Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.
Montreal Heart Institute Research Center, Montreal, QC, Canada.
J Clin Nurs. 2020 Oct;29(19-20):3790-3801. doi: 10.1111/jocn.15409. Epub 2020 Jul 31.
To explore how change-of-shift handoffs relate to nurses' clinical judgments regarding patient risk of deterioration.
The transfer of responsibility for patients' care comes with an exchange of information about their condition during change-of-shift handoff. However, it is unclear how this exchange affects nurses' clinical judgments regarding patient risk of deterioration.
A sequential explanatory mixed-methods study reported according to the STROBE and COREQ guidelines.
Over four months, 62 nurses from one surgical and two medical units at a single Canadian hospital recorded their handoffs at change of shift. After each handoff, the two nurses involved each rated the patient's risk of experiencing cardiac arrest or being transferred to an intensive care unit in the next 24 hr separately. The information shared in handoffs was subjected to content analysis; code frequencies were contrasted per nurses' ratings of patient risk to identify characteristics of information that facilitated or hindered nurses' agreement.
Out of 444 recorded handoffs, there were 125 in which at least one nurse judged that a patient was at risk of deterioration; nurses agreed in 32 cases (25.6%) and disagreed in 93 (74.4%). These handoffs generally included information on abnormal vital signs, breathing problems, chest pain, alteration of mental status or neurological symptoms. However, the quantity and seriousness of clinical cues, recent transfers from intensive care units, pain without a clear cause, signs of delirium and nurses' knowledge of patient were found to affect nurses' agreement.
Nurses exchanged more information regarding known indicators of deterioration in handoffs when they judged that patients were at risk. Disagreements most often involved incoming nurses rating patient risk as higher.
This study suggests a need to sensitise nurses to the impact of certain cues at report on their colleagues' subsequent clinical judgments. Low levels of agreement between nurses underscore the importance of exchanging impressions regarding the likely evolution of a patient's situation to promote continuity of care.
探讨交接班时的交接情况如何影响护士对患者病情恶化风险的临床判断。
在交接班时，需要交接患者护理的责任，并交换有关患者病情的信息。然而，目前尚不清楚这种信息交流如何影响护士对患者病情恶化风险的临床判断。
一项采用顺序解释性混合方法研究，根据 STROBE 和 COREQ 指南进行报告。
在四个月的时间里，来自加拿大一家医院一个外科和两个内科病房的 62 名护士记录了他们在交接班时的交接情况。每次交接后，两名参与的护士分别单独评估患者在接下来 24 小时内发生心脏骤停或转入重症监护病房的风险。对交接班中共享的信息进行内容分析；根据护士对患者风险的评估，对比代码频率，以确定有助于或阻碍护士达成一致的信息特征。
在记录的 444 次交接中，有 125 次至少有一名护士判断患者有恶化风险；护士在 32 次（25.6%）情况下达成一致，在 93 次（74.4%）情况下存在分歧。这些交接通常包括异常生命体征、呼吸问题、胸痛、精神状态或神经系统症状改变的信息。然而，研究发现，临床线索的数量和严重程度、最近从重症监护病房转来、无明确原因的疼痛、谵妄迹象以及护士对患者的了解，都会影响护士的判断。
当护士判断患者有恶化风险时，他们在交接班时会交换更多有关已知恶化指标的信息。分歧最常涉及到新到的护士将患者的风险评估得更高。护士之间的低一致性强调了交换有关患者情况可能演变的印象的重要性，以促进护理的连续性。
这项研究表明，需要使护士意识到报告中某些线索对同事后续临床判断的影响。护士之间的低一致性突显了交换有关患者情况可能演变的印象的重要性，以促进护理的连续性。
