20^th World Nursing Education Conference

Biography

Biography: Anat Drach-Zahavy

Abstract

Patient's handover has been declared as an area of considerable vulnerability to patient safety as well as a point of resilience, as it presents opportunities to identify, correct and ‘bounce back’ from errors happened in the last shift. This presentation describes findings from four different studies on nursing handovers, delineating the resilience strategies nurses develop to maintain patient safety.

Comparing mental models of incoming, outgoing, and expert nurses of 40 handovers, two seemingly contradictory processes in the shift handover were revealed: a “Chinese whisper effect” and an “information restoration” process, where incoming nurses restructure missing information based, perhaps, on their prior knowledge, experience, and unmediated impression of the patient. Another qualitative study using interviews, showed that nurses rely on cross-checking strategies to make sense of the information gained during handovers. These strategies help identifying ‘red flags’ that help them set priorities, and direct their attention to prevent something bad from happening. Another important resilience strategy, is to involve the patient during handovers. We found that nurses revealed resilience by trying to involve those patients that were less reluctance to participate during handover due to their personality traits. Finally, we demonstrated that engagement with resilient handover strategies was linked to treatment errors in patient care in the following shift. Specifically, face-to-face verbal update with interactive questioning; update from practitioners other than the outgoing; topics initiated by incoming as well as outgoing team, and writing a summary prior to handover – all were significantly and negatively linked to fewer treatment errors.

Thus, a nursing handover should not be viewed only as a telegram, where the outgoing nurse provides concise information on the patient, but rather as a dialogue, where the incoming and outgoing nurse share their perceptions on the patient, ask clarification questions, and together discuss their perceptions of the patient.