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Abstract
Quality improvement is an ongoing concern in the healthcare setting. One aspect of care that is
under constant scrutiny is the quality of report given from one nurse to another during change-ofshift. Utilizing a checklist while at the patients bedside will assist the nurses in communicating
pertinent patient information and ensure quality patient care. The checklist will be evaluated by
the nurse manager in order to identify areas of the report that needs improvement. The use of
checklists and the results from data collected will be evaluated throughout the course of the study
in order to demonstrate their effectiveness in streamlining report and improving quality of care.
family, and the nurse manager. The incoming and outgoing nurses will perform the bedside
report with the checklist on each patient during change-of-shift. These team members are vital
to the compliance and effectiveness of policy changes regarding utilizing a checklist during
bedside report. The nurses will use the checklist to help guide change-of-shift report in order
to ensure all pertinent information is being communicated. It is important that the technician
or aid is included in the bedside report because bedside reporting can promote teamwork and
staff accountability, helps prioritize patient care and allows patients to communicate with the
technician or aid about their care (Radtke, 2013, p. 22). The nurse manager will receive each
checklist after report is given and will review them to identify areas of concern that need to be
addressed.
Study
Data Collection
In order to make effective changes, leaders must analyze and reanalyze the data. This is
done in many different ways determined by the type of data being studied (Yoder-Wise, 2014).
For the change-of-shift report, it is necessary to determine first if a change needs to be made.
Appendix A is a survey designed to collect patient perceptions of the efficacy of nurses changeof-shift reports. Although nurses may not be compliant with change initially, if the patients
perceptions of the report are negative it will negatively affect the unit and the hospital. As SandJecklin and Sherman (2013) found, being included in the report process improves patient
satisfaction with care. Appendix B shows a survey designed to record the nurses opinions of
their report experiences. If the nurses believe there could be improvement in the reporting
process, changing the change-of-shift reports will happen more smoothly. Appendix C is the
data collection form utilized during report. This provides an ordered list of every topic that
needs to be covered for the next nurse. The nurse receiving report will mark the appropriate
column correlating to the topics listed. These lists will then be analyzed, using a Pareto chart to
identify the areas of report that need the most attention (Yoder-Wise, 2013).
Goal
Just as nurses and patients make goals to improve the patients health and quality of life,
goals must be formed to improve care processes as well. The goal formed for shift report is:
improved satisfaction with bedside report by nurses and patients by six months. It will take time
for the nurses to get used to the new checklist and to appreciate what it does for the report
process, even if all the nurses involved agree the change is needed.
Strategies
Before implementing any changes to the shift report, the surveys found in Appendices A
and B must be distributed to the patients and nurses in order to determine current satisfaction of
change-of-shift report. Responses from these surveys will be included in the experimental
changes and will be added to the report checklist found in Appendix C. As White (2014)
discussed, it is vital to have the team members input in the policy change to make that change
successful. Introduction of the checklist will occur during staff meetings the week before
implementation. During report, the nurses will utilize the checklist, marking whether or not the
outgoing nurse met each line item or if the oncoming nurse had to ask about the line item. After
report both nurses will sign the checklist and will then turn it in to the nurse manager. In order to
encourage the use of the checklist, lunch will be provided for each month that every person
submits a completed checklist for the first six months. After the initial six month period, the
reward schedule will be re-evaluated.
Evaluate
Evaluation is a constant part of change. The responses on the checklists will be
monitored weekly by the nurse manager to evaluate if there is an improvement in report content.
Each month, the results from the checklists will be compiled into appropriate charts and graphs
to better portray the data collected. The information gained from these data displays will show
where education or further assistance is needed. At the end of the first six months using the
checklist, satisfaction surveys will be re-administered to evaluate if patient and nurse satisfaction
has changed and to gather information that will assist in the continuous improvement of the
change-of-shift report process.
Support and Analysis
Bedside report is an effective method that can result in improved patient and nursing
satisfaction and patient safety outcomes (Sand-Jecklin & Sherman, 2013). It is important for
nurses to perform their change-of-shift report at the bedside because it allows the patients to be
better informed, increases patient understanding, and leads to increased patient involvement in
their care. If nurses are at the bedside, the patient is able to listen to report and learn how they are
improving, what care has been provided, and any future care plans. At this time, patients are
also able to ask questions and help participate in report by discussing changes that the nurse may
not have known. If report is done away from the bedside, it does not provide an opportunity for
the patient to be included in developing or revising plan of care and goals (Cairns, Dudjak,
Hoffman, & Lorenz, 2013, p. 160).
The use of checklists will enable the nurses to communicate more effectively about
pertinent information pertaining to the patient. A core component of nursing practice is to
ensure the communication of information facilitating the transition of care from one provider to
another and the checklist will help guide the nurses through proper report procedure (Cairns,
Dudjak, Hoffman, & Lorenz, 2013, p. 160). In a study conducted by Cairns, Dudjak, Hoffman,
and Lorenz (2013), it was discovered that the use of a standardized patient safety checklist and
face-to-face report at the bedside improved effectiveness of communication of nurses at change
of shift.
Peplaus interpersonal theory can be utilized to support the need for report to occur at the
bedside. Radtke (2013) states that Peplaus interpersonal relations theory defines the
relationship between the nurse and patient as one that is therapeutic and based on trust and
mutual understanding, as well as open communication (p. 20). It is important to understand that
performing change of shift report at the bedside and utilizing checklists allows the nurse to have
effective and open communication with the patient as well as the other nurse. Performing report
at bedside as well as using checklists will lead to increased quality of care and patient
satisfaction.
Conclusion
Quality can be measured in a number of ways using graphs and charts to aid in the
interpretation of data. The measurement methods utilized for change-of-shift report are surveys,
checklists, and graphs that will display the quality and effectiveness of report. Effective
communication is important during change-of-shift reports to increase quality of patient care.
The use of a checklist during bedside report will ensure all pertinent information is being passed
from one nurse to the next. Preforming this report at the patients bedside will enable the patient
to be an active partner in his or her care and will improve the quality of care received.
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References
Cairns, L., Dudjak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing bedside shift report to
improve the effectiveness of shift handoff. The Journal of Nursing Administration, 43(3),
160-165. doi: 10.1097/NNA.0b013e318283dc02.
Costedio, E., Powers, J., & Stuart, T. (2013). Change-of-shift report: From hallways to the
bedside. Nursing, 43(8), 18-19.
Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside
shift report. Clinical Nurse Specialist, 27(1), 19-25. doi:
10.1097/NUR.0b013e3182777011
Reinbeck, D. & Fitzimons, V. (2013). Improving the patient experience through bedside shift
report. Nursing Management, 44(2), 16-17.
Sand-Jecklin, K. & Sherman, J. (2013). Incorporating bedside report into nursing handoff:
evaluation of change in practice. Journal of Nursing Care Quality, 28(2), 186194.
Welsh, Flanagan, & Ebright. (2010). Barriers and facilitators to nursing handoff:
Recommendations for redesign. Nursing Outlook, 58(3), 54-148.
White, A. (2014). Implementing change in the perioperative setting. AORN Journal, 99(2), C7-8
Yoder-Wise, P. (2014). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier
Mosby.
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Appendix A
5
Not Satisfied
2. The Nurse Aid or Nurse Tech working with you was knowledgeable about your health history
and your current health problems.
1
Very Satisfied
5
Not Satisfied
3. The Bedside Report was performed in your room and you were able to participate if you
wanted.
1
Very Satisfied
5
Not Satisfied
Please provide any suggestions you may have to make your Bedside Report experience better:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Appendix B
5
Not Satisfied
2. How satisfied are you with the organization and ease of receiving report?
1
Very Satisfied
5
Not Satisfied
5
Not Often
5
Not Often
5
Not Often
Please provide any suggestions you may have to make change-of-shift reporting better:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Appendix C
YES
NO
I
HAD
TO
ASK
Date ________________
Date ________________
13
POINTS
POSSIBLE
5
10
10
10
POINTS
AWARDED
Comments
14
10
10
10
30
100