Bedside handover at the change of nursing shift: A mixed-methods study

Aim To describe the structures, processes and content of bedside handover at the change of nursing shift in an acute-care context. Background The handover of patient information and care at the change of nursing shift is an essential, albeit risk-laden, time-consuming activity in clinical practice. Design A convergent parallel mixed-methods design was used. Methods Thirty episodes of bedside handover were concurrently audio-recorded and observed using a researcher-developed tool modelled on the five domains of the British Medical Association's Safe Handover-Safe Patients framework. The audio recordings were analysed using content analysis. Quantitative and qualitative data generated were then triangulated to develop a more complete interpretation of the structure, process and content of information transferred at the patient's bedside during the change of nursing shift. This study followed Good Reporting of Mixed Methods Study guidelines. Results Bedside handover was observed to be mainly conducted at a fast pace. However, within these timeframe large volumes of complex information were shared and important nurse-patient interactions occurred. Analysis of the audio recordings provided evidence that the dialogue during handover was nurse-dominated and the outgoing nurse appeared to influence the degree of patient participation. Conclusion Bedside handover at the change of nursing shift involves three key stakeholders: outgoing nurse, incoming nurse and the patient. A combination of intricate communication skills both verbal and nonverbal facilitates the rapid sharing of large volumes of complex information which is necessary for the continuity and safety of patient care across nursing shifts. Relevance to clinical practice The comprehensive description of the complexities of bedside handover in this study provides an insight into this frequently occurring, important nursing practice and can be used to support nurse education and practice development.