Exploring the Content of the Nurse-to-Nurse Change of Shift Hand-off Communication

Abstract

An estimated 250,000 deaths occur annually are attributed to preventable medical errors. Approximately 100,000 of those deaths are related to miscommunication between healthcare providers. Miscommunication between healthcare providers during the transfer of care accounts for 80% of sentinel events occurring in the hospital setting. The hand-off communication continues to be one of the primary causes of sentinel events in healthcare in spite of the continued research focus over the past 10 years. The transfer of care communication between providers is called the “hand-off,” “change of shift report,” or “handover.” The hand-off for purposes of this study is defined as the process of transferring patient care, responsibility, and authority from one nurse to another at the change of shift. Specifically, we are concerned about the communication of clinical events (CE) experienced by the patient because CEs are precursors to a sentinel event. A CE is defined as a change in the patient's condition in the following areas: bleeding, pain, fever, and changes in output, respiratory status, or level of consciousness. The purpose of this research is to explore the content and meaning of the nurse-to-nurse hand-off communication of patients who have experienced a clinical event for nurse hand-off at the patient bedside compared to away from the bedside. The methodology and methods used in research are theory guided. The Cognitive Load Theory and Carrington’s Effective Nurse-to-Nurse Communication Framework provided the structure and guidance for this study. The study was a qualitative descriptive design using the following data collection methods: digital audio recording of the nurse-to-nurse hand-off communication and nurse interviews. The data was analyzed using a within-methods triangulation data analysis using Linguistic Inquiry Word Count (LIWC) a natural language processing program, content analysis and thematic analysis. A convenience sample consisting of ten nursing hand-off dyads (one giving nurse and one receiving nurse) for a total of 19 nurses from a medical-surgical unit were used for the study. The results will increase the understanding of the “what” and “how” of the nurse-to-nurse change of shift hand-off communication. The results of this study have the potential to impact the current nursing hand-off practice regardless. Additionally, the results will inform future redesign of nursing curriculum and healthcare facility orientation and the development of an electronic health record interface to support the nursing hand-off process.