Making bedside handovers work for patients and staff

Good communication during handovers is an important aspect of nursing practice and there is growing acceptance that patients can and should be involved. But does bringing the handover to the bedside result in better care?

Good communication during handovers is an important aspect of nursing practice and there is growing acceptance that patients can and should be involved. But does bringing the handover to the bedside result in better care?

Picture: iStock

‘A handover is one of those nursing rituals that seems to work very differently depending on the ward and the person who is doing it,’ says Christine Norton, professor of nursing at the Florence Nightingale Faculty of Nursing and Midwifery, King’s College London.

Professor Norton was involved in research looking at the patient and staff experiences of various kinds of nurse handovers – including office-based and bedside – that was published in April 2016.

‘What we found was a mixed bag,’ she says. ‘We saw some very good practice, with caring and empathetic nurses, but others were doing a handover at the bedside without involving the patient at all.

Helen Ballantyne: Bedside
handovers give patients more
awareness of nurses’ knowledge,
competence and professionalism

‘We even had the odd time when a handover was done at the end of the bed, with two nurses who had their backs to the patient and were huddled over the notes. If you’re going to do that, you may as well do it in the office.’

Individual treatment

But when bedside handovers worked well she witnessed clear benefits. ‘For staff, if you have a handover in the office, it’s much harder to visualise the patient,’ says Professor Norton.

Patients feel reassured if they think that team members are communicating properly, sharing information about the care they are giving. ‘They want to be treated as individuals, and to feel confident that they’re not just “bed 23” but a real person with things that staff need to know about them,’ she says.

‘In these days of high turnover it’s very easy to feel that you’re just being shunted through and out the other end, without anyone knowing who you are and what’s important to you.’

Research also shows that patients involved in bedside handovers have an increased awareness of nurses’ knowledge, competence and professionalism, says high dependency nurse Helen Ballantyne, whose continuing professional development article on the topic was published in Nursing Standard last year.

‘There’s a lot of evidence to show that patients have a better experience, but this was an unexpected result,’ she says. ‘Hopefully it helps to push the profession forwards, with the public understanding more about our level of responsibility.’

'Bedside handovers save us time. You’re more focused on the key facts and what’s important'

Jade Caslin, deputy ward manager

Preserving patient confidentiality was a recurrent concern about bedside handovers for many nursing staff. Professor Norton says: ‘Conversations are fine in a side room, but in a bay it’s inevitable that others may overhear what’s being discussed.’

Among the difficulties is managing bedside handovers that coincide with visiting times. Staff need to decide whether they’re going to use the handover to give relatives information or see them separately, she says.

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They also need to find out who the visitors are and how comfortable the patient might be to have potentially private discussions in front of them.

Built on trust

Staff may also be unclear about the level of information that needs to be handed over, says Professor Norton. The research found that some handovers were extremely comprehensive, going back to the reasons for admission, while others were simply about what needed to happen during the next shift.

Christine Norton: handovers work
best when underpinned by good
working relationships

Overall, the researchers found these handovers worked best when underpinned by good working relationships, built on trust. ‘The nurses need to understand what each other needs to know,’ she says. ‘It need not be a uniform process and what's included should partly be up to a nurse’s discretion – but perhaps not to the extent that happens now, when it is so variable and depends on the individual.’

Last spring, nursing staff introduced bedside handovers for patients in the emergency assessment unit at Cumberland Infirmary in Carlisle, part of North Cumbria University Hospitals NHS Trust.

‘We were looking at ways we could improve the patient experience, and communication was highlighted as a difficulty,’ says deputy ward manager Jade Caslin, who helped to get the initiative off the ground. ‘The unit is so busy all the time. Some patients felt they didn’t have the chance to say what they thought.’

While there is a belief among some nurses that bedside handovers can take much longer, staff in Carlisle found the opposite. ‘It actually saves us time,’ says Ms Caslin. ‘You’re more focused on the key facts and what’s important.’

In the past, staff spent an hour going round the ward talking to everyone, before the formal handover took place in the nurses’ office. ‘It was very time-consuming,’ she says.

Patient’s choice

Now handovers are done at visiting time, once patients have been consulted. ‘We ask them before we do it and most are very happy for it to happen in this way,’ says Ms Caslin.

‘They find it beneficial, both for them and their relatives. Patients don’t always understand the jargon that some doctors use, so it’s good for them to hear what the plan is from the nurses. There is the occasional person who doesn’t want their handover done this way, so we do it differently for them. It’s their choice.’

‘The patients think it’s great that they’re involved in their care and it gives them an opportunity to ask questions and understand much more’

Jade Caslin, deputy ward manager

Bedside handovers give staff the time to develop an initial rapport with the patient, says Ms Caslin. ‘You meet each other when you start your shift.’

Gaining involvement from relatives is another plus. ‘We explain to them what we’re going to do and that they are more than welcome to listen and ask questions,’ she says.

‘They have the chance to correct any information too. Sometimes a patient has been admitted during the night and may be feeling unwell or have dementia. We can’t always get a full history, so the family can tell us more about them. I think it makes us safer on the ward, because we have all the information we need and it’s fully up to date.’

Staff outline the patient’s condition and the care plan, also looking at other issues such as mobility and any dietary needs.

Families want to know

Involving families can help in discharge planning too. ‘If relatives want to ask questions we just take our time with them,’ says Ms Caslin. ‘You need to understand that patients and their families are concerned. Even if we weren’t doing a handover at the bedside, they would still want to know this information.’

In the past, relatives with queries had to find the staff member, then often wait while they completed other important tasks, such as medication rounds. ‘We find this helps to prevent those frustrations,’ she says.

Picture: iStock

Ms Caslin admits that initially some nursing staff found the change challenging. The team sought feedback on how it was working and made sure they were always on hand to advise if nurses felt unsure, especially on issues of confidentiality.

‘We helped them think about how to handle situations where patients may not want some information disclosed, and to look at what it’s appropriate to say.’

Benefits outweigh disadvantages

The information for handovers is also printed. ‘It means you don’t need to go into all the detail because it’s written down,’ says Ms Caslin. ‘It helps you to avoid talking about anything too sensitive that the patient may not want you to say in front of others. Whenever we feel something should be discussed privately that’s what we do.’

Overall, she believes that the benefits far outweigh any small disadvantages. ‘The patients think it’s great that they’re involved in their care and it gives them an opportunity to ask questions and understand much more,’ says Ms Caslin.

‘Sometimes they can feel so overwhelmed with the amount of information they’ve been given that it’s really reassuring to have someone else to help them go through it, and tell them what’s happening. The more we can involve patients and their relatives the better.’

How to ensure a good bedside handover

  • Explain to patients what you plan to do and ask if they are happy. ‘Give them a choice,’ says Ms Caslin. ‘Sometimes people don’t like it, so you do it differently’
  • Avoid second-guessing what you think patients will want. ‘We need to be conscious that in our patient-centred approach we’re not simply assuming patients want to be involved,’ says Ms Ballantyne. ‘Make sure the handover is geared towards them. We’re the ones at the bedside and have the responsibility to say no, this person doesn’t want to know that information’
  • Ensure patients and relatives are properly involved, if they want to be, with the chance to ask questions. ‘The last thing you want to do is stand and talk over them,’ says Ms Caslin. ‘It needs everyone’s involvement to work’
  • Beware of using jargon and abbreviations that could confuse patients and their loved ones. ‘It’s frustrating for them to hear a lot of medical terms and not know what they mean,’ says Ms Caslin. ‘We had several families point this out to us at the beginning. It became clear that sometimes the terminology we were using was wrong for our audience. You need to use language they will understand’
  • Tailor the information you’re handing over to each setting, advises Professor Norton. For example, in an acute admissions ward, staff may need greater detail, as there is more uncertainty about the patient’s diagnosis and treatment

Lynne Pearce is a freelance health journalist


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