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Clinical Handover For Clinicians And Managers

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Discuss about the Clinical Handover for Clinicians and Managers.



During the time of a disease or health care, a patient can be treated by two or more healthcare practitioners or professionals in different settings such as surgical care, primary care, intensive care and specialized outpatient care. Besides, patients may often move between places of diagnosis, treatments, and care on a regular basis. During this time, they might encounter multiple shifts per day, thus putting their safety at risk in every interval. The handover process between healthcare’s providers might lack some of the essential information about the patient hence lead to misunderstanding (Jorm et al. 2009). Such gaps in communication can result in serious breakdowns in a continuity of care as well as improper treatment or harm to the patient.

This paper addresses the process of clinical handover in nursing practice. It looks at a case study of Mr. Smith, an 87-year-old patient with a colostomy in the sigmoid area of his bowel and ailing from diarrhea and vomiting. Since poor hand hygiene can be one of the leading cause of diarrhea, a medical professional can use the vital signs of his patient to monitor the ailment (see Appendix 2), use progress note to provide information about the patient condition or achievement as well as provide a food and fluid chart to help on a favorite diet program.


Clinical handover

Clinical handover is a method of sharing or transfer of patient information from one health officer to the other. During nursing handover, communications can be shared, via telephone, electronic means, written texts or one on one conversation (Jorm et al. 2009). In a health care setting, the technique of handing over depends on certain things such as the shift (morning, afternoon or night), patient as well as the mode of delivering the service (Johnson and Cowin, 2012).The Australian Medical Association has defined the clinical handover as “the transfer of professional accountability plus responsibility for all the aspects of a patient’s care from one health officer to the other either on a permanent basis or temporary basis.”Therefore, the primary purpose of the handover process is to transfer the relevant clinical information and continuity of patient care.  Effective clinical handover reduces communication errors and improves patient’s safety. Inadequate or poor handover or failure to transfer information, accountability, and responsibility in nursing practice is a significant risk to client’s safety plus a common reason for severe consequences for patients. Effects of poor clinical communication include issues such as incorrect treatment, adverse effects, and delay in medical diagnosis, patient complaints, increase in length of stay and an increase in expenditure (Australian Council for Safety & Quality in Health Care 2005).

The part of information about the Patient That Should Be Included in the Handover

The information and level of details about the patients that is included in a nursing handover depend on several factors including the severity of the patient’s sickness and whether there are pending results of examinations that need quick follow-up. Clinical handover should include essential information such as patient background, date and time of admission, the reason for admission, any necessary medical history such as new referral, investigation, and treatments to mention just a few (Chaboyer et al. 2009). The introduction, situation, background, assessment plus recommendation (ISBAR) is a framework that can be used to present relevant information about patients in any clinical handover scenario. The introduction is the first element of ISBAR that include an introduction to the nurses plus the patient. The situation element explains the immediate condition of the patient including patient stability and complaints. According to Chaboyer et al. (2009), the background provides information such as the date of admission, diagnosis, and treatment as well as test results up to the time a patient is in the hospital ward. The assessment provides the nursing examination of the patient’s conditions. The recommendation provides an outline of the recommendations and risk.


Student Nurse Responsibility in Maintaining Confidentiality

Confidentiality in health setting means preventing the release of health information given by or about an individual in the course of professional practice. Keeping patient’s information confidential is a requirement of the law as well as professional practice for every nurse (Griffith, 2015). This means every health professionals like nurses have a duty of confidentiality regarding patient information. The duty of confidentiality requires that nurses keep information about their patient’s secret. However, the nurse should release health information in a medical facility to improve patient safety or treatment. In this case, Nurse should pass patient health information on in sureness with the expectation that privacy/secrecy will be respected by the guarantee of confidentiality (Griffith and Tengnah, 2013).


When an individual has a problem with their lower bowel such as diseases and a case of bowelcancer, a colostomy is performed (Engida, 2016). A colostomy is a surgical operation that involves shortening the colon to allow for the damaged part to be removed and letting the cut end be diverted to the opening in the abdominal wall. However, the colostomy can be permanent or temporary. Some colostomies appear small, some large, some are on the right side of the abdomen, and some are on the left and others in the middle. A colostomy is one of the common life-saving emergency procedures done worldwide with the intention of either diversion of stool or decompression of obstructed colon to protect contamination of the distal large bowel segment by stool and to relieve obstructed large bowel (Engida, 2016).Therefore, a colostomy is performed to treat different condition and disease. These include perforated bowel, inflammatory bowel disease, colon or rectal cancer, diverticulitis, bowel obstruction, ulcerative colitis, accidental injury or congenital disabilities.

Healthy stoma appearance

“Stoma” is a Greek word meaning “opening” or “mouth.” It refers to the part of intestine pulled through and attached to the skin (Dorman, 2009). When the abdominal wall is open, it creates a stoma, which is created by opening the skin and attaching a pouch to collect feces. The primary purpose of the stoma formation is to divert urine or feces away from disease or damaged track. According to Dorman (2009), some of the signs of a healthy stoma include red moist and shiny in color, when the stoma is above the skin level, and when it appears as if it’s inside the mouth,


Cyril’s colostomy stool characteristics

The sigmoid colostomy is a very common type of colostomy. It originates in the sigmoid colon plus situated on the lower side of the abdomen. The stool of a sigmoid or descending colostomy is firmer than the other colostomy and does not have the caustic enzyme content (Abebe, 2016). In Cyril case, he has a colostomy located in the sigmoid section of the bowel. This means Cyril’s colostomy would produce feces that are solid, regular and firmer.

Contact Precautions in Managing Cyril’s Colostomy

Besides standard precautions, the nurse should use contact precautions when attending the patient to avoid direct contact with the patient. For the case of Mr. Smith, the nurse should wear gloves when coming into contact with Cyril as well as his belongings or immediate environment. The gloves should be removed after use plus prior to touching noncontaminated items or when attending other patients (Merboth and Barnason, 2000). Lastly, the hands should be cleaned right after removing the gloves. Another contact precaution that can be taken is to wear a gown that is fluid resistant. For safety to other patients, do not wear the same gown although. Other additional procedures that can be taken include placement of the patients in a private room to prevent the spread of the infection to other patients in the same ward.  Also, you can instruct the patient to use separate washroom if available and disinfect it prior to using it again.

Nurse action based on the vital sign score

Merboth and Barnason (2000) states that nurses see their patients more often than any other medical officer. Therefore, they are in proper position to monitor the progress of their patients, know any issues early as well as judge what action should be taken for the patient. According to the vital score of the patient, it implied that the body temperature, pulse rate, blood pressure and respiratory rate were normal. After registering a vital sign score 3, the nurse should plan the care that includes; procedure ordered when communicating with the doctor using the ISBAR framework. The nurse should provide nursing measures to ensure comfort as well as boost recovery. This includes four-hourly observations, review oxygen requirement, manage fever, pain or distress, and reporting to the team leader. Most importantly, the nurse should provide three types of information. They are the care given to the patient, the patient’s response to the care, as well as any necessary background information about the patient. Lastly, if the measures haven’t been effective, the nurse may plan as well as take other measures to assist the patient (Engida, 2016).


Communication using ISBAR Framework

“This is XXX, a first year nursing student in the medical section. The reason I am calling is that Mr. Cyril Smith has suddenly appeared pale and lethargic with trembling in his hands and has facial grimacing. He is also saying that he is not feeling very well; instead, he is feeling dizzy and nauseated and got abdominal pain. I find out that his respiration rate is 14 per minute, the pulse is 110, the temperature is 37.9, oxygen saturation is 95%, and blood pressure is 120/80.”

“Mr. Smith is an 87-year-old man who was admitted last evening with diarrhea and vomiting. He has been unwell for past four days. He has a history of COPD, prostatic hypertrophy, and bowel cancer. He currently has a colostomy located in the sigmoid section of the bowel.”

“ On examination, he is alert, has no vomiting and his vital signs are a QADDS score of 3 but still has pain rate of 6/10, has abdominal pain, has nausea and dizziness. I am not sure what the problem is, but I am worried as Mr. Smith is deteriorating”

I think you probably need to come and see him.

“When are you going to be able to get here?”

“Would you like me to ask for a consultant to see the patient now?” 

“Is there anything I need to do in the meantime?”


This paper has pointed out that nurses are the most important people in the life of a patient. During the period of a disease, a patient can be treated by different medical professionals or practitioners in a single day. Besides, patients can be moved from one facility to the other during diagnosis, treatment, as well as care thus encountering different shifts of healthcare professional a day. Such change of shifts can introduce safety risks to the life of a patient. This is because of poor handover communication between the staff as well in different facilities that can result in poor treatment or harm to the patient. Besides, handover process should be done in a way that will ensure essential information, as well as background information of the patient is passed from one health officer to the other. To ensure the safety of the patient a health officer should make sure that the current condition of the patient, recent changes as well as ongoing treatments and any other possible change of the patient are well documented and communicated from one medical officer to the other. For the health practitioners who are not sure about the precautions to put in managing their patient's safety, they should always communicate with a doctor to seek the way forward.



Aiello, A. E., Coulborn, R. M., Perez, V., & Larson, E. L. (2008). Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. American journal of public health, 98(8), 1372-1381.

Australian Council for Safety and Quality in Health Care (2005).Clinical Handover and Patient Safety Literature Review Report. Australian Council for Safety and Quality in Health Care, Canberra.Australia.

Australian Medical Association (2006).Safe Handover: Safe Patients, Guidance for Clinical Handover for Clinicians and Managers. Australian Medical Association, Kingston, Australian Capital Territory.

Chaboyer, W., McMurray, A., Johnson, J., Hardy, L., Wallis, M., & Chu, F. Y. S. (2009). Bedside handover: quality improvement strategy to “transform care at the bedside”. Journal of nursing care quality, 24(2), 136-142.

Dorman, C. (2009). Ostomy basics: a nurse’s introduction to care, counselling, and equipment. Modern Medicine Network

Engida, A., Ayelign, T., Mahteme, B., Aida, Tilahun.,&Abreham, B. (2016). Types and indication of colostomy and determinants of outcomes of patients after surgery.Ethopian Journal of Health Sciences, 26(2): 117-120

Griffith, R. (2015). Patient information: confidentiality and the electronic record. British Journal of Nursing, 24(17): 894-895. doi: 10.12968/bjon.2015.24.17.894

Griffith, R., Tengnah, C. (2013). Shared decision-making: nurses must respect autonomy over paternalism. British Journal of Community Nursing, Vol 18: 303-306.doi: 10.12968/bjcn.2013.18.6.303

Johnson, M., Cowin, L. 2012). Nurses discuss bedside handover and using written handover sheets. Journal of Nursing Management. 21 (1): 121-129. doi: 10.1111/j.1365-2834.2012.01438.x

Jorm, C. M., White, S., & Kaneen, T. (2009). Clinical handover: critical communications. Medical Journal of Australia, 190(11), S108-S109.

McEwan, A. B., & CLARK, P. (1973). The stoma of the ileal conduit. BJU International, 45(6), 600-605.

Merboth, M. K., & Barnason, S. (2000). Managing pain: the fifth vital sign. The Nursing Clinics of North America, 35(2), 375-383.


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