Research Paper on Misalignment in Handoff Communication

Introduction

Health care professionals normally take great pride and exert immense effort to meet patient needs and avail the best possible care. Regrettably, too often, this attentiveness and diligence stalls when the patient is handed off, or transitioned, to another health care provider for continuing care, treatment or services. These transfers can be as major as airlifting a patient to a specialty hospital or as mundane as a nurse ending his or her shift and telling her replacement that the patient has been taken off certain medicine. Normally, this exchange is a huge weak point in healthcare since each handoff runs the risk of have crucial treatment information being forgotten, garbled, or not passed on.

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Therefore, a major problem concerning handoffs centers on communication, whereby, expectations can be out of balance between the sender of information and the receiver. Mainly, this misalignment is where the problem frequently transpires in handoff communication. The potential for patient harm, ranging from minor to grave, is introduced when the receiver acquires information that is incomplete, inaccurate, and not timely, misinterpreted, or otherwise not what is required. Moreover, failure to properly transfer knowledge about the patient can lead to severe outcomes when the receiving health care provider is ignorant of crucial information. Thus, the purpose of this project will be to address this misalignment in handoff communication. In particular, this proposal will address the handoff procedure that nurses use while transferring patients within the hospital focusing majorly on the information to be exchanged, the channel of communication, and the need for patient involvement in his or her handoff.

Organizational Trends

An unsupportive culture within the healthcare facilities leads to failure in handoff communication. Hospitals often do not understand how crucial transitioning is to a patient's health and do not dedicate time and energy to do it right. in particular, healthcare facilities do not offer continuous training to staff mainly on handoff communication. Mainly, when graduates seek jobs, they focus more on organizations that show concern for its employees through practices such as training and development. However, lack of training thereof results in an unskilled workforce attributed with redundant skills, mostly in this age of technological advancement. Finally, lack of attractive remuneration packages also leads to an unmotivated workforce. Such a workforce performs poorly, particularly, in the provision of quality to patients.

Explanation of Causes

When handoff communication fails, many aspects are involved, for example, healthcare provider training and expectations, cultural or ethnic considerations, language barriers, and inadequate, incomplete or nonexistent documentation. The quality of information transferred during the shift change depends on the health care providers' skills, the modality selected, the time spent, and the team's engagement in registering the data that record the problems involving the patient. In particular, some nurses lack good communication skills, which inhibits the transfer of information adequately during handoffs. Mostly, factors related to the behavior, conduct, knowledge, and perceptions of the healthcare professionals interfere in the handoff process.

Also, the shift change modality, whereby, a majority of healthcare providers use verbal type only, leads to failure in handoff communication, mainly because the information transferred is based on the nurse's capacity to list the main information about the patient. When verbal modality is used alone, frailties and low information retention results because of a large amount of data transferred. Another common practice is side talk while transferring handoff information. During side talk, information is forgotten, mistaken information is transferred, and less information is retained. Moreover, the healthcare providers are prone to interruptions that change their focus, which leads to loss and forgetting crucial details. Consequently, incomplete and inadequate information is transferred. Similarly, language barriers also hinder handoff communication. In particular, lack of clear language characterized by abbreviations, jargons or highly encoded and complex clinical information, without concise information and interaction among professionals for clarifications, and passed through unstandardized mechanisms and technological resources.

Identification of Target Audience

In healthcare there are many forms of patient handoffs, including but not restricted to nursing shift changes, physicians transferring entire responsibility for a patient, physicians transferring on-call responsibility, nurse-to-nurse report for patients needing radiographic or imaging procedures, anesthesiologist's report to post-anesthesia recovery room nurse, temporary responsibility for staff leaving the unit for a short time, or nursing and physician handoff from the emergency department to inpatient units or different hospitals. The target audience in this proposal is critical care nurses in intensive care units. Acute care nurse practitioners are crucial in any healthcare facility because they attend to critically ill patients. These nurses apply advanced nursing knowledge and skills needed in critical care to better meet the needs of the patients in the acute care clinical setting.

The reason why this proposal is identifying this target audience is that of their requirement in inclusive caring for survival and recovery of critically ill patients. In acute care, there is no room for mistakes, mostly those arising from failure in handoff communication. Therefore, this project will establish strategies to eliminate this gap among critical care nurses to improve delivery of critical care in the acute care clinical setting and meet the needs of the critically ill patients.

Characteristics of Target Audience

Critical care nurses in intensive care units have certain unique characteristics. First, the time they give to avail care for patients is longer, and their duties are frequently performed at the bedside or in the vicinity of the patient's bed. Mainly, in the intensive care unit, critical care patients are often connected to monitors and artificial respirators, with numerous tubes such as infusion tubes and excretion, drains connected to the body, which means that there are few times that they are left alone. Hence, the bedside function of the nurses' station is distributed as bedside. In particular, items utilized for treatment are placed at the bedside, and there is a treatment table next to the bed to prepare infusion fluids. They spend more time on tasks related to bed bathing for bedbound patients, performing double checks of drugs and devices, confirmation of infusion tubes, and the management of artificial respirators.

Second, in critical care nursing, it is often difficult for a single nurse to give care, and activities, like cleaning, performing suction, and changing body positions, need two or more nurses. Thus, the environment of the critical care nurse is set up so that there are few patients of charge, all of whom can be easily watched by the nurses, even when care is accorded to other patients. The third characteristic of critical care nurses is that they communicate often with physicians and other nurses, who perform other tasks within the intensive care unit while performing their tasks. Also, they communicate with other critical care nurses during shift changes.

Professional Development

Continuing competency is an issue that affects all nurses, and it is of particular importance to critical care nurses. In this context, competency involves both the ability to perform in a given context and the capacity to transfer knowledge and skills to new tasks and situations. The issue to continued competence will remain a challenge to health care providers with the ever-changing in science and technology, the healthcare setting, patient expectations, and regulations. Professional development opportunities emerge as an important issue concerning upgrading skills to continue to grow in their professional practice and continue to avail optimal, quality patient care. Thus, this proposed education will build on the educational and experiential bases of nurses throughout their professional careers to enhance their professional development, working toward the ultimate goal of ensuring quality healthcare for the critically ill patients.

In particular, the proposed education will use a learner-centered philosophy, real-life orientation, and clearly articulated standards. The education programs will focus on outcomes, offer the learners flexibility, and avail criterion-reference evaluation mechanisms. The proposed education will enhance the critical care nurses' professional development by emphasizing outcomes regarding what individuals must know and have the capacity to do relating to handoff communication, and permit flexible pathways for attaining those outcomes. Thus, just as nurses are encouraged to utilize evidence-based data in their clinical practice, the proposed education will base its practice on the current evidence. The project will ensure that it will use evidence of best practices in the main aspects of critical care nursing, including education. Finally, the proposed education will be continuous to support continued learning for the nurses. Various elements that it will use will include nursing orientations, apprenticeships, laddering and supernumerary positions to improve their confidence and competencies and refine their clinical skills mainly in handoff communication.

Proposed Solution

This educational curriculum will be incorporated in the daily routine of critical care nurses in the intensive care unit of a healthcare facility and will lead to the implementation of bedside handoff reports to eliminate the misalignment in handoff communication in intensive care unit. The curriculum will involve lectures that will use a learner-centered philosophy where students will be taught communication skills and record management integrated with various techniques such as electronic medical records. The course will also incorporate real-life orientation whereby students will interact with other nurses including handing over patients at the end of a shift. Also, there will be an integration of the bedside report education into nursing orientation. Then, the curriculum will be continuous to ensure that the students continue learning and they gain additional skills, knowledge, and abilities. Mainly, the continuity will ensure the students change with the changing clinical care settings, especially, regarding technological and scientific advancement.

Intended Outcomes

The intended outcomes of this project will be the use of handoff reports at the bedside in the intensive care unit. The project will also lead to the integration of bedside handoff reports into the electronic medical records. The medical records will supplement the verbal mode of handoff information transfer. The other intended outcome is high patient satisfaction due to reduced medication errors related to communication. Additionally, the proposed educational project will lead to the implementation of the move change-of-shift report to the bedside in the nurses' daily routines.

Evidence Summary

According to Patient handoffs: The gap where mistakes are made (December 2017), the act of passing a patient between caregivers and the information exchanged between the sender and the receiver forms a huge weak point in healthcare. Moreover, each handoff runs a risk of having key treatment data forgotten, garbled, or not passed at all. Such a situation introduce...