Bev O'Connell

Challenging the handover ritual: Recommendations for research and practice

Communicating nursing care during the patients total hospital stay is a difficult task to achieve within the context of high patient turnover, a lack of overlap time between shifts, and time constraints. Clear and accurate communication is pivotal to delivering high quality care and should be the gold standard in any clinical setting. Handover is a commonly used communication medium that requires review and critique. This study was conducted in five acute care settings at a major teaching hospital. Using a grounded theory approach, it explored the use of three types of handover techniques (verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semistructured interviews with nurses and participant field observations. Textual data were managed using NUD*IST. Transcripts were critically reviewed and major themes identified from the three types of handovers that illustrated their strengths and weaknesses. The findings of this study revealed that handover is more than just a forum for communicating patient care. It is also used as a place where nurses can debrief, clarify information and update knowledge. Overall, each type of handover had particular strengths and limitations; however, no one type of handover was appraised as being more effective. Achieving the multiple goals of handover presents researchers and clinicians with a challenging task. It is necessary to explore more creative ways of conducting the handover of patient care, so that an important aspect of nursing practice does not get classified as just another ritual.

Stroke : the increasing complexity of carer needs

&NA; In Australia, more than 346,000 individuals who experience a stroke return to living in their homes with varying degrees of disability. They rely on emotional and physical support from informal carers, typically family members. Informal carers have an indispensable role in patient care poststroke, and the ability of carers to manage this role effectively is crucial for stroke survivors to be able to return home. The aim of this study was to examine the impact of the caring role on carers of stroke survivors, particularly the services provided and the levels of depression and well‐being experienced. The study used a longitudinal design incorporating survey methods. Stroke survivors were assessed for functional ability, quality of life, and depression using three assessment tools: the Stroke Impact Scale, World Health Organization Quality of Life‐BREF scale, and Zung Self‐Rating Depression Scale. A total of 26 people were surveyed: 13 stroke survivors and their 13 carers. Carer knowledge of stroke support services was also explored. Information was collected by using survey methods and structured interviews at 3 weeks and at 3 months postdischarge. The main finding was that depression scores for carers and stroke survivors were below Australian norms at both assessment time points. The major concern identified by carers was poor follow‐up procedures for initiating rehabilitation in the home. This study highlighted that a lack of appropriate discharge planning, in conjunction with early discharge of stroke survivors, can have an impact on the rehabilitation process and place increased and unrealistic demands on carers.

The trials and tribulations of team-nursing

AIM The aim of this study was to review the team-nursing approach to care adopted by two general medical wards in a large private hospital. The delivery model of care was reviewed to determine the factors that enhance and/or hinder the timely delivery, continuity and communication of care. METHOD All nursing and ancillary staff who worked on two medical wards at a private teaching hospital were invited to participate in the study. Thirty eight participants from the two wards took part in focus group discussions, individual interviews and completed the Staff Continuity of Care Questionnaire. FINDINGS Findings indicated that achieving functionally sound teamwork is a complex task that is affected by the interplay of a number of organisational, patient and staff factors. Its smooth application is further affected by the uncertain and changing conditions on the wards, which are difficult to control and impact on the smooth delivery of patient care. The findings revealed strengths and weaknesses in teamwork, communication of care, documentation and discharge planning. The results also highlighted factors that enhance and hinder the smooth delivery of care. This paper details the factors that influence the delivery of care from the perspectives of nursing staff and makes recommendations to enhance the delivery of patient care using a team-nursing approach.

Fall risk factors and the nature of falls in inpatient oncology and palliative care settings

Abstract Using a prospective design, this study examined falls risk factors and the nature of patient falls in oncology and palliative care settings. Two hundred and twenty seven patients admitted to the oncology and palliative care units at a private hospital participated in this study. Of these, 34 patients had a fall and 193 patients did not have a fall.Twenty–four nurses who attended to patients who fell were interviewed. Findings revealed that, when compared to patients who did not fall, fallers had a significantly higher mean age; were assessed as more physically dependent using the Eastern Cooperative Oncology Group scale; were less alert and more confused; were more likely to have responded incorrectly to orientation to person, time and place; were weaker pre-fall in arm muscle strength; and were more fatigued. These factors are worthy of further exploration to determine whether they are more sensitive than the currently used falls risk factors used in oncology and palliative care settings.

Women's explanations for urinary incontinence, their management strategies, and their quality of life during the postpartum period

PURPOSE Although pregnancy is a risk factor for urinary incontinence (UI), minimal information is available to help clinicians understand postpartum womens experiences of UI. Our aim was to explore postnatal womens explanations for UI, strategies for managing and dealing with UI, rationale for not doing anything about UI, and its influence on their quality of life. DESIGN Cross-sectional survey. SUBJECTS AND SETTING The participants were 75 women who had given birth to live children at Viborg Hospital in Denmark during a 3-month period from November 2002 to January 2003 and who had experienced UI since giving birth. METHODS UI questionnaires were mailed to women who had given birth at Viborg Hospital during a 3-month period. The questionnaire included the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and the General Continence Questionnaire. A follow-up letter was sent to potential participants 2 weeks after the initial mailing. RESULTS The most frequently reported lower urinary tract symptoms were small amounts of urine leakage (59%) and leakage related to physical activity, coughing, or sneezing (55%). Half the women reporting these symptoms indicated that they were moderately or greatly bothered by them. Living with UI affected the willingness of some women to go to places where they were unsure about the availability of toilets (27%), as well as the way in which they dressed (31%). Some women reported diminished ability to have sexual relations (23%) and reduced involvement in physical and recreational activities (23%). UI was associated with feelings of frustration (25%) and embarrassment (25%). Most participants (76%) perceived that they had become incontinent due to weakened pelvic floor muscles and because they had not performed sufficient pelvic floor muscle exercises. The most common management strategies for UI were more frequent toileting (64%) and pad use (56%). Some women (24%) reported that they had done nothing about their UI. CONCLUSION Given the profound impact UI usually exerts on the lives of postpartum women and the common use of ineffective management strategies, healthcare clinicians need to actively screen for and treat this condition.

Practice development: what is it and why should we be doing it?

It is increasingly fashionable in nursing to refer to practice development (PD), a concept that is poorly defined, little questioned and seems to have an evangelical following, especially in the UK and Australia. But what exactly is it and is it a legitimate academic activity? According to the website of the Royal College of Nursing (RCN) in the UK, PD is “… an approach that helps you, your team and organisation to provide care that patients feel is right for them”. There is no indication on this site as to whether this statement is based on opinion or on actual research findings. There are questions about the claims of this activity to contribute to patient care and improve patient outcomes in a sustainable way (Atsalos et al., 2007 C. Atsalos, L. O’Brien and D. Jackson, Against the odds: experiences of nurse leaders in Clinical Development Units (Nursing) in Australia, Journal of Advanced Nursing 58 (2007), pp. 576–584. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (2)Atsalos et al., 2007). Another issue that deserves professional attention is the question of how this vague and ill defined activity links with the multidisciplinary team, the shared language used by the team and the explicit understanding of nursing’s contribution to patient care. Copyright

Professional nursing governance in a large Australian health service

Abstract Background: Professional nursing governance refers to the processes and structures that influence nursing practice within an organisation. This study measured the effect of structured meeting communication processes on nurses’ perceptions of professional governance. Method: The intervention was implemented in eight hospital wards. After 3 months, nurses on the intervention wards and eight matched-control wards completed the Index of Professional Nursing Governance (N = 225). Data were compared with a sample of Magnet® (N = 3) and non-Magnet (N = 46) hospitals. Results: There was substantial variation in nurses’ perceptions of governance across the 16 wards, irrespective of the intervention. Compared to non-Magnet hospitals, the overall score and three of the six subscales scores were higher in this study. Magnet hospitals scores, however, were typically higher suggesting greater progress towards shared governance. Conclusions: Professional nursing governance can be highly variable across individual wards and tailored interventions should be considered.

Selecting the right integration of research into practice strategy

Healthcare professionals need to be cognizant of integration of research into practice literature to advance clinical practice. This article describes the strengths and limitations associated with 10 currently used integration of research into practice strategies and the issues that need to be considered when selecting an appropriate strategy. Selecting the right strategy that ensures the uptake of best available evidence is an essential component of developing evidence-based practice and ultimately improving patient care.

The challenges acute care nurse unit managers face and the strategies they use to address them: Perceptions of directors of nursing and nurse unit managers

The aim of this study was to investigate the challenges that nurse unit managers (NUMs) face while working in acute care settings, the strategies they use to deal with these challenges, and the effectiveness of these strategies from the perspectives of NUMs and their supervisors. NUMs (N = 22) and directors of nursing (N = 3) were interviewed for this study. Thematic analysis revealed 14 challenges relating primarily to NUMs interactions with others, both within and outside of their wards/units. These challenges related to the managerial, but not clinical, aspects of their roles; 16 strategies for managing these challenges were identified, the effectiveness of which seemed dependent on how well they were executed. The strategies are: seeking assistance and support; trial and error; satisficing; taking responsibility for own professional development; scheduling of time; working longer hours; delegation; adaptive staffing and rostering; being a visible presence on the ward; team development; facilitating professional development for staff; being available for staff; negotiation and collaboration; communication; working with the processes of a large organisation; and complying with the demands of others, The findings make a strong case for NUMs to be supported in undertaking comprehensive management education.

Team Clinical Supervision in Acute Hospital Wards A Feasibility Study

Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- (n = 36) and postintervention (n = 27), and focus groups (n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.