Deakin University, Geelong, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, VIC 3125, Australia.
Deakin University and Epworth Healthcare, Day Procedures Centre, 320 Victoria Parade, East Melbourne, VIC 3002, Australia.
Appl Nurs Res. 2018 Apr;40:80-89. doi: 10.1016/j.apnr.2017.12.013. Epub 2017 Dec 18.
Nurse bedside handover quality is influenced by complex interactions related to the content, processes used and the work environment. Audit tools are seldom tested in 'real' settings.
Examine the reliability, validity and usability of a quality improvement tool for audit of nurse bedside handover.
Naturalistic, descriptive, mixed-methods.
Six inpatient wards at a single large not-for-profit private health service in Victoria, Australia.
Five nurse experts and 104 nurses involved in 199 change-of-shift bedside handovers.
A focus group with experts and pilot test were used to examine content and face validity, and usability of the handover audit tool. The tool was examined for inter-rater reliability and usability using observation audits of handovers across six wards. Data were collected in 2013-2014.
Two independent observers for 72 audits demonstrated acceptable inter-observer agreement for 27 (77%) items. Reliability was weak for items examining the handover environment. Seventeen items were not observed reflecting gaps in practices. Across 199 observation audits, gaps in nurse bedside handover practice most often related to process and environment, rather than content items. Usability was impacted by high observer burden, familiarity and non-specific illustrative behaviours.
The reliability and validity of most items to audit handover content was acceptable. Gaps in practices for process and environment items were identified. Context specific exemplars and reducing the items used at each handover audit can enhance usability. Further research is needed to develop context specific exemplars and undertake additional reliability testing using a wide range of handover settings.
CONTRIBUTION OF THE PAPER.
护士床边交接班质量受到与内容、使用的流程以及工作环境相关的复杂交互作用的影响。审核工具很少在“真实”环境中进行测试。
检验用于审核护士床边交接班质量的改进工具的可靠性、有效性和实用性。
自然主义、描述性、混合方法。
澳大利亚维多利亚州一家非营利性私人医疗服务机构的六间住院病房。
五名护士专家和 104 名参与 199 次换班床边交接班的护士。
使用专家焦点小组和试点测试来检查交接班审核工具的内容和表面有效性以及实用性。使用跨六间病房的交接班观察审核来检验工具的内部一致性和实用性。数据收集于 2013-2014 年。
对 72 次审核进行了两次独立观察，27 项（77%）项目的观察者间一致性可接受。检验交接班环境的项目可靠性较弱。有 17 项没有观察到，反映出实践中的空白。在 199 次观察审核中，护士床边交接班实践中的空白最常与流程和环境有关，而不是与内容项目有关。实用性受到观察者负担、熟悉程度和非特定说明性行为的影响。
审核交接班内容的大多数项目的可靠性和有效性是可以接受的。确定了流程和环境项目实践中的空白。可以使用特定于上下文的示例并减少每次交接班审核中使用的项目来提高实用性。需要进一步研究来开发特定于上下文的示例，并使用广泛的交接班环境进行额外的可靠性测试。
论文的贡献。
