Sonja Cleary

'Being in the know': Nurses' perspectives on the role of 'end-of-shift' verbal handover

Aim: To explore and qualitatively review ‘end-of-shift’ verbal communication practices and processes; and to further develop a core theoretical construction of nurses’ perspectives on handover in contemporary Australian clinical settings. Method: The following study will report the results from phase 1 of a two-phase study examining the Australian nurses perspective of verbal handover. The data were gathered over a 2-month period in 2013 for phase 1 of the study. Phase 1 of the research was undertaken using Strauss and Corbins Grounded Theory methodology, to explore the perceptions of verbal handover by acute care nurses. The participants included 41 registered nurses purposively sampled from acute care surgical and medical backgrounds in a metropolitan hospital in Melbourne, Australia. Data were collected using intensive interviewing techniques in six focus groups with an average of seven members in each group. The data were then coded and analyzed concurrently allowing the categorization of core concepts. Results: Communication proved to be the underlying core concept with linked themes such as mode of handover, relevance of information, professional roles of nursing, duty of care, timeliness and scope of practice. Conclusion: Communication during handover time must be tailored to support the oncoming nurse in preparing for the shift ahead. To do this effectively, information shared must be relevant and fashioned in such a way that the oncoming nurse can prioritize patient care needs while ensuring adherence to their scope of practice. This Grounded Theory has helped toward the reconceptualization of verbal handover, one that attempts to enhance current end-of-shift communication practices and processes, thereby optimizing clinical outcomes.

Clinical governance breakdown: Australian cases of wilful blindness and whistleblowing

Background: After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to ‘blow the whistle’. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. Objective: To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia. Research design: Critical case study methodology using Fay’s Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. Ethical considerations: Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. Findings: Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a ‘social crisis’ in the organisation and to whistleblowing. Conclusion: Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers’ awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.