Literature review of Handover Of Care
Handover of care is essential in mental health settings as it improves the quality and safety of patient care. The National Patient Safety Agency defined handover of care as “The transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis”. (http://www.health.gov.au, accessed on 6th March 2010) It enables staff to pass on important information about patients and provides a facility for staff morale to develop. To provide a greater understanding of handover of care and its significance in mental health nursing, this essay will attempt to lead the reader to the development of new insights into handover of care by comparing and contrasting literature in the form of a comprehensive literature review.
Hart, C, defines a literature review as “The selection of available documents (both published and unpublished) on the topic, which contain information, ideas, data and
evidence written from a particular standpoint to fulfil certain aims or express certain views on the nature of the topic and how it Is to be investigated, and the effective evaluation of these documents…” (P13, 2003) Another important purpose of carrying out a literature review is to demonstrate that the author has a sound understanding of published work in a particular topic. “The literature review is a methodology in its own right”. (p21 Aveyard, H, 2007)
Before starting any search it is vital for the author to decide on the type of sources being searched. A need for authenticity and hierarchy of evidence meant that primary sources were selected, however the specific inclusion criteria made this difficult and two secondary sources were used. The primary sources used in the review were created by people who either saw or took part in the data being documented, this use of primary sources added validity to the review. “Secondary sources are publications that report on the original work” (Parahoo, K, 1997, p84) and can be functional to provide a different view of the original study carried out.
The search strategy used began with brainstorming key words relevant to the topic. The key words used were handover, shift report, mental health and psychiatry. This made finding appropriate literature easier as it provided a wider range of articles to search. The Royal College of Nursing (RCN) e library was used which enabled instant access to the British nursing index (BNI). This was chosen as it is one of the main search engines in health and social care. After selecting the database the researcher typed in the key words and pressed enter. The BNI then produced all relevant abstracts of articles which the researcher read and decided which were related to the subject area. This was time consuming as the search could produce up to two hundred articles and only one may have been relevant. The researcher then searched Cinahl and Medline using the same method. The inclusion criteria was so specific it left the exclusion criteria unaddressed; the shortage of literature on the subject meant that all articles found had to be included in the review. The inclusion criterion regarding the subject area took priority over the type of sources used therefore two of the five articles in the review are secondary sources. (Cutcliffe, C and Ward, M, 2007)
The article titled “Shift report: a ritual play on a residential adolescent psychiatric unit” (O. Yonge, 2008) looked into the importance of handover in relation to staff culture. The paper provided a detailed literature review where the common theme was that verbal handovers were used to enhance and improve staff relationships. The methods used to conduct the study were all qualitative, participant observation and ethnographic interviews were used. The strength to using these was that the researcher gained a complete understanding of the study by combining the two methods. (Parahoo, K, 1997) The use of participant observation added validity to the study as the researcher was actively involved therefore could observe accurately. A limitation to this is that the presence of the researcher may have changed the behaviour of participants.
The paper highlights in the findings that handovers were informal and enjoyable for staff enhancing team building. It can be learnt from the article that handovers in residential settings are more relaxed due to the informal setting. This has a positive impact on the dynamics of the nursing team however it has a negative effect on patient care due to nursing interventions rarely being discussed.
The article by Cleary, M, Walter, G and Horsfall, J (2009) made reference to the above literature to emphasise that the format of handover shapes the type of care patients receive. The article mainly focuses on the problems handover can present and how they can be improved. The rationale for the article is that an increase in staff changes and hospitals depending more on agency staff have enhanced the need for effective delivery of information. The same gap in knowledge in mental health and handover was also identified akin to McCloughen, A, O’Brien, L, Gillies, D and Mcsherry C (2008) study of handover. The article is a secondary source and gained its information from primary and secondary sources. One author is a registered nurse, the second author is a professor of child and adolescent psychiatry and the third a clinical director in this area. This adds validity to the paper as they are all highly credible and experienced in the subject however the authors have not used evidence or collected any data which decreases the value of information.
The article has identified that ineffective handovers have caused adverse events, are time consuming and lack structure. The authors proposed a solution to the problems which was to use a computerised system as part of the handover process. The article concluded that verbal handovers in mental health are important and quality could be improved. The authors suggested in the conclusion that interaction from staff incorporated with computer generated patient profiles was the answer to improvement in handover also minimising time consumption and improving quality of patient care. A computerised system may help but more evidence based research needs to be conducted to achieve this.
The literature by Mcloughan, A, O’Brien, L, Gillies, D and Mcsherry, C, (2008) analysed nurses perceptions of handover; they had a similar opinion to that of Clearly, M, Walter, G and Horsfall, J. (2009) This was that handover needed a formal structure to improve the quality of information being transferred. The article explores verbal handover in relation to practice and beliefs about handover from the perspective of nursing staff.
The study provided a literature review which identified that several studies found the quality of handover was poor meaning that patient centred individualised care was not achieved. The study gained its information from qualitative data using a standardised approach. (Parahoo, K, 1997) The researcher used a probability sample inviting all nursing staff from the hospital to participate in the audio taping and interviews including registered nurses and unit managers. This increased the validity of the study however the subjective choice of sampling had no inclusion or exclusion criterion.
The interviews were semi structured using a framework of questions that specifically related to a content matrix formed from the literature review. The same content matrix was used to analyse the verbatim quotes from the audio taped transcripts. The strength of using the content matrix was that it ensured that all aspects of the aims of the study were addressed however it presented a weakness because using this method meant the researcher could not have fully synthesised the results meaning there was no freedom for any new themes to emerge. (Parahoo, K, 1997)
The key points found were that handover concentrated on problems rather than solutions therefore referrals to other professions were made rather than implementing nursing interventions. The perceptions of nurses were that handovers were considered to be an essential part of their role and that a formal structure to handover was needed to improve the quality of information being delivered. The study concludes that verbal handover lacked format and consistency. This study emphasised the findings in the study by Yonge; (2008) that handovers determine the standard of care that patients receive. It also highlighted that the venue and access to patient information were key features in determining the quality of handover.
The article by Dodwell (2008) looked at different styles of communication within the multidisciplinary team and focused on how the use of different methods of communication can result in mixed messages being transmitted. It is written from the perspective of a psychiatrist and a former poet therefore uses the analogy of poetry and his experience of psychiatry to emphasise the traits of the nursing handover in mental health settings. The author identified his rationale for the article. He refers to an idea from a book that the vocabulary and various linguistic forms of communication provide a setback in communication between different professionals within the multidisciplinary team that is not recognised. The use of a secondary source presented an obvious limitation in that he may have misinterpreted the idea from the book that he used. (Parahoo, K, 1997)
The author did not attempt to collect evidence or data to support his idea. He used his poetic knowledge combined with his own practical experience as a psychiatrist to explore communication in handover to suggest that there is a clear difference in methods of communication. The article did not use any methodology however he was highly credible to write the paper as he is a consultant psychiatrist and has a master’s degree in psychology. Dodwell (2008) identified that written poetry often uses vocabulary which is outdated and found comparisons to this with his experience of written handovers. He also compared oral handover to poetry stating that they are both repetitive and limited in content.
The article concludes that effective communication in handover could be achieved by acknowledging that there is a clear difference between oral and written handover and the language used by professionals is interpreted differently. The article proposes the idea that handovers are insufficient in information and through the relaying of information in so many ways the actual intervention recommended from doctors is distorted. This presented the idea that effective communication in handover could be achieved by redefining clinical language throughout handover by combining the use of both methods.
The study conducted by Buus, N (2006) contradicted Dodwell’s article by stating clinical language in handover was used. His study looks in particular at communication and interaction between staff during the nursing handover in local and institutionalised settings and how these factors influenced the amount of clinical knowledge being transferred. A gap in knowledge from the constructionist interpretation of handover was the rationale for the study.
The researcher used a qualitative approach over one year’s study of ethnographic fieldwork. Purposive sampling allowed the researcher to select the best available setting and group of people relevant to the study resulting in quality data. The limitation to this was that the researcher may have chosen his samples through convenience thus affecting the reliability of the findings. (Cutcliffe, J and Ward, M, 2007) The study found interactive handovers were informal allowing staff to give their opinion and had less clinical knowledge in content. The non-interactive was lead by hierarchy, participants less qualified did not contribute and more clinical language was used than handovers with nursing staff who used abbreviations. The study concluded that handover was informal with no structure and nurses did not learn clinical knowledge through them.
The article by Dodwell (2008) presented a similar opinion that the transfer of clinical knowledge always changed depending on which staff members attended the handover. Dodwell discussed the language used in this context however this study differs in that the content was mostly on patient’s behaviour and the nursing interventions relating to them. The article suggests through the findings that conventionalism has a negative effect on the quality of handovers due to hierarchy allowing only the more experienced staff to participate and that structure is required. This suggests that there needs to be a healthy balance of conventionalism for a good quality handover thus still enabling room for staff morale to develop.
This review has found that handover of care serves two different purposes. Nursing staff use handover as a social meeting to express themselves about patients.
This enhances the composition of the team and provides a strong foundation for nursing interventions to be administered correctly. The second purpose is for patient information to be transferred. The review has found that the balance of these purposes is uneven in the way that staffs social needs prioritise over patients. This could be due to the venue and informality that mental health settings present. It is clear that handover needs to be a systematic process with a focused structure to allow handover of care to fulfil its true potential of being an intervention in itself. In order to formulate a process like this more research needs to be conducted with aims and methods specifically relating to the two purposes established thus filling the gap in knowledge in this area which the review identified.
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Buus, N, (2006) ‘Conventionalized Knowledge: mental health nurses producing clinical knowledge at intershift handovers’. Issues in Mental Health Nursing, Vol 27, 1079-1096
Cleary, M, Walter, G, Horsfall, J, (2009) ‘Handover in Psychiatric Settings; Is Change needed?’. Journal of Psychsocial Nursing. Vol 47, No 3, 28-33
Cutcliffe, J, Ward, M, (2007) ‘Critiquing Nursing Research’. London, Quay Books Division
Dodwell, D, (2008) ‘Kalevala or Keats: poetic traditions as a model for multidisciplinary miscommunication and team splitting’. Journal of Psychiatric and Mental Health Nursing. Vol. 15, 547-551
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McSherry, C, (2008) ‘Nursing handover within mental health rehabilitation: An exploratory study of practice and percerption’. International Journal of Mental Health Nursing, Vol 17, 287-295
‘Innovative Approaches to Enhancing Clinical Handover’ (online) (2010) Available from; http://www.health.gov.au/ (Accessed on 6 March 2010)
Parahoo, K, (1997) ‘Nursing Research; Principles, Process and Issues’. Houndsmills, Basingstoke, Hampshire and London, Macmillan Press Ltd
Yonge, O, (2008) ‘Shift Report: a ritual play on a residential adolescent psychiatric unit’. Journal of Psychiatric and Mental Health Nursing. Vol 15, 45-51