Bedside Nurse Miscommunication

In every profession there are changes that propel how tasks are done; nursing is no stranger to this. One of the biggest changes that have come into nursing’s daily events is how report hand-offs are being done. Gone are the days of taped report that each off going nurse must tape about each patient and the oncoming nurse must listen to. Nurses are now being encouraged to move their report to the bedside, in front of the patient (Trossman, 2007). It is very important to know how this can affect the patient and even the nurse’s schedule. With every change, there are positives and negatives that can finalize the decision to keep or forego

End of shift reports between nurses has been an important process in clinical nursing practice. Allowing nurses to exchange vital patient information to ensure continuity of care and patient safety. Therefore, the chance of potential communication gaps causing an error is high. According to the Joint Commission, communication is the primary cause of medical errors, with handoffs accounting for 80% of these errors [ (Zhani, 2012) ]. The most commonly practiced model of report takes place in the staff room, at the nurses’ station, or other locations away

The hand over process of communication between nurses to nurses is done with the intention of transferring essential information for safe, and patient centered care. Traditionally, this shift report has been done away from the patient’s bedside, at the nurse’s station, or other place like staff’s room. In addition, the shift report used to be delivered through audio recording of the patient’s information. These reporting mechanisms did not include face-to-face reporting of the patient information, nor involvement of patient. Therefore, information regarding the patient’s care was not shared with the patient, leaving them out of his/her own care plan. Recent studies and development of Patient Centered Care Philosophy have challenged this belief of giving a report away from the patient. Tan (2015) said, “Shift report must not only be restricted in nurse to nurse communication, but it must involve patients as the recipients of care” (p. 1). Incorporating the patient into the end of shift report is essential for providing patient centered care and patient satisfaction. Nurses at the St Jude Medical center in the acute in-patient rehabilitation unit are not exceptional. Most of the end of the shift report between nurses are still done away from the patient. Aim of this paper is to make a change in the work place, which is the process of giving end of shift report at the bedside incorporating patient and families in the acute in-patient rehabilitation unit at St Jude Medical

Effective communication is crucial aspect of nursing yet too often is placed low on the priority list, especially at shift change. Information related to the care of patients is frequently disseminated at a crowded, noisy nurse station with several nurses rushing to leave and others attempting to get the information necessary to plan care and limit the constant distractions. It is this interaction that allows for information vital patient safety information to be communicated including the acuity of patients.

Bedside reporting has the primary function of sharing patient information between nurses, as they change shifts. The nurse ending their shift would report all the changes that have occurred in the state of the patient and all measures which have been taken for the respective patient. This information would be transmitted to the nurse commencing her shift, who would then write and further transmit all patient information occurring during their shift, to the nurse coming to replace them.

Traditionally, nursing shift-to-shift reports were organized methods of communication between only the oncoming and leaving nurse, designated to a location such as the central nursing station or nook of a hallway. Shift reports can be considered the foundation of how the day is going to plan out because it introduces the patient, diagnoses, complications, medications, consults, upcoming test and the entire plan of care. These reports are full of complicated and vital information and while set in certain locations that are vulnerable to interruptions, such as the nursing station, medical errors and miscommunication are more likely to be made. The Joint Commission’s 2009 and 2010 National Patient Safety Goals (Joint Commission, 2015) included two patient safety standards, first to encourage patients to be involved in their health care plan and second, to implement a standardized communication process for handoff reports between providers. Soon after in 2013, The Agency for Healthcare Research and Quality under the United States Department of Health and Human Services introduced a set of strategies to improve patient engagement along with safety and quality in patient care. Within these strategies the new method of nurse bedside shift report was developed, which suggests nurses to conduct shift-to-shift reports at bedside in the room of each patient, rather than out of the room. The benefits of this new method were

Traditionally nurses delivered clinical information about the patient, the clinical events on their shift and the plan of care to the oncoming shift to ensure continuity of care and to make sure that their colleagues were informed about tasks or instructions that needed to be completed by the next shift. This process had a variety of names; report, handover or handoff. The format was often different from unit to unit. It usually took place in an off stage room or office or at a charting station from away from the

Bedside reporting involves giving information or a report to the oncoming nurse in the presence of a patient. This method gives the patient an opportunity to ask questions and get clarification regarding his or her care. Bedside reporting increases patient satisfaction, quality of healthcare and nurse-to-nurse responsibility. Hospitals need to design a better handoff process that can easily reduce patient risks and increase patients’ involvement in their care. Emergency rooms shift reports usually take place at the nursing station of every patient care area. The departing nurse gives information verbally to the oncoming shift. Therefore,

Change of shift in the nursing profession is unique (Caruso, 2007). Information is transferred between nurses verbally and through written communication. In many facilities shift report from one shift to another involved sitting down and getting all your orders from a caredex and then talking with the previous nurse face to face going over pertinent information regarding their patients. This type of report usually happens in a report room or sometimes in the hallways or other common

For many places, this includes doing the handoff communication at the bedside of the patient so that the incoming and outcoming nurses as well as the patient are part of the process (Yoost & Crawford, 2016). Doing the shift handoff at the bedside can be safer for the patient because not only can the patient contribute to what the nurses are saying, the nurses can also catch any errors that may arise (Groves, Manges, & Scott-Cawiezell, 2016). It can also prevent, or at least decrease the chance a nurse stating information about the wrong patient or confusing patients with one another (Groves, Manges, & Scott-Cawiezell, 2016). Bedside report also allows the incoming nurse to get a good idea of what to expect with that patient. This is because not only does the nurse get to hear the information from the outgoing nurse, but the nurse also gets to see the patient firsthand (Maxson, Derby, Wrobleski, & Foss, 2012). Having the patient in the room as well allows them to ask any questions that they might have. This allows everyone to understand what is going on with the care of the

The time nurses collaborate and share information with other nurses, med techs, and CNAs coming on duty for the following shift is called the shift report. This notifies all staff on duty of what is required of them on this shift and what happened previously on the latest shift. Shift report is also a time to communicate any observation, ideas, and thoughts concerning the patients. CNAs spend the majority of time with the residents and usually are the first to notice even subtle of changes in the residents under their care. Changes in urinary and bowel continence, appetite, behavior, mood, and sleeping habits are first seen by the CNA. Effective communicate is necessary not only for a healthy work environment but also for the betterment of the patient’s health. Having the ability to communicate observations openly with the nurse is necessary in certifying the residents are getting the best care possible.

Handoffs during shift change between nurses is one of the most important ways to communicate essential information related to the patients’ care and their safety. This is an evidence-based practice that improves communication among nurses and patients since the handoffs are conducted at the patients’ bedside, face-to-face, with the computer using SBAR. The patients are involved in the update of their care with the incoming nurse, enabling them to share concerns and to add valuable information, which increases patients’ satisfaction. Additionally, during the handoffs, the nurses with the patients are able to review and update the patients’ white board with the goals, activities, procedures, labs, consults, and symptom management for the incoming

Gone are the days of taped change of shift reports or written communications between nurses for hand off. The Centers for Medicare and Medicaid (CMM) have recently linked quality of care to payments. The hospital value-based purchasing program now adjusts the reimbursement hospitals receive on several key concepts including the patient experience. Patient satisfaction accounts for 30% of the total performance scores (Centers for Medicare & Medicaid Services [CMM], 2015). General medicine consistently receives low scores on communication with patients. The purpose of this paper is to find solutions to the patient perceived lack of communication by reviewing the current process of bedside reporting during shift changes and find the appropriate change theory to reverse the current findings.

The bedside shift-to-shift communication in relation to the CNO/RNAO did not address our research question directly but it can be related to the accountability CNO professional standard, “providing, facilitating and promoting the best possible care for client” (CNO, p. 4). The nurse is responsible to hand off his/her patient to the next nurse appropriately and the incoming nurse is accountable to learn as much as many information she/he can get from the previous nurse before providing care to the patient to promote pt. safety and enhance his or her care. I’m currently at North York Gen. hospital and we’ve learned that bedside-shift communication is in their policy, as a matter of fact they have four ways of pt. transferring; written, electronic,

Bedside report defined by Ferguson and Howell (2015) termed the method as transfer of vital patient information from one nurse to the next nurse during a report that allowed “an opportunity to ask questions, clarify and confirm” (p. 736). The increase communication and accountability established during report lead to effective communication and better patient outcomes. Patients feel satisfied because they are more aware of their caregiver and included in their plan of care. Visualization of the patient during shift report improves risk management, creating patient safety related to falls, medication errors, and identifying patient issues (Maxson et al., 2012, p. 144).