Exploring Information Sharing Problems in Nursing Handover: An Activity Theory Perspective

The sharing of patient handover information between individuals and teams of nurses in clinical settings is a complex process that requires consolidation and integration of information from different sources and types of artefacts. The aim of this study is to identify the most critical information-sharing problems nurses experience during handover. Handover information-sharing problems are explored using Activity theory (Engestrom, 1987) as a lens to better understand the nature of these problems. A qualitative research approach was conducted to collect data from four units in a large Saudi Arabian hospital. Findings indicate that Activity Theory is a comprehensive theory to analyse a full spectrum of socio-technical handover problems. Findings further indicate that handover information sharing problems relate mostly to: 1) incompatible handover artefacts, 2) inadequate guidelines and training to conduct handover processes, 3) insufficient and fragmented documented information to share during handover and 4) nurses’ personal style

Cognitive Artifacts in Support of Medical Shift Handover: An In Use, In Situ Evaluation

Technologies introduced to support complex and critical work practices merit rigorous and effective evaluation. However, evaluation strategies often fall short of evaluating real use by practitioners in the workplace and thereby miss an opportunity to gauge the true impact of the technology on the work. This article reports an in use, in situ evaluation of 2 cognitive artifacts that support the everyday work of handover in a healthcare setting. The evaluation drew inspiration from the theoretical viewpoint offered by distributed cognition, focusing on the information content, representational media, and context of use of the artifacts. The article discusses how this approach led to insights about the artifacts and their support of the work that could not have been obtained with more traditional evaluation techniques. Specifically, the argument is made that the ubiquitous approach of user testing with its reliance on think-alouds and observations of interaction is inadequate in this context and set an initial agenda for issues that should be addressed by in use, in situ evaluations

Crossing boundaries: Establishing a framework for researching quality and safety in care transitions

Background Despite the breadth and diversity of research and policies on care transitions, research studies often report similar components that affect the quality and safety of care, including communication across professional groups and care settings, transfer of information, coordination of resources or training of healthcare personnel. In this article, we aim to deepen our understanding of care transitions by proposing a heuristic research framework that takes into account the components and factors influencing the quality and safety of care transitions in diverse settings. Methodology Using a pragmatic qualitative narrative meta-synthesis of empirically grounded research studies (N = 13) involving 31 researchers from seven countries (Australia, Canada, Denmark, Germany, the Netherlands, Norway and the UK), we conducted a thematic analysis to identify the components analysed in the included studies. We then used these components to create a framework for researching care transitions. Results Our narrative synthesis found that the quality and safety of care transitions are influenced by a range of patient-centred, communicative, collaborative, cultural, competency-based, accountability-based and spatial components. These components are encompassed within a broader set of dimensions that require careful consideration: (1) the conceptualising of the care transition notion, (2) the methodology for researching care transitions, (3) the role of patients and carers in care transitions, (4) the complexity surrounding care transitions, (5) the boundaries intertwined in care transitions and (6) care transition improvement interventions. These six dimensions constitute an analytical framework for planning and conducting research on care transitions in diverse settings. Conclusion The proposed six-dimensional framework for researching quality and safety in care transitions offers a roadmap for future practice and policy interventions and provides a starting point for planning and designing future research.publishedVersio

WS19. From pedagogy to practice: implementing transformative learning in clinical reasoning

BackgroundHealthcare professionals must provide high quality care that is both efficient and safe. Underpinning this requirement is a presumption that individuals are able to make accurate clinical decisions. Knowledge is not sufficient: judgment and reasoning are required to translate clinical information into accurate decisions to produce effective care. Clinical reasoning skills need to be developed in healthcare professionals in a way that produces change in behaviour. This is aplies to the spectrum of healthcare education: from undergraduate to postgraduate to lifelong practice. Though much is understood about clinical decision-making theory, direction for systematic implementation of teaching in both undergraduate and postgraduate medical education programmes is lacking. In particular, evidence describing transformative teaching methods is limited. This workshop will explore how to design effective spiral curricula in clinical reasoning, compare and contrast experiences from three medical schools in the UK, discuss challenges in implementation, share a variety of teaching methods, provide hands on demonstration of technological resources that have produced changes in learner behaviour and support attendees to adapt methodology to their programmes.Structure of workshopWe will briefly review current knowledge on clinical decision-making learning before sharing experiences from three UK medical schools.Attendees will participate in discussions supported by interactive exercises to explore each subtopic. These exercises will include role play, video and trial of electronic teaching tools used in our current practice. The session will conclude with a reflection on principles and ideas shared during the event

Treat him as a normal baby: paediatrician's framing of parental responsibility as advice in the management of a genetic condition

Oral Presentation - Parallel Session 2: 2E Risk and Uncertainty/Ethics: no. 2E.4Parental responsibility in the management of genetic conditions has been the focus of both family-oriented interview-based research (e.g. Arribas-Ayllon et al. 2008; 2011) as well as real-life face-to-face genetic counselling research (Sarangi fc; Thomassen and Sarangi 2012). The current paper is an attempt to contribute to the latter tradition involving paediatricians and parents where parental responsibility is constitutive of professional advice. The genetic condition in question is G6PD deficiency (commonly known as favism), a mild hereditary disorder prevalent in Asia (Zayts and Sarangi 2013). We draw on 18 consultations in a maternal unit in Hong Kong (recruitment ongoing) where paediatricians communicate with mothers of newborns diagnosed with G6PD. We employ theme-oriented discourse analysis – comprising activity analysis and accounts analysis (Sarangi 2010) – to examine how the paediatricians frame their advice-giving trajectories – on to which elements of parental responsibility (in terms of future actions and moral selves) can be mapped. We show how 'causal responsibility' (Sarangi, fc) that concerns potential consequences of the mothers' actions in managing the condition emerges as a dominant thread in our data corpus. 'Causal [parental] responsibility' is embedded in the paediatrician's advice-giving trajectories which include, among other things, how to 'treat' these children, ranging from safeguards against certain medications and food to prevention of negative physiological scenarios (such as an acute hemolytic reaction). We examine closely the attendant discourse devices through which parental responsibility is framed, e.g., modalisation, contrast, character/event work. We conclude that, in terms of temporality, 'causal [parental] responsibility' is 'forward-looking' as the mothers' responsible actions can normalise the child’s immediate and future wellbeing.postprin

Roundtable Discussion (RTD03) - Is there a downside to using Simulated Patients to teach and assess communication skills?

Background Simulated Patients (SPs) are widely used to facilitate the learning of communication skills enabling students to receive detailed feedback on experiential practice in a safe environment. They are also used in the assessment of students’ communication skills in Objective Structured Clinical Examinations (OSCEs). We have observed that our most experienced SPs are highly conversant with medical jargon and consultation skills and have almost become ‘medical faculty’. Consultations can therefore lack the true patient perspective, with SPs focussing their feedback on process rather than giving a true patient perspective. Roundtable objectives To consider the challenges in ensuring that highly experienced SPs continue to respond from a true patient perspective To critique whether the use of SPs in OSCE stations is a valid way to assess students’ communication skills with real patients To consider whether using consultations with Simulated Patients is useful for students in the later years of an Undergraduate medical course who are learning to integrate the different components of a consultation and reasoning clinically in a real-life clinical context To share best practice with colleagues Roundtable A brief interactive presentation including the authors’ experiences of working with experienced Simulated Patients which will draw on current literature regarding the evidence for using Simulated Patients in the teaching and assessing of communication skills Delegates will have the opportunity to take part in three roundtable discussions • OSCE Stations using SPs assess how good students are at communicating with SPs but not with real patients • Experienced SPs are in danger of responding with a faculty not a patient perspective • By using SPs in teaching we over focus on process and forget the global picture

Evaluation of video reflexive ethnography as a tool for improvement of teamwork and communication at the multi-disciplinary maternity unit handover

The implementation of video reflexive ethnography (VRE) is suggested to be a successful tool through which to prompt change and improvement at the inter-professional handover in acute healthcare. This thesis was designed to evaluate VRE as an improvement approach, focused on prompting improvement at the inter-professional clinical handover in an acute maternity team. The main aims of the work were to: 1) understand how team reflexivity has been implemented as a tool for improvement in inter-professional hospital-based healthcare teams, 2) to understand whether VRE is feasible and acceptable as a tool for improvement in an acute maternity unit, 3) the role of the facilitator in the successful delivery of VRE and 4) whether and how VRE was successful in prompting change and improvement. A mixed-methods approach was taken to address these main objectives, and a systematic review of the literature was conducted. Semi-structured interviews and ethnographic field notes were employed to gather data on the feasibility and acceptability of VRE, staff perceptions of the VRE process, and the contextual factors important in the successful delivery of VRE. Qualitative data from the reflexive feedback sessions was explored to understand how staff discovered potential issues from the video footage and collectively developed potential solutions. A short before and after survey was employed to gather the perceptions of the wider staff group on the changes to the handover process. The quantitative data generated was assessed using independent samples t-tests, and suggested significant perceived improvement in communication at the inter-professional handover. Qualitative data was assessed using a combination of inductive and deductive thematic analysis and adapted framework analysis, and illustrated the specific discoveries and solutions identified in the reflexive feedback sessions, as well as information about feasibility, acceptability and salient contextual factors in the delivery of VRE. The qualitative data was used to develop an initial logic model to map the process of VRE. The thesis also considers the implications of the research and potential for future work, as well as limitations and the challenges of undertaking applied research in an acute healthcare environment

Clinical handover of patients between nurses in the emergency department and somatic wards – an explorative interview study.

Master's thesis in Health and social sciencesBackground: Leading international health organizations have focused on improving the quality of clinical handovers. Research demonstrates areas for improvement where clinical handovers in healthcare are essential for quality, safety, and continuity of patient care. One hospital had received many incident reports about the quality of interdepartmental handovers between the Emergency Department and somatic wards, and wanted to improve them. Aim: The aim of this study was to explore how clinical handovers are experienced between the ED and ward nurses, and gather suggestions for improvement. Method: This study pursued a qualitative, inductive, explorative approach with 6 focus group interviews of nurses (N=19) on both ends of the ED-Ward handover (2 ED, 1 surgical, 3 medical). The interdepartmental handover is by telephone from ED to ward nurses. Graneheim and Lundman’s (2004) content analysis method was used to analyze interview texts. Rasmussen’s system approach and Dynamic Safety Model formed the theoretical basis for interpretation. Results: Four bodies of data emerged from the interviews: Poor handovers and Successful handovers from ED or Wards’ perspectives. Poor handovers occurred in a busy ED without handover structure where efficiency trumps quality causing consequences for nurses and patients on the wards. Nursing assessments and documentation lacked, and patients’ status upon arrival on wards didn’t always match the handover description. Successful handovers were described as bridging needs of patients and nurses. Conclusion: The results provide evidence for improving the interdepartmental handover but will take organizational buy-in and collaboration over time to develop and implement evidence-based, locally suitable handover routines and protocols