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Running head: BEDSIDE PATIENT REPORTING 1

Evidenced Based Nursing: Examining the Rising Trend of Bedside Patient Reporting

Kristine Cargill, Cheryl Klinkner, Cheryl Nienaber and Bailey Sundberg

Ferris State University

BEDSIDE PATIENT REPORTING 2

Abstract

Various types of nurse shift change reporting exist; however, this paper examines the increasing

interest of the bedside reporting method in the acute care setting. The authors begin by searching

two popular scholar databases: PubMed, CINHAL and include their findings from the databases.

The authors then select four substantial studies to critically appraise. The authors’ purpose is to

determine whether or not, enough research and knowledge exists to support that bedside

reporting increases effective communication while producing: better patient outcomes, increased

patient satisfaction, and nurse job satisfaction.

Keywords: bedside handover, change of shift nurse report, patient satisfaction, nurse job

satisfaction, patient outcomes.


Evidenced Based Nursing: Examining the Rising Trend of Bedside Patient Reporting

Missing home plate after hitting a home run can cause a team to lose the game, but

miscommunication during end of shift report can cause one to lose their life. It has been

repeatedly demonstrated that during change of shift vital patient information is deficient.

According Alvarado et al. (2006), the Joint Commission on Accreditation of Healthcare

Organizations [JCAHO] found in 2003 that “almost 70% of all sentinel events are caused by

breakdown in communication” (Abstract, para. 1). The nursing profession can control where and

how the communication of patient information takes place: whether verbally on the unit or in the

patient's room, audio taped, written, or through electronic forms (Friesen, White, & Byers, 2008,

Ch. 34: p. 6-7). Nurses have the duty to provide a safe environment to the patients entrusted to

their care: avoiding adverse outcomes, medication errors, and maintaining or increasing patient

satisfaction. This begins with effective team communication. In fact number two of the JCAHO

National Patient Safety Goals (2008) states to, “improve the effectiveness of communication

among caregivers” (Revere & Eldridge, 2008, p.1). If the current level of communication during

change of shift reports are not effective what could be an alternative method for reporting?

The group began by taking inventory of their clinical experiences, and the forms of which

they have completed report in the past. It was found that the commonality among the group

members was; all authors had acute care experience, and that none had participated in bedside

reporting in the past. By searching the PubMed and CINAHL databases using the keywords

listed in the abstract of this paper, approximately 150 scholarly publications were returned. The

year of publications ranged from 1997 to current, showing that this topic has been of interest in

the past. The authors limited the search results by year of publication within last five years, to

include only studies with nurses as part of the research team. Filtering provided the authors with


50 publications. After review of results, four relevant studies were selected by the authors, each

being critically appraised to determine whether or not enough research exists, to support that

bedside reporting increases effective communication and produces: better patient outcomes,

increased patient satisfaction, and increased nurse job satisfaction in the acute care setting.

Article One

Descriptive Summary

The article titled, Bringing Change-of-Shift Report to the Bedside (Griffin, 2010),

focused on the purpose of change-of-shift report, common practices of the report, and how

changing to bedside report can increase patient safety and satisfaction. As previously discussed

change-of-shift report can be completed in numerous methods, usually near the nurses’ station or

another private location. This allows for interruptions or conversations of another subject to

occur. It is important to focus on the patient and their current plan of care [POC] at change of

shift. By bringing report to the bedside where patients and families can be involved with the

current POC, allows for an uninterrupted and on-subject transfer of patient information, and is a

main component of patient-and-family centered care.

Critical Appraisal

Problem and purpose statement.

The problem statement is not clear, yet there is obvious information on why a change in

method of nurse-to-nurse report is needed. According to Griffin (2010), “the Institute for Health

care Improvement collaborated with the Robert Wood Johnson Foundation and created an

initiative titled, Transforming Care at the Bedside, with the aim to improve patient safety, which

included bringing report to the bedside” (p. 349). By bringing the report to the bedside it

decreases the possibility of miscommunication between nurses, medical staff, and patients


regarding the current POC. Further Griffin (2010) points out that, “report is the time when one

nurse transfers accountability and responsibility of patients to another nurse”, with the off going

nurse giving a complete summary of the patients POC to the oncoming nurse (p. 348). Griffin

(2010) clarifies that “the communication during this process is intended to ensure the continuity

of care giving and patient safety” (p. 348). Two of the National Patient Safety Goals set by the

JCAHO can be met through bedside reporting. First, JCAHO encouraged patient involvement in

care, serving as a patient safety strategy. Secondly, it was also recommended that a patient

selected individual should be designated as an advocate when the patient is unable to make

informed decisions independently (Griffin, 2010, p. 349).

Review of Literature.

This article is not a research study but a review of existing literature regarding the

importance of bringing change-of-shift report to the bedside. The article used up to date, relevant

sources to review. This article was published in 2010 making any sources between 2003 and

2010 current thus increasing relevance, which applies to 13 of the 16 sources cited. The author

did not complete a critical analysis on all of the sources listed; rather used JCAHO’s National

Patient Safety Goals to support the author’s favorable position of bringing report to the bedside.

The author used the core concepts published by the Institute for Patient and Family Centered

Care [IPFCC] for implementing bedside report. Both JCAHO and the IPFCC are recognized

organizations that provide up-to-date information in improving patient safety and satisfaction.

By focusing on safety issues and involving family, the literature made clear the importance of

transforming nurse to nurse report from behind the scenes to directly at the bedside.


Framework.

The implicit framework for this study is linked to previous research to improve patient

safety, and encourage patient and family participation in the patient’s POC. Having change-of-

shift report at the bedside provides the patient and family members an opportunity to ask

questions. It also gives the off going nurse a chance to say good-bye and the oncoming nurse

can quickly greet her patients within the first few minutes of shift change. Griffin (2010) claims

that using the four concepts of patient and family centered care provided by the IPFCC, “with the

primary goal of improving the experience of care through mutually beneficial partnerships” can

be met through bedside reporting (p. 349).

Four core concepts.

Respect and dignity.

Griffin (2010) says the first core concept of “respect and dignity requires that nurses

honor patient and family perspectives and choices” (Griffin, 2010, p. 349). This means to

respect the patients’ beliefs, cultures, thoughts and ideas regarding their medical care. Bedside

report gives nurses the opportunity to meet the patients and their families, beginning clear

dialogue related to each individual’s uniqueness ensuring mutually agreed upon personalized

care (p. 349).

Information sharing.

Griffin (2010) defines information sharing as being “complete and unbiased information

shared with patients and families so they are able to participate in the care and decision making”

(p. 349). It is important that the nurse works with the patients and families to make sure that new

information is accompanied with education, resulting in verbalized understanding obtained by

the nurses to ensure that all parties can make informed decisions if needed.


Participation.

The third concept of participation Griffin (2010) states that, “in patient-and family-

centered care, patients and families are encouraged and supported to participate in care and

decision making at the level they choose” (p. 349). It is important to encourage all patients to

participate in report since it can be a valuable process in their care, but also to practice their right

in determining who the patient wants also to be involved. The amount of outside participation

can vary depending on the patient’s cultures, condition, or treatments from that day.

Collaboration.

Finally the fourth concept Griffin (2010) describes is collaboration. This is the time

nurses, families and patients work together to achieve the same goal, increase patient satisfaction

and safety through bed-side report. According to Griffin (2010) it all, “begins in the policy and

program development phase, utilizing previous families and patients experience to develop a

successful report process” (p. 350). Nurses come together and give comments and suggestions to

improve the report process and create a handoff tool to make bedside report a success. This is

where families and patients can give suggestions contributing to bedside report, helping nurses

develop a solid practice which improves patient safety and increases patient satisfaction. Griffin

(2010) states that, “experienced patients and families can offer advice, support, and education for

staff or other patients and families about the report process” (p. 350). Nurses tend to focus on

the technical aspect of care giving and families focus on the non-technical portion, which are

both important (Griffin, 2010). Both nurses and patients along with their families have valuable

input during the collaboration phase. Making sure all aspects of the patients care is covered.


Results.

Challenges.

The review of literature [ROL] regarding bedside reporting does indicate some

challenges. One such challenge is reluctance of nurses to break tradition or current practices

because of their comfort level. Bedside reporting also brings the challenge of maintaining

patient privacy. What happens if patients are in semi-private rooms, then what type of

information should be shared at the bedside? Confidentiality is a number one priority in the

health care industry, and there could be a change in the patient condition like new test results that

needs to be discussed. The nurse must pass this vital information to the oncoming nurse, but

how, or do nurses share this information at the bedside while protecting confidentiality? There is

also a concern of additional parties present when bedside report should begin, and perhaps that

patient does not feel comfortable asking the party to leave the room. As patient advocates, how

do we address this problem? Finally, nurses are concerned about time management. Will bedside

report take longer, resulting in delayed departure from the floor, or the oncoming nurse being put

behind schedule?

Griffin (2010) addresses these concerns by reminding the reader that “the goal is to

modify staff behavior so that patients and families can be included in the report process” (p.

350). Report could still consist of a brief huddle privately between the two nurses, before

heading to bedside report. Many of these concerns could be addressed by explaining to the

patient upon admission the process of bedside report works and clarifying with the patient whom

they would like involved. This would set boundaries immediately, alleviating any questions

about who can or cannot be present. As with any policy, a clear procedure should be


implemented addressing all of the above questions or scenarios, and how they can be handled in

a positive manner making bedside report a great experience.

Benefits.

Griffin (2010) states that one of the biggest benefits in giving bedside report is the

“patients are seen sooner in the shift and the nurse leaving can introduce the patient to the

oncoming nurse” (p. 351). By doing the bedside report, patients are seen as an individual with a

plan of care instead of just a diagnosis and treatment. This method also ensures that the patient,

family and staff all have the same POC in place while keeping all parties informed of the

patient’s current status. Bedside report is also an opportunity to educate the patient and family

about new diagnosis and treatments, while at the same time Griffin (2010) points out that “the

nurses are able to receive information from the patient and family as they provide an additional

resource for diagnosis and treatment” (p. 351). This method also provides a double check

moment between the nurses to make sure all medications, drips and treatment provided were

done correctly and documented. Bedside report is a benefit not just for nurses but also for the

patient and family involved.

Implementing.

Griffin (2010) makes clear that, as “with all new equipment and processes, nurses must

be engaged in the development, and provided with education” (Griffin, 2010, p. 352). A tool

should be developed in which the basis of bedside report needs to follow. It is important to focus

on communication skills and using terms patients and families will understand, avoiding medical

jargon when possible and providing explanations when it is not. Resources need to be available

to the staff on how to approach and carry out bedside report, as well as an ongoing evaluation of

the process including possible alternatives for process improvement (Griffin, 2010, p. 352).


Patients and families also need to have the chance to give feedback regarding their thoughts and

feelings about bedside report., as Griffin (2010) points out that “patients and families are experts

in the experience of care and can be catalyst for practice improvements” (p. 352).

Conclusion.

In conclusion, it is important to involve patients and families in the plan of care. Bedside

report offers the opportunity for patients to ask questions, receive feedback, and allows for the

nurse to assess further patient educational needs. It clarifies for the nurse the individual coming

into their care, and clarifies for the patient their caregiver. It allows for both nurses to complete a

double check between shifts to make sure the patient is being provided a safe environment. The

open discussion concept permits patients and families to feel they are a part of the team, thus

improving patient satisfaction.

Article Two

Descriptive Summary

The article, Standardization of Change-of-Shift Report was written by three registered

nurses, combining for one doctoral, a master’s and a bachelor’s degree. The focus was on

creating a standardized shift report to promote time efficiency and quality of transferred patient

information (Athwal, Fields, & Wagnell, 2009, pg. 143). This study took place on a progressive

care unit [PCU] at a Magnet hospital located in San Diego County. The unit consisted of 34

beds and 55 licensed nurses (Athwal et al. 2009, pg. 143). In this article the author’s describes

the framework for the study and the results of the standardized shift report.


Critical Appraisal

Problem and Purpose Statement.

The study was limited as it was done only at one hospital on one unit, further, having 55

nurses made the sample size small. The problem statement was not clearly defined in this article.

The audience assumes the problem from the background section which details complaints from

nurses, patients, and physicians regarding the unit’s current method of shift report. The nurses’

complained that the current report was not structured, some lacked the ability to decipher the

important information to share, and the length of report often put nurses into (Athwal et al.,

2009, pg. 144). Unlike the problem statement, the purpose of Athwal, Fields, and Wagnell

(2009) study was, “to describe a bedside clinical nurse–led initiative to design a standardized

shift report that created a more time efficient process while improving the quality of information

reported” (p. 143). Information leading to the purpose statement gives the audience an

understanding of why the purpose of the study is important.


The review of literature described several different ways of handling shift report which

included written report and bedside reporting. For this study, the council decided to use a

combination of written report using a standardized sheet along with bedside reporting. The

review of literature was limited because it was one paragraph. The authors listed three specific

articles in the review of literature paragraph and only used a generalized statement about each

article (Athwal et al., 2009, pg. 144). The information regarding the articles lack description and

any appraisal. Athwal et al. (2009) stated that “the new shift report incorporated best practices

from the literature; however, the authors did not reference what best practices were found in the

research of literature (p. 144).


Framework.

The new shift report was developed from literature and staff suggestions, and consisted of

a combination of written patient information and a bedside introduction. At the beginning of the

shift, the nurse would review the written patient update and then briefly meet with the nurse to

clarify any questions regarding the written information (Athwal et al., 2009, pg. 144). Both

nurses would then proceed to the bedside to complete the report. The written shift report is a

standardized sheet that includes all pertinent patient information with a section at the bottom for

a nurse to write any patient updates. The standardized shift report sheet was introduced to the

reader in Figure 1 (pg 145). The report sheet allows for two shifts of use, and then a new sheet is

stapled to the top of the previous sheets. The new shift report was developed to save time,

increase patient satisfaction, and standardized the information that was reported between the

nurses (Athwal et al., 2009, pg. 144).

The authors referenced written protocols that were presented to staff during educational

in-services about the new procedure, but the authors do not include the protocol for the reader.

The guidelines may provide detailed information the audience would need to implement a

similar program at their facility or unit. It does not list what information was included, how

often the in-service was held, and if all nurses attended the same in-service. If all staff nurses did

not receive education on the new shift report process, this could create confusion and alter

results. The new process was reviewed after one month, and minor changes were made;

however, the authors did not describe the changes or the problems that lead to the changes

(Athwal et al., 2009, pg. 145).


Results.

According to Athwal et al. (2009), “the new shift report was evaluated on the amount of

time spent for shift report, overtime expenses related to shift report, call lights, staff satisfaction,

and patient falls” (p. 146). The time spent in report ranged from 30-60 minutes prior to bedside

reporting, this time decreased to 10-15 minutes with the new procedure (Athwal et al., 2009, pg.

146). In reference to the nurses’ complaints about overtime, the results indicated the unit saved

approximately $8,000 over two months in overtime pay because of the time effectiveness of

bedside report. Call light usage by patients, and unnecessary falls of patients, decreased with the

new report process, which the authors related this to the nurse being at the bedside sooner

(Athwal et al., 2009, pg 146). Nurses were not only satisfied with the decrease in overtime

contributed, but agreed that the new procedure provided them with more pertinent information

during report. Data regarding nurse and patient satisfaction were not adequately revealed to the

reader prior to the change in report method, further, the results from both parties after

implementation were taken through surveys or interviews with the nurse managers. The claims

made by the authors of increased staff and patient satisfaction could be bias based on the method

of obtaining the result information.

Conclusion.

The goal was met to standardize shift report. Nurses were satisfied with the new process

because they did not have to work overtime and the staff knew what information was expected to

be given in report. The conclusion statement was clear and stated the purpose was met. The

authors also mentioned benefits of the new process which were a decline in patient falls, call

light use during report, and financial savings (Athwal et al., 2009, pg. 146). Overall, this study

is weak. The sample size was too small and confined to one unit, leaving the audience to


question if this process will work on other units. The authors do provide sound outcome results

such as those mentioned above. Due to the positive results, it is suggested that this reporting

method be further studied and trialed on different units and implemented if successful outcomes

are achieved.

Article Three

Descriptive Summary

The article, Incorporating Bedside Reporting into Change-of-Shift Report (2010), written

by Dawn Laws BSN, RN, CRNN and Shelly Amato MSN, RN, CNS, CRRN provided a glimpse

into how one stroke rehabilitation center was able to make bedside reporting effective. Although

it is not stated directly, the assumption is that Metro Health Rehabilitation Institute of Ohio was

used for this study as both authors are on staff at that facility. The figures regarding the number

of nursing staff and the number of patients involved in the research was not provided. The study

addressed the staffs’ concerns over confidentially and time management, as well as discussed

how this particular group overcame the barriers encountered. Nursing staff agreed that bedside

reporting could increase safety, and promote teamwork and patient participation (Laws &

Amato, 2010, p.72).

Critical Appraisal

Problem and Purpose Statement.

Laws & Amato (2010) stated “communication failures during shift reports as a leading

cause of sentinel events in the United States” (p.70). Standardization of shift-to-shift reporting

was necessary to fulfill one of the “Joint Commission’s 2006 National Patient Safety Goals”

(Laws & Amato, 2010, p.71). This would involve changing the current system of tape

recordings to a standardized system that allowed for a more precise flow of information to be


exchanged. Patients in the facility sought ways to be part of the decision making process and

these needs were not fulfilled under the current system. Finally, the nursing staff and patients

both agreed that it was necessary to promote teamwork within the healthcare facility and the

home environment.

The unit in this study did not have a standard procedure for report and “the content of

shift report would sometimes degenerate into irrelevant and outdated statements” (Laws, &

Amato, 2010, p. 71). The next point addressed is the “patients’ desire to be more involved in the

plan of care” (Laws, & Amato, 2010, p. 71).


Laws and Amato (2010) used references from 1989 to 2007. The 1989 article, Walking

Rounds a Step in the Right Direction, may have been a valid resource yet there are perhaps more

up to date references that could be used. It is assumed that the article is referring to a form of

bedside reporting. However, the authors do not reference this article in their report. The two

individual studies that are referenced included a study by Jordan (1991) which review the lack of

care plans, and a study by Mangino (2006) which review concerns of confidentiality while

giving/receiving report.

Framework.

The facility utilized a Nursing Partnership Model of Care which incorporates “a

partnership with the patient, and family that promotes interaction through open communication

and mutual transaction” (Laws, & Amato, 2010, p. 71). Three steps are utilized to bring about

change in the current process.


Pre-implementation.

The biggest challenges at the launch of the study were patient participation and nurse

insecurity related to communication. Champion nurses, who have been specifically trained to

help educate staff, were available to address these challenges. Change of any nature is usually

met with resistance. By preparing the staff with the necessary tools the transition to bed-side

reporting will be a smooth process. Initial concerns were addressed through in-service

education, manuals, and handouts.

Implementation.

Patient education was also provided and patients were encouraged to assist with goals to

ensure their needs were addressed and plan of care could be adjusted as necessary. The use of an

informal survey was utilized to assemble this information and develop a plan of action. Patients

are searching for ways to become more involved and educated on their conditions to promote

better health.

Post-implementation.

Post implementation surveys were taken to review the changes in safety, confidentiality.

teamwork, length of report and accountability. Laws and Amato (2010) noted that

“confidentiality remained a concern for some nurses despite being informed that discussing a

patient’s case is an acceptable practice for nurses and physicians” (p. 73).

Results.

A survey conducted four months after the implementation of bedside reporting showed

positive results. Bedside reporting showed safety at 28% pre-implementation and 70% safety

post-implementation. Confidentiality rose from 59% to 100%; patient involvement increased

from 29% to 78%; team cooperation from 29% to 49%; and accountability jumped from 39% to


59%. Patient’s length of stay was the only area that did not change; it remained at 79% over the

four months (Laws & Amato, 2010, p. 73, figure 2).

Summary of Evaluation.

It is assumed that the authors of this study work in this facility. This could present bias

on the actual results of the study. A post-implementation survey was selected to measure the

results of the study. This tool would normally be considered useful; however, the authors fail to

note how and where this survey was administered. Participants may have felt pressure to answer

the questions in a certain manner.

The article could have been stronger if statistics were available that addressed real

numbers and not just feelings. Safety is one of the main focus points of bedside reporting. It

addresses the actual safety of a patient as well as making sure key information is shared between

staff. However, there are no actual numbers to indicate if injuries or sentinel events decreased.

The chart provided represents how the nurses felt, not what was actually happening.

While initial change can be difficult, by working together and promoting teamwork, the

best outcomes for the patients are achieved. Patient satisfaction and safety, along with increased

sense of teamwork and cooperation will enable staff to prioritize the work flow for the shift and

ensure patient safety (Laws & Amato, 2010, p. 74). Nurses originally perceived that reporting

would take longer yet the chart indicates that at the end of four months, the nurses felt it was the

same. Again, statistics at the start, middle, and end of the four month would have provided

valuable information. Additional information needed to be included from the patients’

perspective. Was bed side reporting a quality that patients valued, and was it able to assist them

in feeling that their needs were being addressed. As a nurse it is important to include the patient

in their plan of care to assist with understanding and continued recovery.


Article Four

Descriptive summary

The quantitative study, Bedside Handover: Quality Improvement Strategy to Transform

Care at the Bedside”, was accepted for publication in 2008. Five of the six authors are

Registered Nurses, three with Post-Doctoral degrees, and two with Masters level degrees. The

study took place in Queensland, Australia at a public hospital consisting of 330 beds, and as of

2006, 454 full time nursing staff members. Bedside handover was implemented on two medical

and one rehabilitation unit. The trial affected approximately 74 full time nursing employees.

The study discusses why this specific change was targeted, provided the framework used to

shape the desired change, provides post-implementation results, and includes two tables

consisting of practice guidelines for bedside handover and competency performance indicators

(Chaboyer, et al., 2009, p. 136-137).

Critical Appraisal

Problem and purpose statements.

Chaboyer et al. (2009) do not clearly identify the problem statement of their study.

However, through reading the introduction the authors imply that “bedside handover in nursing,

while not new, is one strategy purported to improve patient centered care; however, there has

been limited formal examination of its implementation…the majority of work in this areas has

been published a decade or more ago” (p. 136). The authors continue to discuss the lack of

implementation guidelines by stating, “most researches believe bedside handovers are time-

effective but there is limited documentation of how bedside handover should be implemented,

and both who and what it should encompass” (p.137). Essentially as the authors sum up, the lack

of evidenced based guidelines leaves units wishing to explore this avenue of nurse handover to


rely “on trial and error or other inefficient methods to implement this innovation” (p. 137). It is

assumed that the problem focus of this study is the lack of research and documentation available

from those who have implemented bedside reporting, allowing others to be guided in changing

their practice.

The purpose statement is clearly identified by the reader even though again it lacks its

own distinct heading and area in the introduction section. The authors’ state that this “article

describes a quality improvement activity aimed at improving patient-centered care: bedside

handover in nursing. The rationale for the change, steps used to implement bedside handover,

and patient and staff satisfaction after this practice improvement are described” (Chaboyer et al.,

2009, p.137).

Review of literature.

The review of literature [ROL] lacks its own section with proper heading, it is assumed

that the ROL section consists of only two paragraphs, following the assumed problem statement

and preceding the purpose statement and methods section. The very short and brief ROL section

could be because the lack of previous research or lack of current research which is essentially the

problem. If this is the case Chaboyer et al. (2009) could have included in the ROL section of

their report the numerical results of pertinent studies or research when they searched databases

for literature about bedside handover. This would have added concrete evidence to the claim of

lack of studies and research, especially current. In the introduction section the authors call by

name two studies that are recent, however do not list the year of publication in the narrative.

Both are primary sources within five years of the publication of this report. Neither of these

sources are critically appraised by the authors, but were briefly defined by the authors’. By

including two recent studies and not critically appraising them the reader could draw the


following conclusions: there really is not significant research and studies completed on bedside

handover, the studies mentioned were not strong studies, or that the authors did not do a

thorough review of existing literature. Again the authors could have provided evidence of lack

of available literature by including search results from databases. The authors’ Chaboyer, et al.,

did continue to review literature as it pertained to the following sections of their report, which

will be discussed as the sections are appraised.

Framework.

A team of nursing leaders in the Australian hospital consisting of: the director of nursing,

and nurse unit managers, “undertook a review of strategies to improve nursing handover as part

of a broader agenda to improve nursing service delivery” (Chaboyer et al., 2009, p.137). This

change was driven by complaints of the current system from patients, physicians, and the nursing

staff. The team used Lewin’s 3-step Model for Change as the framework to guide their step-by-

step plan to change the current practice of nurse reports on the three different floors within the

hospital. The authors defined Lewin’s 3-step model’s key concepts as, “unfreezing, moving, and

refreezing” (p. 137).

Lewin’s 3-step model for change.

Unfreezing.

Chaboyer et al. (2009) defined the first step of unfreezing as, “equilibrium needs to be

destabilized (unfrozen) before old behavior can be discarded (unlearned) and new behavior

successfully adopted” (p.137). The authors saw this step being met when the different parties of

care began to complain about the current system (p. 137).


Moving.

The authors did not define this step, which would have strengthened their model choice,

however, it can be assumed by the narration that this is the step where the change is developed

and implemented or in this case tested. The first step in this stage the authors state guidelines

were written by “a group of experienced managers and clinicians based on previous literature

and on the TCAB [transforming care at the bedside] pillars” (Chaboyer et al., 2009, p. 137). The

focus of the guidelines were: “preparing for handover, informing patient of handover, defining

content of handover, including safety scan and consideration for how to handle sensitive

information” (p. 137). Chaboyer et al. (2009) also created a table in the published study of their

developed “practice guidelines for bedside handover” (p. 138) which described the “preparation

(for handover), content (to be discussed during handover), and (documentation,

objective/subjective data of the) safety scan” (p. 138). The second step of this stage involved

those who would be implementing the change, the practicing nurses. An environment of open

communication was introduced as administration shared their observations and plans with the

bedside nurses, while listening and addressing their concerns (p. 138). Mainly, “very little

resistance was encountered…because of staff dissatisfaction with existing handover procedure”,

and the concerns voiced were of “patient confidentiality and how bedside handover could be

implemented on the night shift with patients sleeping” (p. 138). Also during this step the group

of managers and clinicians held “in-service education and development of written materials were

used to ensure the second step…was accomplished in a way that ensured consistency” (p.138).

Refreezing.

The final step of Lewin’s Model for Change again was not described but it can be

assumed to incorporate making the successful change permanent in policy, procedure, or


guidelines. Chaboyer et al. (2009) state this step consisted of “address[ing] by developing a

nursing competency…performance indicators, including competency in orientation programs

and annual performance appraisals” (p. 138). Again, the authors created a table for their

published study labeling the performance indicators they identified for the “bedside handover

competency” (p. 139). The authors had a successful change implementation which in the end

became as they state, “part of the way we do things” in these three units of the hospital (p. 138).

Results.

The data collection method of this study was through interviews with patients, nurses and

other members of the multidisciplinary team. The first interview took place prior to

implementation of bedside handover and centered on the different groups perception of the idea

of bedside handover. Each party represented in this interview had a positive view with one

patient stating, “it’s the only way I find out what’s happening” (Chaboyer et al., 2009, p. 139).

After initial concerns from the nursing staff, about confidentiality, and uncertainty related to the

process of bedside handover, nursing staff began to “embraced bedside handover” (p. 139).

The second interview took place six months following the implementation of bedside

nursing. Chaboyer, et al. (2009) stated that 54% of staff participated in this round of interview

through surveys (p. 139). Personally, the group would have placed higher confidence in study

had this percentage been higher. Chaboyer et al. (2009) also offered no reasoning to explain why

less that 2/3 of staff responded to the survey, which again would have been beneficial to the

study. Further, descriptions of the interviews would have strengthened this particular section.

The authors could have included the questions asked, the setting in which the interview took

place, and who conducted the interview. By including these particular components of gathering

results it would address any issues of biases’ that could or did exist.


The top three benefits that were given from those 54% who returned the survey are:

increased “support from shift coordinators and team leaders (59% agreement), improved patient

safety (44% agreement), and improved patient outcomes through discharge planning (44%)

agreement” (Chaboyer et al., 2009, p.139). It was also reported that since “shift coordinators and

team leaders attend bedside handover along with the other staff, they have a better understanding

of the situations with which nursing staff will have to deal during the shift” (p.139). Another

comment focusing on the attendance of nursing leaders in handover was it “provided an

opportunity for these leaders to model the behavior, share their expertise, and respond to queries”

(p. 139). Finally, staff also commented on the fact that other members of the multidisciplinary

team attended handover, which “promoted better communication between professional groups”

(p. 139).

The final component addressed in the results section is the changes that have been made

to the bedside handover process since 2006 when the change was implemented. Chaboyer et al

(2009) stated “on the rehabilitation ward patients now lead the handover, with nurses adding

information as required” (p.140). The reader would like to know the reason for the change of the

party leading report on this ward, which was not given. The reader assumes it coincides with

patient education and gives the nurse an idea of the patients understanding, and knowledge about

disease or injury processes, and signals success rate of discharge and compliance of at home

treatments. The medical wards introduced the “SBAR (situation, background, assessment,

recommendations) acronym to use when the patient’s condition has changed or when staff was

unfamiliar with the patient” (p. 140). Again, the reader would have liked the authors to describe

the reasoning for this change to protocol. The third change resulted from the use of float nurses,

nurses who began work mid shift, and for break coverage between nurses that were not part of


the bedside handover process. The hospital implemented a “double sided, one page handover

sheet containing basic demographic and clinical information about all the patients” (p. 140).

Discussion.

The discussion section of this report focused on the benefits reported with changing to

bedside handover, which included: increased patient-centered care and patient safety, along with

increased satisfaction with teamwork among nurses and collegiality. The authors continue with

their review of literature in this section as well, backing up their study results with other studies

that resulted in similar findings.

Chaboyer, et al (2009) stated that this change in reporting method yielded increased

patient-centered care and patients present on the wards “perceived bedside handover positively…

they became active participants in the handover process” (p. 140). By having the patients

participate in conducting bedside handover patients were provided “with an opportunity to gain a

better understanding of their plan of care” (p. 140). The authors then cited a primary source study

by Timonen and Sihvonen (2000) that concurred with the authors findings of improved patient

center cared, but sited barriers such as; “focus on documents, the use of medical jargon, and

having too many nurses present at the bedside presented barriers to patient participation”

(Chaboyer et al, 2009, p. 140). By supporting the authors findings with similar studies who

produced the same results strengthens the validity of their study, however, the reader would have

liked to been better introduced to this primary source with a brief description of the type of study

that was conducted. The authors also neglected to state the year of the study in the discussion

section leaving the readers to flip to the reference section to find how recent the study was. The

study by Timonen and Shivonen (2000) was published 9 years prior to Chaboyers’ et al. (2009)

which is considered outside the relevant source time frame of five years. However, considering


the problem statement being what it is, it further illustrates the lack of published studies and

research on the topic of bedside handover.

To support increased patient safety that was found as a result of implementing bedside

handover the authors cite reasons surrounding the idea of “oncoming staff undertake this activity

with input from outgoing staff” (Chaboyer et. al, 2009, p. 140). The authors cited that nurses

were able to identify “missing information or ambiguous statements can be easily addressed…by

scanning the patient, environment, and bedside chart” (p. 140). The authors continue by stating

“the scan also appears to limit inconsistencies between the patients reported and actual condition,

with visual sightings of the patient triggering questions and additional information (p. 140). The

authors could have strengthened this result statement with statistics from quality indicators such

as; medication errors, adverse outcomes, or other avoidable injuries prior to implementing

bedside handover, and then the statistics of the same quality indicators following implementation

as part of the six-month assessment. This would have provided the reader with concrete

evidence of the statement made by the authors of increased patient safety being a result of

bedside handover.

The authors described their finding of increased nurse teamwork and collegiality because

by having report at the bedside with oncoming, outgoing, and leadership nurses “brought the

nursing teams together” (Chaboyer et al., 2009, p. 140). The authors then back up this finding by

citing another source, which appears to be a secondary source by Zaccaro, Rittmana, and Marksb

whose article identified “three factors that influence team performance” (Chaboyer et al., 2009,

p. 140). The first factor is to “successfully integrate individual actions into the team” (Chaboyer

et al., 2009, p. 140). The authors see the act of bedside handover taking “place with a number of

nurses from both the outgoing and incoming staff, actually promot[ing] this integration”


(Chaboyer, 2009, p. 140). The second factor to influence team performance is coordination that

addresses that “teams function in complex, dynamic environments” (Chaboyer, et al., 2009, p.

140). The authors believe that with all aspects of care addressed during bedside handover

successfully addresses coordination within a team (p. 140). Finally, the third factor of “team

leadership as an important factor in team performance” (Chaboyer et al., 2009, p. 141) was

addressed with the nursing director and nursing unit managers not only taking part in developing

plans for the study and the transition to bedside handover, but these leaders were also present

during bedside reports. Offering the practicing nurses “opportunities for them to gain support

from shift coordinators and team leaders” (Chaboyer, et al., 2009, p. 141)

In this section the authors Chaboyer, et al. (2009) also stated limitations or other variables

that took place within these nursing units the same time as the transition to bedside handover.

The limitations are stated as: the study was “undertaken in one hospital; thus, the local context

may have influenced the project. Second the move to bedside handover was informally

evaluated, with nurses and patients being asked to comment on the process…other improvements

were occurring at the same time that may have influenced the findings” (p. 141). Such

improvements were claimed to include using whiteboards in patients rooms to distinguish care

staff, nurses beginning to do hourly rounds, and the nursing managers doing daily patient rounds

(p. 141). The authors could have strengthened this section by providing their reasoning for

considering the above limitations to be such, along with the influence they may have had on

study results.

Group Member’s Influential Experiences

According to N. Burns and S.K. Grove (2011) nurses acquire knowledge through:

“traditions, authority, borrowing, trial and error, personal experience, role modeling, intuition,


and reasoning” (p. 16-18). Between the four authors there is a vast array of specialties:

pulmonary, emergency, medical surgical, and skill rehabilitation. The nurse author currently

working in pulmonary uses the computerized Situation, Background, Assessment, Response

[SBAR] and then gives a two-three minute report on the key information. The problem with this

particular system is that multiple nurses are giving and receiving report at the same time which

provides a setting for chaos and increases the chance of error. However, the same nurse

completed her Associates Degree Leadership requirement at facility that utilized bedside

reporting. The benefits of this system far outweighed the risks in her opinion. She explains

benefits to include: being able to meet all of her patients, visualize their diagnoses, ask questions

of the outgoing nurse, and double check all records for completion. Her current pulmonary floor

has also recently entertained the idea of bedside reporting.

Another author has worked 12 years in the emergency department [ED], in the last 10

years the department began utilizing bedside introductions. Due to privacy issues that arise

during ED visits such as regarding abuse, psychiatric disorders, or assaults, full bedside reporting

is not appropriate. During this bedside introduction the off going nurse gets a chance to say good

bye and the oncoming nurse gets to immediately say hello, giving the patient comfort in knowing

who is taking care of them. This also gives the nurses a chance to review any drips that may be

going, review vitals and get an actual view of the patient. This makes for a decrease in

miscommunication and a safer environment for all. It also gives the patient to ask questions and

understand what is next in their plan of care.

The third author works on a medical surgical floor that utilizes the Kardex system and

verbal reports for nurse handoff. The Kardex provides the nurse information on the following:

IV solutions, tests that were performed or need to be performed, lab tests ordered, consulting


physicians, past medical history, and reason for hospitalization. The verbal report provides test

results, patient’s current condition, and any other pertinent information not recorded on the

Kardex. In her experience this type of reporting usually results in important information being

overlooked. Missing important health information can delay treatment and cause confusion

between patients and the health care team. She finds that many of her patients are unaware of

what test they are having done, x-rays or EKG’s for example, and the reason for the testing.

Bedside reporting would allow more communication of the plan of care with the patient and may

help answer patient questions.

Unlike the first three authors who work in the acute care setting the final author works in

post-acute rehab, where the numbers of patients under her care would not be conducive for

bedside reporting every shift. A daily routine for this nurse includes total licensed care for 32-40

patients therefore verbal report including changes in conditions in patients or full reports on new

admissions. The author does believe that bedside reporting would be beneficial in the area of

care, however, just with the numbers of patients it would only be time efficient to include only

new admissions in the daily bedside reporting. This would give the oncoming nurse the time to

meet the patient, review all admission paperwork is completed, understand any abnormal

assessment findings, and know all pharmaceutical and non-pharmaceutical interventions

available for this patient. Throughout a patients stay in the rehabilitation facility the patient and

family members participate in multi-disciplinary care conferences periodically throughout the

process, where their plan or care is reviewed, areas that need improvement are discussed,

potential discharge time frame, post-discharge care is discussed, and all questions of either

patient or family are answered. This conference actually takes the place of bedside reporting for

the post-acute patient.


To Utilize, or Not To Utilize

The beginning question or purpose of the authors research was to determine whether

enough research exists to support that bedside reporting increases effective communication and

produces: better patient outcomes, increased patient satisfaction, and increased nurse job

satisfaction in acute care. The authors concluded that bedside report does increase effective

communication, increase nurse and patient satisfaction, and produce better patient outcomes’,

however; it is not appropriate for all acute care settings. The decision to trial bedside report must

be made based on the uniqueness of the unit, and the current level of satisfaction of the current

report system. Also there is no cut and dry approach to adopting bedside reporting on any unit,

again every unit is different and these individual characteristics must be taken into account. All

of the chosen articles in review demonstrated that bedside reporting produces all of the outcomes

questioned by the authors. However, these articles all implemented bedside reporting on a

medical surgical type floor. It is the authors opinions that if the any floor is having decreased

reporting satisfaction among nurses, or struggling to increase patient satisfaction rates, nurse

managers should discuss various other options of reporting, including bedside reporting.


References

Alvarado, K., et al., 2006. Transfer of Accountability: Transforming Shift Handover to Enhance

Patient Safety. Healthcare Quarterly, 9(75-79). Retrieved from:

http://www.longwoods.com/content/18464

Athwal, P., Fields, W., & Wagnell, E. (2009). Standardization of Change-of-Shift Report.

Journal of Nursing Care Quality, 24(2), 143-147. DOI:

10.1097/01.NCQ.0000347451.28794.38

Burns, N., Grove, S.K., 2011. Understanding nursing research: Building an evidenced-based

practice. Maryland Heights, MO: Saunders Elsevier Inc.

Chaboyer, W., McMurray, A., Johnson, J., Hardy, L., et. al. (2009). Bedside handover: Quality

improvement strategy to “transform care at the bedside”. Journal of Nursing Care and

Quality 24(2): pp. 136-142. Wolters Kluwer Health: Lippincott Willians & Wilkins.

Friesen, M.A., White, S.V., Byers, J.F. 2008. Patient safety and quality: an evidence

based handbook for nurses. Agency for Healthcare Research and Quality. Chapter 34.

Handoffs: Implications for Nurses. Retrieved from:

http://www.ahrq.gov/qual/nurseshdbk/docs/FriesenM_HOIN.pdf

Griffin, T. (2010, October/December). Bringing Change-of-Shift Report to the Bedside: A

Patient-and Family-Centered Approach. Journal of Perinatal and Neonatal Nursing,

24(4), 348-353. http://www.longwoods.com/content/18464

Laws, D., Amato, S., (2010). Incorporating Bedside Reporting into Change-of-Shift Report,

Rehabilitation Nursing 35 (2), p.70-74.

Revere, A., & Eldridge, N. (2008, Jan/Feb). Joint Commission National Patient Safety


Goals for 2008. Topics in Patient Safety, 12(1), 1-4.

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