Lincoln University College, Wisma Lincoln, No. 12-18, Jalan SS 6/12, 47301 Petaling Jaya, Selangor Darul Ehsan, Malaysia
*Corresponding Author’s Email: asgaing@yahoo.com
Keywords: Clinical Hand Over, Effective Teamwork, Healthcare, Nursing Practice
Once considered the primary concern in healthcare (Clapper & Ching, 2020), communication now recognizes itself as just one of many significant challenges. Recent research emphasizes the importance of accountability (Curtis et al., 2020), conflict management (Fernández Castillo, Khalid & Salas, 2024); Keller et al., 2020), decision-making (Papermaster & Champion, 2021), and fostering progress through reflection and coaching (Zajac et al., 2021) within healthcare teams. These findings suggest that while communication remains crucial, it's imperative to take a holistic approach to competencies within healthcare teams, including handing over practices.
Handing over nursing practices is a critical component of effective teamwork and patient care delivery. These practices encompass the exchange of crucial information and responsibilities among healthcare providers, typically occurring during shift changes, patient transfers, or transitions between care settings. Kim & Seomun (2020). A comprehensive handover involves sharing pertinent details about the patient's condition, ongoing treatments, medications, vital signs, and any recent changes in their health status. This information exchange ensures continuity of care (Wong et al., 2019), allowing incoming nurses to seamlessly pick up where the outgoing nurse left off, thereby minimizing disruptions in patient care (Nzele & Sekinat, 2023).
Effective handing-over practices also promote clear and concise communication among team members, fostering a collaborative environment where every healthcare professional is well- informed and engaged in the patient's care plan (Harris et al., 2019). By sharing insights, observations, and concerns during handoffs, nurses can collectively address potential issues, identify changes in patient status, and coordinate care interventions more efficiently. This collaborative approach not only enhances patient safety but also improves clinical outcomes by minimizing the risk of errors or oversights (Wong et al., 2019; Kim & Seomun, 2020).
Moreover, handing over practices plays a crucial role in promoting accountability within the healthcare team (Wong et al., 2019). Nurses hold each other accountable for the care provided by documenting and communicating important information during handoffs, ensuring that all relevant parties are aware of the patient's needs and treatment plan. This accountability fosters a sense of responsibility and ownership among team members, leading to better coordination and follow-through on patient care tasks (Kim & Seomun, 2020). Additionally, effective handing-over practices contribute to a culture of continuous learning and improvement within the healthcare team. Through reflective handover sessions, nurses have the opportunity to discuss challenges encountered during patient care, share best practices, and brainstorm strategies for enhancing care delivery. This reflective process not only strengthens teamwork, but also promotes professional growth and development among team members.
In essence, handover practices in nursing are vital for promoting effective teamwork, ensuring patient safety, and delivering high-quality care (Poelen, Van Kuppenveld & Persoon, 2023). By facilitating communication, promoting accountability, and fostering a culture of continuous improvement, these practices play a central role in optimizing patient outcomes and enhancing the overall quality of healthcare delivery.
Effective communication is vital in healthcare to ensure high-quality care and prevent adverse outcomes (Ratna, 2019). Breakdowns in communication can lead to medication errors and treatment delays, even patient harm, or fatalities (Manias et al., 2021). Poor communication within healthcare teams is a major cause of adverse events (Arnold & Boggs, 2019). Maintaining high communication standards is essential for patient safety. Understanding communication complexities in healthcare is key to assessing their impact on adverse events.
Furthermore, effective communication and patient information transfer during shift handovers are critical for safe healthcare (Tabalan, 2016). Formal handover procedures in clinical settings help exchange crucial information among providers during shifts. Implementing strong handover processes is crucial for safe healthcare practices, as inadequate information transfer during handover can harm patients.
During transitional phases or handovers between different stages of the treatment process, healthcare professionals or teams transfer the written documentation regarding patient care to one another (Yahalom & Manias, 2024). Healthcare records play a dual role, not just documenting past events but also actively shaping future treatments and outcomes through collaboration (Harvey & Koteyko, 2012). Over time, these records undergo continuous adjustments to align with evolving patient needs. Documents facilitating patient transitions between clinical settings are particularly vital for maintaining care quality and continuity (Munchhof et al., 2020). Nurses rely on precise documentation to plan and execute patient care effectively (Cooper et al., 2021). According to Scaioli et al. (2020), there is significant variation in the quality of these documents, especially concerning their content and overall quality, as highlighted by Sajan, Haeusler & Parrish (2020).
Healthcare professionals transfer written documentation of patient care during transitional phases or handovers (Yahalom & Manias, 2024). These records serve to document past events and shape future treatments through collaboration (Harvey & Koteyko, 2012), continuously adapting to evolving patient needs. Documents facilitating patient transitions between settings are crucial for maintaining care quality and continuity (Munchhof et al., 2020). Nurses rely on precise documentation for effective care planning and execution (Cooper et al., 2021). However, there is significant variation in the quality of these documents (Scaioli et al., 2020), particularly in content and overall quality (Sajan, Haeusler & Parrish, 2020).
An organized handover process not only transfers vital patient information but also fosters teamwork among healthcare providers (Smith et al., 2021). Enhanced teamwork during handovers ensures seamless communication and coordination, involving clear communication, active engagement, joint decision-making, shared responsibility, and a seamless care transition (Jones et al., 2022). This teamwork improves patient safety, care coordination, and the overall quality of care delivery. Effective teamwork during handovers enables healthcare professionals to work cohesively towards common goals, leading to improved patient outcomes. Therefore, integrating effective handover practices into teamwork protocols is crucial for optimizing healthcare delivery and promoting patient safety (Johnson et al., 2022).
Teamwork competencies are vital for effective interprofessional care (Paquette et al., 2023). Nursing training emphasizes teaching patient handovers to enhance communication skills within teams and improve patient safety. Incorporating teamwork curricula into education programs can significantly increase nursing students' teamwork competencies (Ross et al., 2021). Effective teamwork may necessitate a comprehensive intervention targeting individual, team, and system-level elements, taking into account intricate social and professional structures (Etherington et al., 2021). Integrating structured learning experiences that emphasize teamwork and communication skills during events such as patient handovers, into healthcare settings is crucial. This approach prepares healthcare professionals to collaborate effectively in interprofessional teams and deliver high-quality patient care (House, Wilmoth & Kitzmiller, 2022).
This study aims to investigate nurses' experiences and perspectives on handover practices and their influence on teamwork within elder care settings, contributing to the design of strategies and protocols that enhance communication and teamwork for better patient care outcomes.
This qualitative, descriptive study utilized semi-structured interviews with nurses and other healthcare professionals involved in handover processes. Data analysis was done using thematic analysis to explore handover practices and their impact on patient care. The participants included Registered Nurses, Nursing Sisters, Staff Nurses, registered caregivers, and Physiotherapists. They were responsible for providing care to elderly individuals attending day care, staying over weekends, or for short-term stays as advised by the clients’ physicians or as required by family caregivers seeking relief from caregiving responsibilities. The scope of care provided encompassed assistance with daily living activities, monitoring vital signs, wound care management, rehabilitation, recreational activities, and escorting services. The research, conducted within a constructivist paradigm, delved into the various interpretations that nurses attributed to their perceptions and experiences of these documents (Pilarska, 2021). The study aimed to elucidate how these interpretations varied across different contexts and their role in fostering teamwork among colleagues.
This study obtained approval and ethical clearance from the Helsinki Declaration (Cantín, 2014). The researcher individually approached potential participants and explained the purpose of the study. The researcher provided nine participants who expressed their willingness to participate with a written consent form to sign, signifying their voluntary participation. Participants were assured of their right to withdraw from the study at any time without needing to provide a reason, and they were informed that their involvement would not affect their caregiving responsibilities. Following each interview, participants were given time for reflection, and confidentiality was strictly maintained throughout the entire process.
Data collection involved conducting narrative interviews based on Mishler's (1995) approach, which offers a systematic method for exploring individuals' life experiences. The interviews were conducted throughout September 2023, following ethical clearance obtained. These interview sessions were held in a designated room at MC Respite. Each interview, conducted individually by the researcher with the support of the Matron In-charge, lasted approximately 60 minutes. To establish rapport and create a comfortable atmosphere, each session began with a warm welcome. The interviews commenced with open-ended questions to prompt participants to share their perspectives, and probing questions were used to encourage comprehensive narratives. All interviews were recorded, transcribed verbatim, and included non-verbal expressions such as pauses, sighs, and smiles.
Thematic analysis, guided by Clarke and Braun's (2013) approach, was utilized for coding and analyzing the data, conducted independently by the researcher. The process involved identifying key themes related to participants' perspectives on effective written documentation and their perceptions of written communication in elder care settings. Responses were meticulously coded manually to identify recurring themes and subthemes. To ensure credibility, transferability, dependability, and confirmability, the study adhered to the fundamental qualitative research principles outlined by Maher (2018). Credibility was established through member checks with participants, allowing them to validate final themes and interpretations. Transferability was addressed by providing a detailed study context and comparing the findings with existing literature. Dependability was ensured by meticulously documenting the study protocol and methods for potential replication. To enhance confirmability and reflexivity, the researcher included memos within transcripts, outlining assumptions, biases, and personal viewpoints. This comprehensive approach helps mitigate the limitations of any single method or data source, resulting in a more robust understanding of the subject under study.
This study obtained approval and ethical clearance from the management of the Private Respite Care Centre, Malaysia with reference number MCR/2023/28 on August 28th, 2023,
The study involved nine participants, including one nursing sister, four staff nurses, three registered caregivers, and one physiotherapist. They ranged in age from 26 to 37 years, and all possessed prior experience in the elderly care setting. Their collective viewpoints confirmed that handover practices do indeed enhance teamwork and accountability. The researcher identified three main themes regarding handover practices. Firstly, it emphasized the significance of objectivity and clarity in records and documentation, stressing the importance of impartial and clearly written handover documents. Secondly, it highlighted the critical need for key information inclusion, emphasizing the necessity of incorporating essential details such as client information and care plans for continuity of care. Lastly, it acknowledged the theme of promotion of understanding and accountability, suggesting that effective documentation promotes clear understanding among healthcare professionals and fosters accountability, ultimately leading to improved patient outcomes.
Participants emphasized three crucial attributes of records and documentation essential for ensuring safe and effective patient care: language and communication, awareness of the audience, and clinical knowledge. These qualities were identified as valuable for informing their work, promoting safety, and fostering teamwork among healthcare professionals.
To ensure the effectiveness of a document, the staff writing it must consider not only the nursing team but also allied health professionals such as therapists, caregivers, and potentially family members who may read it via platforms like WhatsApp group chats…. (P1)
Concise and informative language effectively communicates information that safeguards safety and promotes teamwork among healthcare professionals…. (P3)
When provided with precision, the handover summary ensures the clear and understandable conveying of information, along with an impartial presentation of facts. This enhances comprehension among working colleagues, fostering effective communication and teamwork.
In my opinion, the handover summary clearly delineates the roles and responsibilities of team members. The utilization of medical terminology rendered the document effective, as it facilitated the reader's comprehensive understanding of the clients and their condition ….(P3)
The handover summary incorporates essential details such as monitoring trends of vital signs throughout the 8- or 12-hour shift, specifics of the medication list, including dosage and frequency, and details regarding dressing positioning or nasogastric feeding. Participants stressed the importance of finding a balance in utilizing medical terminology, suggesting that an optimal level of terminology usage, as emphasized by Sajan, Haeusler & Parrish (2020), is crucial for ensuring the document's comprehensibility, as highlighted by Scaioli et al. (2020).
The key information for effective sharing between shifts involves documenting client details, care plans, assessments, interventions, and upcoming tasks, such as the next nasogastric tube (NGT) feeding… (P1)
Documentation of an evidence-based shift-to-shift handover protocol for nurses and healthcare professionals in elder care settings necessitates a systematic strategy concentrated on bolstering communication, teamwork, and accountability, all while adhering to established industry standards. The overarching goal of this structured approach is to streamline information exchange, ultimately leading to enhanced patient care and strengthened collaboration among staff members within elder care environments (Mahran et al., 2024).
To provide comprehensive care, it is critical to effectively share information between shifts by documenting client details, care plans, assessments, interventions, and pending tasks. Through teamwork, this structured approach ensures continuity of care and improved patient outcomes.
… (P4)
I noticed that the systematic approach to the handover protocol for nurses and healthcare professionals in elder care settings indeed enhances teamwork and work commitment…. (P7)
Handovers are a critical aspect of daily operations within healthcare institutions, including those specializing in elder care. Increased proactive preparation by healthcare providers before transfers could decrease errors related to medication continuation (Manias et al., 2021). They facilitate the transfer of vital information among healthcare professionals and ensure seamless continuity of care. Mahran et al. (2024) underscore the significance of optimizing handover practices in enhancing communication, teamwork, and accountability within healthcare teams, ultimately leading to enhanced patient outcomes, as supported by Nzele and Sekinat (2023) studies. Furthermore, House, Wilmoth, and Kitzmiller (2022) and Poelen, Van Kuppenveld & Persoon (2023) highlighted that the shift-to-shift handover is indispensable for conveying Person-Centered Care (PCC)-driven information within healthcare settings. As a cornerstone of effective communication between healthcare providers, it ensures that patient care remains tailored to individual needs, preferences, and values. During these handovers, frontline caregivers exchange crucial details about patients' holistic requirements, encompassing social, cultural, and spiritual backgrounds, essential for delivering care aligned with their individuality (Forbes, Jayamaha & Lee, 2024). This exchange fosters continuity of care by enabling incoming providers to seamlessly pick up where their predecessors left off, armed with insights into each patient's unique needs and aspirations (Wang et al., 2022). Moreover, the handover facilitates collaborative decision-making, promotes patient engagement in care planning and fosters trust between patients and providers. Implementing the knowledge and application of structured patient handover with both verbal and electronic transfer will improve quality of care (Lazzari, 2024) . Ultimately, by prioritizing the exchange of PCC-driven information, the shift-to-shift handover plays a vital role in upholding person-centered approaches to healthcare delivery, enhancing patient satisfaction, and improving health outcomes (Zolkefli, 2022).
Across diverse healthcare environments, enhancing communication (Chien et al., 2022) in handover practices encompasses four key dimensions: frequency, timeliness, accuracy, and problem-solving (Forbes, Jayamaha & Lee, 2024). Additionally, it involves three relational dimensions: shared knowledge, shared goals, and mutual respect (Smith et al., 2021). Nurses, along with other healthcare professionals, require encouragement to deliver excellent healthcare and foster significant connections with patients (Villacarlos & Daño, 2020). Effective communication during handovers has been associated with improved staff and patient outcomes, fostering a culture of teamwork and accountability within healthcare teams (Jones et al., 2022; Zolkefli, 2022). As study revealed that the implementation of a structured handoff curriculum was associated with enhanced communication among residents, and these enhancements must remain consistent over time (Reilly et al., 2024).
The study was conducted within a private care facility, specifically involving its staff members. It is important to acknowledge that this setting may limit the generalizability of the findings to other contexts. Furthermore, this restricted the diversity of perspectives included in the research, as the sample primarily consisted of individuals associated with this facility.
Interprofessional training sessions are suggested to be introduced to improve teamwork and patient outcomes in elder care settings. These sessions aim to enhance collaboration and communication skills among healthcare professionals. Developing standardized handover protocols with input from various professionals ensures comprehensive information exchange during shift changes. Fostering a collaborative environment through team-building activities and open communication channels is crucial. Utilizing technology, such as digital platforms or electronic health record systems, can facilitate seamless communication and information sharing. Providing continuing education opportunities for professionals to stay updated on best practices is essential, along with regular evaluation and monitoring of handover processes and interprofessional collaboration for continuous improvement.
The present findings underscore the importance of gaining insights and experiences on handover implementation from an interprofessional perspective to achieve optimal teamwork within professional hierarchies. This collaborative approach involves professionals from different disciplines working together to provide comprehensive patient care. Interprofessional collaboration fosters effective communication, mutual respect, and shared decision-making among team members, all of which contribute to improved patient outcomes. By involving professionals from various backgrounds in the handover process, healthcare teams can benefit from diverse perspectives and expertise. Additionally, interprofessional collaboration can help bridge gaps between different healthcare disciplines, leading to a more integrated and cohesive healthcare delivery system. This, in turn, can lead to improved patient outcomes through more effective communication, better coordination of care, and a more patient-centered approach to healthcare delivery.
The authors declare that they have no conflict of interests.
The researcher extends sincere appreciation to the participants for their willingness to share their insights. Furthermore, gratitude is expressed to the management of the Private Respite Care Centre, Malaysia facility for granting permission and supporting this qualitative research endeavour.
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