Bedside handoffs transform nursing shift changes into relationship-based care

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NEW ORLEANS—Patient handoffs conducted at bedside support the principles of relationship-based care and benefits both nurses and patients, according to researchers at the Oncology Nursing Society 37th Annual Congress.

The traditional patient handoff at the change of shifts is a nurse-to-nurse exchange of information: what happened during the current shift and what needs to be done on the next shift. Although this process is about patients, the information exchange rarely focused on patient priorities nor is it done in the presence of the patient.

Bedside handoff, however, is an ideal representation of the three principles of relationship-based care, explained Korkoh-jah George, RN, BSN, Acute Care Nursing at Memorial Sloan-Kettering Cancer Center in New York, New York, in her presentation. (1) Care of the patient: the patients' presence during the handoff discussion promotes their inclusion in care decisions; (2) care of self: bedside handoff fosters accountability for one's practice; (3) care of colleagues: bedside handoff fosters mutual trust and respect between nursing-team members.

George and colleagues developed a standardized process and created an electronic handoff report to facilitate it. The nurse prints the electronic report, which also includes the patient's history, reason for admission, medications, and laboratory test results, and reviews the nursing notes from the shift to the next shift's nurse.

Qualitative evaluations show nurses feel empowered because the handoff is more comprehensive, and they are able to prioritize their care more effectively. The process encourages open and honest communication about care plans and the nurses' clinical practices. Unit assistants reported fewer nursing requests during shift changes. It also gives patients an opportunity to participate in their daily care discussions and relate their concerns and priorities to the oncoming nurse. Patients felt that the nurses were “talking with me, not about me,” which helped them feel less anxious about their care.

Patient handoff at the bedside has transformed both how and where handoff takes place. By including the patient in the nurses' handoff discussion, the exchange of information becomes more patient-centered, clinically-focused, and outcome-oriented.

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