Continuum of Care
Antonia Smith Christian Brothers University
NURS 405: Global Health Nursing
Instructor: Dr. Burnett
November 16, 2016
Continuum of Care Nursing is a profession of compassion and healing. Nurses are subjected to compassion fatigue, burnout, high stress, and moral distress. Many nurses work 12-hour shifts within a facility with staffing shortages and are determined to balance work with multiple aspects of life outside of work. Under stress, over worked, and minimally assisted, nurses are vulnerable to making mistakes that could lead to death. “The Institute of Medicine reported that communication failures account for most adverse outcomes in hospitals” (Margo, 2013). This paper will discuss increasing patient safety and closing the gap in communication by adding RN staff huddle to bedside shift report. For patients in an ICU, how does RN staff huddle plus bedside shift report compare to bedside shift report alone, in relation to staff knowledge of all patients on the unit to result in increased patient safety during a 12-hour shift?
“Historically, nurses have provided patient information to the oncoming nursing staff to ensure the continuity of care (Chaboyer et al., 2009)” (Maxson, Derby, Wrobleski, & Foss, 2012, p.140). In that era of nursing, shift report also consisted of audio tapes, written reports, and the nurse in charge informing the oncoming nursing staff of their patient assignments. Shift report has
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The Mental Health Unit engages in phone reporting, which is something that I have never done before. As you are not face to face with another nurse in phone reporting, it is crucial to provide the on-coming nurse with all of the necessary information regarding their new patient(s) as they will not be able to ask any questions, that is if they have any. Therefore, in order to meet this long-term goal, I will observe my co-caring nurse as he or she is giving report, write out what I would like to say in report and go over it with him or her, and ensure that he or she is beside me while giving report in case I forget something or there is something that should be added in. As developing this skill could take some time, I trust that I will be able to improve my skills associated with end of shift report by the end of this clinical
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
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.
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.
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,
Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, eating, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. Long-term care can be given at any age depending on
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
Unlike physicians who spend approximately 30 to 45 minutes per day with a patient, the presence of nurses at the bedside is essential throughout the day. Apart from attending the patients, they regularly interact with families of the sick and other healthcare practitioners, such as physicians and pharmacists. Given their constant presence at the bedside, nurses play a critical role in maintaining patient safety by continuously observing patients for deterioration or improvement of health. They also help in the detection of medical errors, identification of near misses, and discovery of weaknesses that might be inherent in some systems (“Nursing and Patient Safety,” 2017). Since the role of nurses is crucial to the maintenance of patient safety, it is logical that increasing their workload is bound to adversely affect their ability to deliver quality work and safe services.
Errors pervade in our lives whether it is our home, in our workplace, or in our society. The effects of healthcare errors have impacted all our lives either directly or indirectly. Patient safety and quality care are at the core of healthcare system which strongly depends upon nurses. “To achieve goals in patient safety and quality, thereby improve healthcare, nurses must assume the leadership role. Nurses need to ensure that they and other healthcare providers center healthcare on patients and their families. Even though the quality and safety of healthcare is heavily influenced by the complex nature
A nurse’s typical day isn’t without stress; it is usually a lot of complex planning, critical thinking, time management, an abundance of communications with all departments of the hospital, and documenting events that have happened throughout the day on their entire patient assignment. “Nurses who are mandated following the completion of their regular shift are often ill-equipped to continue working. They have not planned for that situation with: proper advanced rest, arrangements for
End of shift reports in this unit are often taken place at the central nursing station, at nurses’ lunch room, or at the medicine room. Although JCAHO has defined bedside shift report as one of the strategies to encroach patient satisfaction (Guide to Patient and Family Engagement in Hospital Quality and Safety, 2013), many nurses are still reluctant to this methods for many reasons. It seems as the cynicism of the implementation is still exceedingly high. Many argue that the implementation is non-beneficial and outweigh the cost. These include the longer time they spend in the report, the unavailability of the patient (e.g. confused, comatose patient), the confidentiality and privacy (e.g. visitors in the room), nervousness in front of the
Various revolutionary changes are occurring in the nursing profession thereby indicating that the practice of nursing is expected to transform in the coming years. Available literature shows that nurses are likely to modify how they handle various aspects of nursing care. Regarding the continuum of care, Keller et al. (2017) ascertain that nurses have been managing patients at different stages in their lives. However, nurses did not implement adequate follow-up in the past. Therefore, in future, focus on preventive care rather than curative care is likely to improve the way nurses care for patients from childhood to adulthood thus enhancing the continuum of care. About the nurse-managed health clinics, previously, nurses did not find opportunities to practice independently (Sutter-Barrett, Sutter-Dalrymple, & Dickman, 2015). However, currently, a growing number of committed nurses are providing quality health services to vulnerable communities, which indicates that they are filling a gap that existed in the healthcare industry (Sutter-Barrett et al., 2015). Information from these two research studies shows that increased commitment to preventative care will lead to the need for more nursing professionals to promote health and prevent illness across life spans.