Running head: LAYING THE FOUNDATION

LAYING THE FOUNDATION

Laying the Foundation for New Approaches to Practice

Walden University

Kim Hecker

Evidence Based Practice Issue: Resistance in using bedside handoffs. in units in which the institution has established this the standard. A group of nurses at the practicum site are refusing to adopt bedside handoffs.

Science underlying practices

Change of shift handoffs have been moved to the bedside. This practice implemented based on evidence proclaiming a decrease in errors in information exchange. Patients are encouraged to ask questions and correct any information not accurate. Publication of bedside handoffs range from 2009 to 2013 (Mardis, et al., 2016).

The Joint Commission identified as a key factor in serious adverse events causing preventable harm to patients. Nursing shift handoffs are known to be a high-risk window of time for sentinel incidents (Australian Medical Association, 2006; American Hospital Association, 2014). The Joint Commission (2015) estimated 80 % of significant medical errors is due to miscommunication during handoffs and transfers. Bedside handoffs offer patients an opportunity to participate in their healthcare, provide another set of ears to catch any misinformation being passed and it decreases method does not leave the patient alone too long and improve patient satisfaction scores (Wakefield, Ragan, Brandt & Tregnago, 2012; Mardis, et al, 2016). Bedside shift handoffs improve patient involvement and satisfaction, in turn increases patient satisfaction scores (McMurray, et al., 2011).

Possible causes of the difference in outcomes from what would be expected according to the research literature.

Nurse managers identified several bedside handoffs process issues, the loss of being open and straightforward in the nurse-to-nurse communication. Uncomfortable with interpersonal communication due to a lack of training, and poor understanding of HIPAA communication protocols. Because of these issues bedside handoff was believed to be stressful and there seemed to be uncomfortable with coworker’s feedback, resulted in staff using any excuse not to perform bedside handoffs (Mardis, et al., 2016).

Negative attitudes affect practice outcomes. Veteran nurses tend to have a difficult time adjusting to new methods and may influence newer nurses. Anticipating negative reactions can help neutralize them before the entire unit is tainted with negativism (Wakefield, Ragan, Brandt & Tregnago, 2012). Concerns about Health Insurance Portability and Accountability Act (HIPAA) a breach of privacy a significant concern (Wakefield, et al.). Worried the bedside handoff could increase the anxiety, especially if they don’t understand the medical terminology used by the nurses. Senior leadership had not given this implementation as high of a priority as other projects. Hospitals with strong leadership support and focus on staff buy-ins were successful in implementing the practice change. The hospitals transparent and honest in the possible issues upfront were more likely to succeed. Hospitals with little leadership support, decreased staff buy-ins, and high turnover were not as successful (Natafgi, Xi Zbu, Baloh, Vellinga, Vaughn, & Ward, 2017).

Organizations are continually attempting to practice the latest evidence-based practice in a quickly evolving environment. Nurses tend to feel like they are a pond in a chess game, if nurses are not included in the implementation process of changes they could resist the process. A change in senior leadership strategies and more of a consistent methodology to bedside handoffs will improve nurse compliance (Schiedenhelm, 2017).

Summary

The framework to reintroduce bedside handoff will be Peplau’s theory of interpersonal relations and Lewin’s theory of planned change. Peplau’s theory establishes a therapeutic relationship between the nurse and patient (Nyström, M. (2007). Lewin’s framework has three phases: the unfreezing, moving and refreezing so staff can be involved and instructed by leadership about the problems related to the process of change (Hussain, Lei, Akram, Haider, Hussain, & Ali, 2016).

Training, planning and gradual implementation of the new practice. Sharing the potential barriers to staff and maintaining transparency showed to have better long term outcomes. (Wakefield, Ragan, Brandt & Tregnago, 2012). A survey for nurses designed to measure their perception of bedside handoffs, the pros and cons. The survey identified barriers, another study to identify the strengths and weaknesses of the current state of bedside handoffs. Also assess the organizations readiness to support a culture of transparency and a culture of nonpuniative approach to error. Lewin’s change theory will help embed the bedside handoffs.

During the unfreezing phase, super-users (SU)present the evidence supporting the change, addressing the employee barriers and reeducate the nurses on the influence of bedside handoffs on patient satisfaction, decrease report time, decrease in hand off errors and miscommunication. Work in groups to closely acknowledge any feedback in the unfreezing stage. Next is the moving phase, SU help the implementation by working closely with their group. The SU will monitor the nurses while the bedside handoff is being conducted, they will then mentor and support them in any way to make the transition smooth.

References

Australian Medical Association. Safe handover: safe patients. AMA Clinical Handover Guide. AMA, Sydney, 2006. Available from: http://ama.com.au/node

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2016). Conceptual paper: Kurt Lewin’s process model for organizational change: The role of leadership and employee involvement: A critical review. Journal Of Innovation & Knowledge, doi:10.1016/j.jik.2016.07.002

McMurray A., Chaboyer, W., Wallis M., & Fetherston, C. (2010). Implementing bedside handover: Strategies for change management. Journal of Clinical Nursing, 19,(17-18) pp. 2580-2589.

Mardis, T., Mardis, M., Davis, J., Justice, E., Riley H., Donnelly, J., Ragozine-Bush, H., & Riesenberg, L., (2016, January/March) Bedside shift-to-shift handoffs: A systematic review of the literature. Journal of Nursing Care Quality, 31(1), pp. 54-60. Retrieved from Walden University Library

Nyström, M. (2007). A patient-oriented perspective in existential issues: a theoretical argument for applying Peplau’s interpersonal relation model in healthcare science and practice. Scandinavian Journal of Caring Sciences, 21(2), 282-288

Scheidenhelm, S., & Reitz, O.E. (2017). Hardwiring bedside shift report. Journal of Nursing Administration, 47(3), pp. 147-153. DOI: 10.1097/NNA.0000000000000457

Wakefield, D.S., Ragan, R. Brandt, J. & Tregnago, M., (2012). Making the transition to nursing bedside shift reports. The Joint Commission Journal on Quality and Patient Safety, 38(6), pp. 243 -253. Retrieved from Walden University Library