Patient participation in nursing bedside handover: a systematic mixed-methods review

Background: Numerous reviews of nursing handover have been undertaken, but none have focused on the patients’ role. Objectives: To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Design: Systematic mixed-methods review. Data sources: Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Review methods: Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Results: Segregated synthesis of research of patients’ perceptions revealed two contrasting categories; (1) patient-centred handover and (2) nurse-centred handover. Segregated synthesis of research of nurses’ perceptions included three categories: (1) viewing the patient as an information resource; (2) dealing with confidential and sensitive information; and (3) enabling patient participation. The segregated synthesis of QI projects included two categories: (1) nurse barrier to enacting patient participation in bedside handover; and (2) involving patients in beside handover. Once segregated findings were configured, we discovered that the patients’ role in bedside handover involves contributing clinical information related to their care or progress, which may affect patient safety. Barriers relate to nurses’ concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. Conclusions: Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and ensure patients’ viewpoint is captured. Many barriers and strategies identified QI projects were from the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure improved quality of QI projects

Student Evaluation of Clinical Education Environment (SECEE): Instrument development and validation.

This paper describes the refinement and testing of the Student Evaluation of Clinical Education Environment (SECEE) inventory, an instrument designed to measure nursing student perceptions of the clinical learning environment. Although a quality student clinical experience is considered critical to nursing education, no comprehensive instruments measuring the clinical learning environment have been published. The SECEE inventory contains 29 forced-choice items divided among four scales: Communication and Feedback, Learning Opportunities, Learning Support, and Department Atmosphere. Items were included based on nursing students and faculty input, a review of the literature and sample clinical agency contracts, and data resulting from administration of the original version of the SECEE instrument. Items requesting students to identify aspects of the clinical setting that helped as well as hindered learning were also included. A convenience sample of nursing students from two small liberal arts institutions (SMW and SMA) and one large university (LMA) completed the SECEE inventory at the end of the spring 1998 semester. A sub-sample of students completed the inventory twice during the semester, for test-retest reliability determination. Data analysis indicated that students responded consistently to the instrument as a whole and to the four scales. Rearrangement of four items within scales resulted in further improvements in reliability. Test-retest correlations for all scales were statistically significant. Correlations between individual student evaluations of two distinct clinical sites were not significant for any of the four scales, indicating that students responded differently to the instrument when evaluating different clinical sites. Significant differences between scale scores were found between institutions for all scale scores. Differences were also found between academic levels of students within each institution, and between clinical site groups within institutions SMW and SMA. Student narrative comments supported inclusion of the majority of forced-choice items and allowed identification of items that may be beneficial to include in future inventory revisions. Overall, the SECEE inventory appears to be a reasonably valid and reliable measure. Minor revisions are suggested for future revisions