was identified across the team, where teams include, in addition to the two nurses, the electronic health record, other hospital staff and patients/families with a bedside handoff. New potential nurse-centred process and outcome measures were proposed.
Evaluating handoffs by their effect on the nursing performance both during and after the handoff offers a new framework to objectively assess handoff effectiveness.
The handoff is a process which may significantly affect the incoming nurse's transition into and administration of nursing care.
定性研究医护交接作为交接护士工作流程中的一个过程。具体而言，本研究旨在确定理想的交接，交接偏离理想的方式以及对护理的后续影响。
已经研究了交接的功能和信息内容。然而，典型的研究将交接视为孤立的活动，将护士的看法作为质量的主要衡量标准。
进行半结构化焦点小组讨论，讨论护士对理想交接的看法，交接偏离理想的方式，包括频繁和重大的偏离以及对后续护理的影响。
21 名医护护士参加了五个录音焦点小组讨论中的一个。三个小组在医院 A 进行；两个小组在不相关的医院 B 进行。使用一般归纳方法对逐字记录进行分析。与回答研究问题相关的记录片段被编码为理想或不理想。然后开发概念主题。
确定了两个主要主题：团队/团队合作和构建和传达对患者病情的共同理解。揭示了护士准备活动的重要性，包括新护士阅读患者健康记录和出院护士对患者进行巡视。还确定了团队之间共享期望的影响，其中团队包括除两名护士外，还包括电子病历、其他医院工作人员以及床边交接的患者/家属。提出了新的潜在以护士为中心的过程和结果衡量标准。
通过评估交接对交接期间和之后护理绩效的影响，为客观评估交接效果提供了新的框架。
交接是一个可能会显著影响新护士过渡和护理管理的过程。
