CHAPTER ONE

INTRODUCTION

1.1Background 

Nursing handover is a report given when the nursing professional transfers the responsibility for the patients and what has been done in his or her shift to another that is arriving. ((July 5 2022)

According to Radtke K. (2013), Nurse handover is defined as the reports with the objective of relating what occurred and what care was given to a patient during the previous shift, for the next shift’s members to know the fundamental aspects of the patients’ present condition, in an effort to guarantee continuity of care. He further stipulated that Nurse Handover has always been a vital element of the nursing care process, and communication is a core element in this process especially during the transfer of information. 

The nurse handover is complex and includes communication between the change of shift, communication between care providers about patient care, handover, records, and information tools to assist in patient care. It is also “a mechanism for transferring information, primary responsibility, and authority from one or a set of caregivers, to oncoming staff” (Spanke MT, Thomas T. 2010).

According to Griffin T. 2010, the transfer of this essential information and responsibility for care of the patient from one nurse on duty to another, is an integral component of communication system in nursing care practice which supports the transition of critical information and continuity of care and treatment.

Scott I. (2012) stipulated that, in the nurse handover process, information about the patients’ physical, psychosocial, and spiritual aspects, as well as medical facts, opinions, and impressions, are shared to resolve care problems, to give and receive help, to construct relationships, and to manage conflicts. According to Schroeder (2006) the specific component of shift report should include PACE (Patient Problems, Assessment\Action, Continuing \Changes, Evaluation; other researchers have suggested, other templates such as SBAR (Situation, Background, Assessment, and Recommendations ;( Raines and Mull, 2007). Regarding all such guidelines, the content of handover must contain short and long term goals. It should also be broad and specific enough to meet the patient’s needs. Furthermore it should also contain information’s such as medical and nursing care and physical, psychosocial, Spiritual, and family needs at the same time (Rushton 2010) 

Failure of effective handover is a major problem to cause harm to patient, which is also the most important step of ensuring patients safe handover. Handover is in fact a valuable affair and an essential part of processes and work flows in the hospital (A Raeisi 2019.)

As the World Health Organization (WHO) contended, the factor of miscommunication may cause patient harm (WHO, 2007). Information about patients’ care officially occurs in written nursing records or in oral reports called (shift) handovers and unofficially with verbal way during the activities of the nursing routine (Payne et al, 2000, Meissner et al, 2007, Johnson

et al, 2012a).

The purpose of each handover involves the effective communication of high quality clinical information at any time or when responsibility for caring of the patients is transferred to the person or another shift or hospital .The transmission of information at the end of the shift is one of the main functions of delivering and evolving with secure and safe transfer of turns.  Nurse Handover has always been a vital element of the nursing care process, and communication is a core element in this process especially during the transfer of information. (S Eggins 2016). 

N Alberta David (2018) The passage of time and introduction of scientific and technological advances, has led to a new focus on the delivery of information with quality and timeliness. The nurses’ shift change or handover is a report given when the nursing professional transfers the responsibility for the patients and what has been done in his/her shift to another that is arriving. The transfer of this essential information and responsibility for care of the patient from one nurse on duty to another, is an integral component of communication system in nursing care practice which supports the transition of critical information and continuity of care and treatment.  

Taylor, (2002) came up with a type of nursing handover which is nonverbal: Located in an office setting, nurses inform themselves by reading the patient’s record, involving progress notes, medication charts, observation charts and nursing care plan. Furthermore Kassean, 2005, came up with other nursing hand over styles which includes; bedside handover, break handover, transfer of patient within the hospital, patient on discharge.

Evidence–based shift report tool was used by (Chung K, et al, 2011) to improve nurses’ communication; the initiative outcomes showed decreased frequency of missed information. 

The Australian Medical Association (2006) stated that Clinical communication can have significant impact upon continuity of patient care and clinical outcomes. Clinical handover not only relays relevant information regarding a patient and their treatment at an acute phase of an episode of care but also transfers responsibility and accountability of care.

Every time a patient moves from one setting to another, there is the risk that essential care needs will not be communicated ( Shendell-Falk N, et al. 2007). Ineffective clinical handover may lead to incorrect treatment, delays in diagnosis, life-threatening adverse events, patient complaints, increased health care expenditure and increased length of stay, ( Australian Medical Association, 2006). As posit by ( McMurray A, Chaboyer W, Wallis M, Johnson, J, Gehrke T. 2011), the traditional methods tend to be long, incoherent, and incorrect regarding the patient’s information; the content sometimes deviates to irrelevant declarations or a priori judgments that carry negative prejudices from the professionals toward the patients. In this way, one can convert the report into a vehicle for disrespect, lack of communication, unconscious negativity, and projections that can weaken interpersonal relationships and ethical values. 

Another factor that can influence the handover are distractions, including parallel conversations, the movement of carts and supplies, clothes and food, cleaning machines, the high volume of radios and televisions, telephone calls, interruptions by medical and support staff, and conversations in the corridor and nursing center situations that are more common during shift changes in the morning and the afternoon, given that they are hours of greater circulation (Sles S. 2010). Hence according to, incomplete information, distractions, and errors in communication during the nurse handover process are the principal causes of adverse events, such as medication errors, prolonged hospital stays with unnecessary diagnostic tests, and patient dissatisfaction. 

The studies conducted by the joint commission International (The WHO collaborating Centre for patient Safety solutions) revealed that a poor information communication is the main risk factor for 65% and the contextual risk factor for 90% of sentinel events. 

Although there are controversies about the efficacy of handover practices ,some articles highlight the importance of oral shift report that could not be substituted by any other method because of handover is the only place where different aspects of professional nursing care are identified(Gordon and Findley,2011; Manais and street,2000; scovell,2010); otherwise, other studies question its efficacy and report that there is no need to have and oral shift report because most of the discussed information could be located within nursing documentation and therefore, such a practice is time-consuming (Manais and street,2000, sexton et al,2004). 

In general, the goal of nursing handing over is the transfer of relevant information and continuity of patient care; however, there is no agreement about its content and the related literature recommends different templates for presenting data (Jonson, Jefferies and Nicholls, 2012). 

1.2 Statement of Problem 

An accurate handover of clinical information is of great importance to continuity of care and patient safety. If clinical information is not shared accurately and in timely manner it may lead to delay in treatment and diagnosis. Certain factors have been identified that influence the nurse handover such as; distractions, including parallel conversations, the movement of carts and supplies, clothes and food, cleaning machines, the high volume of radios and televisions, telephone calls, interruptions by medical and support staff, and conversations in the corridor and nursing center situations that are more common during shift changes in the morning, afternoon, and evening shift given that they are hours of greater circulation. Incomplete information, distractions, and errors in communication during the nurse handover are the principal causes of adverse events, such as medication errors, prolonged hospital stays with unnecessary diagnostic tests, and patient dissatisfaction. 

This is a major challenge faced in the Cameroon hospitals as per handing over of shifts. It was observed that nurse handover at almost every change of shift generated discrepancies and disagreement among nurses. This conduct provokes personnel actions that do not contribute to a good process and becomes a vicious cycle that impacts the handover itself, given that it generates negative responses that do not contribute to the continuity and professional critical judgment for prioritizing and organizing care. 

1.3Research Objectives 

1.3.1 General Objectives 

To assess Knowledge, Attitude and Practice of a Proper Nursing Handover in Buea Regional Hospital. 

1.4.2 Specific Objectives 

1. To examine nurses knowledge on proper shift handover in Buea Regional Hospital. 
2. To assess nurses attitude towards nursing handover in Buea Regional Hospital.
3. To determine nurses practice towards nursing handover at Buea Regional Hospital.
4. To determine the barriers to proper nursing handover at Buea Regional Hospital.

1.4 Research Questions 

1. What knowledge do Nurse have on nursing handover at Buea Regional Hospital. 
2. What attitudes do nurses have toward nursing handover at Buea Regional Hospital
3. How do nurses practice nursing handover at Buea Regional Hospital
4. What are the barriers to proper nursing Handover at Buea Regional Hospital.