The role of proper handover and communication in patient safety cannot be denied which has been reported both by research scholars and WHO. Recent review’s from different developed country’s suggest handover issues still haunts patient safety costing health care department and common mass both cost and life(Hesselink et al, 2012). The competence, confidence and knowledge of handover differ from person to person which is reflected from uneven pattern of effects of poor handover in a particular region. Handover failure can be attributed to many factors, but the most common factors which lead to failure are poor communication between nurses or professional groups and poor handover practices in between nurses during shift changes. Current real time evidence based studies suggest, a multi-disciplinary approach is required in order to establish an effective handover strategy and continuation of care within different professionals in health care industry(Chabboyer, McMurray and Walis, 2010). An effective handover protocol must encompass information passing to patients, carers to ensure their participation in decision making process. The importance of interpersonal skills and communication in nursing handover is inevitable. These two skills have also been included in nursing curriculum outcome as per ANMC code of conduct.
This essay deals with a learning need which I have experienced during my clinical placement in context of handover and lack of knowledge and confidence both. The essay will be written as a first person as a reflective piece of an article. As per PREP guidelines, the essay is divided into three parts. The first part will deal with the practical learning need identified and its importance. The second part deals with its critical analysis. The third part deals with the correlation between identified practical learning need and my work. As per ANMC professional code of conduct the reflective essay will keep the name of persons confidential. The scenario’s will be discussed in terms of pseudo names. In the present assignment I will be reflecting upon my first handover as a student nurse and loopholes identified as practical learning need. The reflective essay will be written as per Jhons reflective model. The rationale of using this reflective model is it motivates the practi’ioner's to make use of cues from reflection of experience and utilising it for work improvement. The advantage of such a model is provides a platform to revisit your past action and reflect in order to learn from actions compared against established research based evidences. This type of reflective model will help in carrying out a formal assessment of student nurse.
It was during my clinical placement during my last year in mental health ward. I was working at level 6, thus has to manage everything by my own with full responsibility and accountability for whatever I do. I have been assigned one patient, a 75 year old lady suffering from Alzheimer disease along with disability in moving. She was also undergoing treatment for diabetes. That day was bit busy, as I was having some issues in my ward for which I was visiting ward manager chamber.
Although I was fully prepared for my shift, but I was not prepared to give handover as my shift was going to over within 15 minutes just before 1 pm. So, I rushed towards my patient and hurriedly went through bed chart. Although, I hurriedly noted down her date of birth, date of admission, age and measured vital status. But I was making silly mistakes such as not noting down the medications and interventions currently going on. I was frustrated by this and was looking very bad. My staff colleagues helped me in making the handover and the ward head nurse helped in cross checking it to see whether anything has been missed or not. She pin-pointed certain points to be written as far as current symptoms are concerned. Although, the hand over was successful, but it didn’t went under my supervision. I felt bad at my inability to handle such situations. Although, my staff’s consoled me and understood the situation through which I was going, but this can’t be granted at the cost of patient life.
The above incident I found as a practical need although looks common, but the chances of miss-communication and error is high. So I immediately started searching for nursing journals, and articles which suggest how to go for an effective handover. I collected all recent articles from Google database and CINHAL database. I categorised them as per my need. Post categorization, I made notes of handover protocols recommended, skills required for handover and how to perform better in pressurised situation. As per the articles and journals, I noted down all those information which I need to share with my colleague who will be taking over charge from me. I also made some notes on exactly what to make her understand in which aspects.
But slowly, I realised it is not bad to have a note get prepared prior to handover; at the same time it seemed to be time consuming. In an environment like health care sector being a nurse, I cannot afford much time for this. Also, I was getting heavily used to it which was in real making my progress very slow. So I decided to reduce the note to such points which are of utmost importance. If something, I was forgetting I was going through patient folders and noting it down during handover. I took it as a lead, and once gave a handover without any note. I followed patient file as a guide. Although, I was very nervous due to the amount of accountability but it gave me an immense pleasure as well as confidence to go for my next handover without any note preparation. Also, my self-consciousness was bit low after that incident, but with such a practice it was improved a lot and my communication skills are also enhanced with my colleagues. No more I felt low in self-esteem, due to my inability.
Nursing handover is defined as oral communication with the person who is taking charge in context of patient health status and interventions. Although, many scholars argue for a written context also, still the most accepted one is the oral communication. The central theme of any handover is the patient safety which has been supported constantly by scholars from years. The reflective model proposer Jhon has also defined handover as an aesthetic value added by a nurse by briefing colleague about patient health(Jhon, 2013). In my situation, I was going very theoretically rather I will rate myself as a classroom student. I was trying to remember in a mechanical way, about patient information as if it is in my course curriculum. I felt happy that my colleagues helped me to make that hand over successful, at the same time I was feeling very embarrassed. Being a nurse working at level 6 I was supposed to do it I rather guide others. I was thinking what others will be thinking about me, that I am incapable of handling such a small incident and what I will be doing in pressurized situation. It clearly indicated two things, firstly I was lacking the required knowledge for a successful handover secondly, I was deeply lacking in knowledge. Research suggests, when student nurse are placed in clinical situation they tend to face issues due to lack of practical knowledge and anxiety developed due to self-consciousness(Mellinclavage, 2011). I think this was the major reason of my failure. Research articles indicated observation can help in improving the handover skills(Gordon and Findley, 2011). Whatever knowledge I have accumulated with regard to handover, it was through observing my seniors and staff colleagues. But, currently the Australian curriculum has included different skills and requirements to make a student eligible and get ready for clinical placement. I was lacking in knowledge of handover which should not have occurred if I would have given proper attention towards my curriculum(Wilson, 2011). Although, research suggest there is a huge gap between theory and practical in context of nursing where students fail to implement theoretical knowledge in a practical situation. I assume this is one of the factors which also led to such an incident.
While searching internet database, I got OSSIE guidelines for clinical handover published by Australian Commission for Safety and Quality in healthcare (2010) (Manser and Foster, 2011). It was a wonderful guideline, which has not only explained how a handover process should be, but also has different sections on how handover guidelines developed based upon evidence based studies. I felt bad for not searching for this type of literature during my studies, which I think would have helped me to face such situation.
The strategy I followed has also been proposed by certain scholars and to my surprise, contemporary studies strongly recommend such handover practice. Research suggest written handover can act as helping guide for those nurses and other allied staffs who have been managed service and less knowledge about the settings(Welsh, Flanagan, Ebright, 2010). At the same time, it reduces the time of reporting. With this knowledge, I continued my job and continued handovers in my ward. I was happy, that my approach towards handover in a written format was not odd and research has shown its advantages too. The staff colleagues gave me good support and said they also have faced same issues during their student time. This gave me good amount of self-confidence that I can also attain such expertise only by improving my knowledge and implicating it in my routine practice.
With regard to personal learning experience, it was a valuable learning experience. As far as pre-registered student nurse is concerned they are not expected to know everything of a clinical situation. I am happy, that I have identified my practical need much ahead of my final placement as a registered nurse. If this incident would have occurred during my professional career, it would have affected me much from professional as well as personal point of view. I was strongly supported by colleagues, mentor and my friends also. This was another factor which helped me in overcoming fear, anxiety and developed my skills. Research shows support of senior staffs enhances the handover skills and only through their support the newly registered nurse can gain knowledge and perform better (Kerr et al, 2011).
Another important factor which will help students like me to develop expected nursing skills is effective communication. Communicating with staff nurses with regard to your problems can help in solving those problems with ease(Jones and Burgeois, 2010). As I saw, regularly working with other staff nurse and asking doubts slowly reduced my dependency upon notes. Bi-directional communication has also been suggested as a tool for development of nursing skills(Drach and Shilman, 2015). The failure in carrying out a handover resulted in valuable feedback from my team and my staff nurses. Research suggests, when student nurses are given valuable feedback on their work in a positive way, the chances of error reduces. Feedback also helps student nurses to assess their knowledge and skills, improvise upon their loopholes and march towards perfection (Henderson et al, 2012). Similarly, during my handover I was so disturbed I have uttered patient name and age in a loud voice to my staff nurse, which I was not supposed to which breached patient confidentiality. This should have been done by bed side where I would have explained the same issue with much ease without disturbing others.
In over all, this was a great learning experience and important too. Nursing handovers are an important part of nursing and health care industry as it deals with patient safety. To have a good clinical handover skill, one need to understand the importance of handover as well as how handover process should be done. It is not feasible to perform effective handovers by theoretical knowledge. Together with practical knowledge, supports from senior staffs, and from administration of setting a good handover protocol can be developed which will help new comers.
Chaboyer, W., McMurray, A., & Wallis, M. (2010). Bedside nursing handover: a case study. International Journal of Nursing Practice, 16(1), 27-34.
Drachâ€Zahavy, A., & Shilman, O. (2015). Patients' participation during a nursing handover: the role of handover characteristics and patients' personal traits.Journal of advanced nursing, 71(1), 136-147.
Gordon, M., & Findley, R. (2011). Educational interventions to improve handover in health care: a systematic review. Medical education, 45(11), 1081-1089.
Henderson, A., Cooke, M., Creedy, D. K., & Walker, R. (2012). Nursing students' perceptions of learning in practice environments: A review. Nurse education today, 32(3), 299-302.
Hesselink, G., Schoonhoven, L., Barach, P., Spijker, A., Gademan, P., Kalkman, C., ... & Wollersheim, H. (2012). Improving patient handovers from hospital to primary CareA systematic review. Annals of internal medicine,157(6), 417-428.
Johns, C. (2013). Becoming a reflective practitioner. John Wiley & Sons.
Kerr, D., Lu, S., McKinlay, L., & Fuller, C. (2011). Examination of current handover practice: evidence to support changing the ritual. International journal of nursing practice, 17(4), 342-350.
Levett-Jones, T., & Bourgeois, S. (2010). The clinical placement: An essential guide for nursing students. Elsevier Health Sciences.
Manser, T., & Foster, S. (2011). Effective handover communication: an overview of research and improvement efforts. Best practice & research Clinical anaesthesiology, 25(2), 181-191.
Melincavage, S. M. (2011). Student nurses' experiences of anxiety in the clinical setting. Nurse education today, 31(8), 785-789.
Welsh, C. A., Flanagan, M. E., & Ebright, P. (2010). Barriers and facilitators to nursing handoffs: Recommendations for redesign. Nursing outlook, 58(3), 148-154.
Wilson, R. (2011). Improving clinical handover in emergency departments: Ron Wilson reviews findings from an audit of a simplified handover process that can involve patients and their families in discussions about care. Emergency Nurse, 19(1), 22-26.
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