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hift report among nurses has been defined as a system of nurse-tonurse communication between shift changes intended to transfer
essential information for safe, holistic care of patients (Riegel, 1985, p.
12). Report, or handoff, is unique to the nursing profession. Although shift
work is a common concept, nurses are not simply changing personnel during this critical moment. Change of shift signifies a time of careful communication in order to promote patient safety and best practices. The risk
exists, however, for this critical opportunity of relaying important information to become muddled by irrelevant information instead of focusing
on the needs of the patient. In addition, the person at the center of the
communication the patient is seldom part of this process. Many different approaches to shift report exist, including written report, phone
recording and tape recording with possible verbal updates, or verbal
reports in a designated room, nurses station, or at the patients bedside.
In the best of circumstances, the report will be patient-focused and patient
care will proceed with minimal disruption.
In a qualitative study conducted by Kerr (2001), the researcher identified report as a highly complex communication event with multiple functions. This finding highlights the importance of continuous quality assessment and improvement of this critical nursing practice to ensure continuity in patient care and best practice. The importance of an informative and
effective nurse-to-nurse report has been highlighted most recently in the
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
National Patient Safety Goals (NPSGs). The JCAHO recommends that organizations implement a standardized approach to hand off communications, including an opportunity to ask and respond to questions (p. 6).
Attributes of effective handoff communication are further identified by
JCAHO as interactive, up to date, and with limited interruptions.
Background
The medical-surgical cardiology unit described in this article is divided into three pods with 12 beds each. It is staffed according to an all-registered nurse (RN) model of care. Cardiology specialties include medical
and surgical cardiology, heart transplantation, and ventricular assist
device therapy. The unit is supported by a level II emergency department,
a three-room cardiac catheterization laboratory, and an 18-bed operating
room suite. Unit staff include a nurse manager, a unit-based educator, a
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Figure 1.
Stages of Change
Unfreezing Stage Objectives
To recognize the need for change. To build trust. To encourage participation.
Interventions
Presented concept to staff RNs
Promoted dialogue among staff
RNs
Addressed RN concerns
Recruited interested staff RNs
Moving Stage Objectives
To plan the change. To initiate the change. To revise the process based on
feedback.
Interventions
Created a reporting template
Created the report process
Created an implementation plan
Assisted and monitored the
implementation process
Collected feedback from staff
RNs
Revised process based on feedback
Refreezing Stage Objective
To integrate the change into practice.
Interventions
Identify stage of change RNs
are in and mentor accordingly
Provide ongoing reminders of
the process
Incorporate reporting process
into related clinical education
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Figure 2.
Bedside Report
Room:
Patient Label: __________________________________ Age: _______
Diagnosis: _____________________________________ Alerts/Precautions:____________________________________________
_______________________________________________
Code Status: ___________________________________ Hx pertinent to diagnosis: _____________________________________
Allergies: ______________________________________ Procedure: ___________________________________________________
MD: ___________________________________________ Consults:_____________________________________________________
VS: ___________________________________________________________________________________________________________
Neuro: _________________________________________ Ambulation:__________________________________________________
Lungs: _________________________________________ Chest Tube: __________________________________________________
O2: ____________________________________________ IS: ___________________________________________________________
Cardiac/Tele: ___________________________________ Edema: ______________________________________________________
Pulses: ________________________________________________________________________________________________________
GI/Abdomen:___________________________________ Diet: ___________________ Last BM: ____________________________
Tubes: ________________________________________________________________________________________________________
GU/Urology: ___________________________________ Foley/Void: ___________________________________________________
Skin/Dressings: ________________________________________________________________________________________________
Pain: __________________________________________________________________________________________________________
Intervention: __________________________________________________________________________________________________
Social/Psych: ___________________________________ Family Support: ______________________________________________
IV site: _________________________________________ IVF: __________________________________________________________
Labs: __________________________________________ Tests: ________________________________________________________
Disch/Plan: ____________________________________________________________________________________________________
Prep pt:
Bed
Bath
Prn Meds
Toilet
Room prep
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Conclusion
The lesson learned while
implementing nurse-to-nurse bedside report was that nurses view
report as a sacred cow, and the
challenges when attempting to
change this process can not be
underestimated. Despite a unit
culture of shared governance and
motivation, and familiarity with
change among staff nurses, consistent reminders and support
with the bedside report process
were required to arrive at the
refreezing stage and to maintain
this clinical practice.
Although nurses communicate
extensively with their patients, it
was surprising to the implementation team to learn that conducting report involving the patient
was somehow perceived as difficult and uncomfortable for nurses. The reason for the uneasiness
was identified by the nurses as a
fear of having to interrupt the
patient if the patient monopolized the report episode. One may
speculate that the uneasiness is
due to a lack of knowledge in
effective communication techniques. Having staff nurses who
felt comfortable communicating
in the presence of and with the
patients share their techniques
appeared to be helpful to nurses
who felt unsure of this process.
Informing the patient of his or her
role in the nurse-to-nurse bedside
report process also was important in guiding patient participation and minimizing the disclosure of irrelevant information by
the patient.
Although anecdotal reports
from patients proved to be very
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