Running head: ARE BEDSIDE NURSING REPORTS BEST PRACTICE?

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Nursing Handoffs: Are Bedside Nursing Reports Best Practice?
Aubry Hire
Ferris State University
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Abstract
Shift change is an important time for nurses. It is when they give information to the oncoming
nurses. The information received is what will help the nurse to care for the patient. Incorrect
information can negatively harm the patient. There are currently several ways that nurses give
report, but there are barriers to many of these. Bedside reporting is one type of reporting that
seems to have fewer barriers than others. Four articles were critiqued, using the clinical question
that was developed as a guideline. Nursing research was utilized, as this is a nursing problem.
Bedside reporting has few high level articles, but here very few downfalls to using this method.
Bedside reporting increases both patient and nurse satisfaction.
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Nursing Handoffs: Are Bedside Nursing Reports Best Practice?
To ensure continuity of care, nursing shift report is essential in passing along information
from the current nurse to the oncoming nurse. Patient handoff is, allowing nurses to exchange
necessary patient information to ensure continuity of care and patient safety, (Maxson, Derby,
Wrobleski, & Foss, 2012). There are currently many different ways that nurses perform this
important ritual, including recordings, face to face in a conference room, bedside reporting, and
many more. The purpose of this paper is to determine if bedside reporting is best practice for
both the nurse and the patient.
Clinical Question
There are many different types of reporting that are currently in use for nurses to update
the incoming nurse about the patients condition. There are voice recordings, face to face in a
conference room or the nurses station, bedside reporting, written reports, combination reports,
and different styles that work in different departments. With the exception of bedside reporting,
reporting takes place away from the patient. Communication barriers, problems associated with
standardization, equipment issues, environmental issues, a lack or misuse of time, difficulties
related to complexity of cases or high caseloads, a lack of training or education, and human
factors are cited as the most common barriers to effective handoffs (Riesenberg, Leizsch, &
Cunningham, 2010). With all of these barriers present, there is the question of which of the
methods of reporting is the most effective.
It is essential for nurses to know which type of reporting is the most accurate, time
conscious, and safe for the patient. Nurses need to get the most accurate information from the
departing nurse. This will help to ensure that the oncoming nurse can provide the best care for
the patient. The departing nurse will many times have incidental overtime because of the length
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of the report; this is personal time that is taken, and it also costs the hospital overtime pay (Evans
et al., 2012). Oncoming nurses have to make a critical decision about what patients need the
most immediate care. This can affect the patients safety if the departing nurse forgets a critical
part of information that will affect the next shift.
Reporting is a process that all nurses give and receive at shift change time. This
transition from one care provider to the next is a time where critical information can be lost or
misunderstood (Riesenberg et al., 2010). Nurses are the most numerous health care providers,
and thus nurse reporting at shift change is a very common occurrence. Each nurse must receive
all of the information that is pertinent to the patients. Communication is the foundation on which
nursing is laid upon. If there is any breakdown in communication, even for just a moment, there
could potentially be disastrous results for a patient. The American Nurses Association says that
research is needed to improve communication issues for patient safety and education (White &
OSullivan, 2012).
Methodology
A common tool used when doing research is to use a Population-Intervention-
Comparison-Outcome-Time question, a PICOT question. The PICOT question being answered
in this paper is: Among staff nurses in a hospital setting, does implementing bedside shift
reporting lead to greater patient and nurse satisfaction when compared to other kinds of shift
change reporting? (P) staff nurses, (I) bedside shift reports, (C) other kinds of shift change
reporting, (O) greater patient and nurse satisfaction, and (T) is not specified for this question.
This tool gives researcher guidance as to what kind of literature and research they are looking
for; it helps to define what is really trying to be answered in the paper.
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The first step in doing any research is to read the background literature. To find the
literature, the phrase nursing handoff was entered into the search bar of The Cochrane Library.
Four results appeared and the first one was chosen because it directly deals with patient
satisfaction. The next step was to find more research. The FLITE Librarys webpage was
opened and the Databases tab was clicked on. Next browse by subject or academic major was
selected and nursing was chosen. PubMed was selected from the available list. The Nursing
journals filter was selected. Bedside shift report was entered in the search bar and 21 results
came up, two articles were chosen for content and being recent. The next search was for
nursing handoffs systematic, five results came up and one was selected for content and being
recent.
The search was driven by nursing research and high level evidence. Nursing research
was chosen to be used because that is the profession that bedside reporting would impact the
most. Advanced practice nursing journals were not used because, for the most part, bedside
reporting is not something that they will commonly preform. High level evidence is wanted
because it proves that a certain intervention is best practice. The AACN was used as a standard
for looking at the levels of evidence. The AACN uses a lettering scale form A-E and M. A is
the highest level of evidence and M is the lowest ranking of evidence.
Discussion of Literature
Article Critique: Bedside Shift-to-Shift Nursing Report: Implementation and Outcomes
The first article (Evans, Grunawalt, McClish, Wood, & Friese, 2012) was from MedSurg
Nursing, a peer-reviewed, nursing journal (www.medsurgnursing.net). The authors of this article
were five registered nurses; they are all based in Ann Arbor, Michigan. The main subject of the
study was shift-to-shift nursing reports. The background and literature review supported a need
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for this study. The literature was outdated, from 1988. The articles in the literature review were
low levels of evidence, levels C and D (Armola et al., 2009). This study looked at bedside shift
to shift reporting. The purpose of this article was to see if bedside reporting was effective in
increasing nurse satisfaction with report process and decrease report time. The sample
population for this study was 42 full time nurses who participated for six months. This study
was a correlational study. This was appropriate because the study looked if bedside reporting
was the cause of increased satisfaction and decreased report time. This study has a level C rating
according to the AACN level of evidence ranking system. There was no statically analysis used.
The data was nominal and interval. It included average time and percentages.
The results are clear in indicating that time spent on reporting decreased from 45 minutes
to 29 minutes and that nurse satisfaction with report process increased from 37% to 78%. The
results answer the question if bedside reporting decreased report time and increased nursing
satisfaction (Evans, et al., 2012). This article had several threats to validity. The first was
maturation. The nurses could have become better at giving the pertinent information, thus
lowering the report times. The second is the Hawthorne Effect. The nurses knew they were
being watched so they worked faster and answered what wanted to be heard on the questionnaire.
The conclusions of this study are similar to other studies that have been performed. The results
indicate that bedside reporting is an effective and useful tool. The nurses report that they can do
a quick assessment on the patient, ask the nurse questions, there were fewer distractions, and
they could answer patients questions.
Article Critique: Utilizing Bedside Shift Report to Improve the Effectiveness of Shift
Handoff
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The second article (Cairns, Dudjak, Hoffman, & Lorenz, 2013) was from The Journal of
Nursing Administration, a peer-reviewed, nursing journal (www.jonajournal.com). The authors
of this article are five registered nurses located in Pittsburg, Pennsylvania. The main subject of
the study was shift-to-shift nursing report. The background supported a need for this study;
saying that while there are many positives to bedside reporting, there were still barriers to
bedside reporting. The problem investigated was bedside shift-to-shift nursing reports. The
purpose of this article was to evaluate the implementation of bedside reporting using end of shift
overtime, call lights during report time, nurses perceptions, and patients perceptions. The
population of this study was the nurses and the patients in a trauma unit with 23 beds. The study
lasted for three months. This studys design was also a correlational study. The level of
evidence for this study, according to the AACN, is level C. There was no statistical analysis
used. The data was ordinal, using Likert scales, and ratio, using actual number of times
something was done.
The results show a strong correlation between bedside reporting and in increase in
nursing satisfaction, patient satisfaction and a decrease in call lights and overtime pay. The
amount of overtime went down by an average of 10 minutes a day. There was a 33% decrease in
the amount of call lights during report time. Nursing satisfaction jumped a substantial amount,
increasing 39.8%, and patient satisfaction increased by 10% (Cairns et al., 2013). The results are
clear and they answer the question that the paper was trying to answer. The results seem valid,
but there are several threats to validity. The Hawthorne Effect may be a big threat to validity, as
the nurses knew what was expected and they tried to perform the task faster and more efficiently.
A second threat to validity is the pretest/posttest factor. The nurses knew what they were being
asked about. The results are consistent with other studies that have been performed on this
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subject. This study shows that bedside reporting is an effective reporting method that should be
looked at by all hospitals for a possible nursing report style.
Article Critique: Nursing Handoffs: A Systematic Review of the Literature
The third article (Riesenberg et al., 2010) was from the American Journal of Nursing
(www.ajnonline.com) a peer-reviewed, nursing journal. Two of the three authors are registered
nurses and one has a bachelors of science. They are all based in Newark, Delaware. The main
subject of the article is nursing handoffs. The background indicated a need for this study
because the Joint Commission had set a goal, but it had not been reached for nursing handoffs.
The problem investigated was different types of nursing handoffs. The purpose of this study was
to review literature on nursing handoffs and to identify features of structured handoffs that have
been shown to be effective, (Riesenberg et al., 2010). The sample population for this study was
20 articles; 15 intervention without a control group, 3 cross-sectional, 1 qualitative, and 1 cohort
study (Riesenberg et al., 2010). The design of this study was a systemic review. This made
sense because they were reviewing the literature. The level of evidence for this article,
according to the AACN, is level C. The statistical analysis was performed using Cohens test.
This is an appropriate test for interval data, which is what was used in the article.
The results state that there is very little evidence on the use of any specific structure,
protocol, or method of reporting (Riesenberg et al., 2010). The results are clear in stating that all
of the articles on the subject of bedside reporting were low levels of evidence, with none being
randomized control trials. The authors want high quality studies to be performed according to
the Standards for Quality Improvement Reporting Excellence (SQUIRE). It is also noted that
one method may work well in one department, but may not work well in another department.
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The results do answer the question of what is the best method of nursing reporting. The results
seem valid, but there may be a few threats to validity. Firstly, the authors had to assign each of
the articles a score and they may not reflect the true score of the article, an instrumentation
change. Secondly, articles may have been missed using the search limits, a selection bias. The
results are similar to what other studies have found.
Article Critique: Bedside Nurse-to-Nurse Handoff Promotes Patient Safety
The fourth article (Maxson et al., 2012) is from the MedSurg Nursing, a peer-reviewed,
nursing journal (www.medsurgnursing.net). The authors are four nurses who work for the Mayo
Clinic in Minnesota. The main subject of the study is nurse-to-nurse handoffs. The literature
indicated a need for this study. It showed that barriers to bedside reporting existed, but there
were many benefits. Most of the research is over five years old, indicated that it may be
outdated. The problem investigated was bedside nurse-to-nurse handoffs. The purpose of this
study was to see if patient satisfaction increased and staff satisfaction increased. The population
was 30 patients before the change to bedside reporting and 30 patients after and 15 nurses both
before and after. This study had a controlled study design. It is level B evidence from the
AACN. The statistical analysis used was the Wilcoxon rank-sum test and the chi-square test;
this was appropriate because the data was ordinal and nominal, respectively.
The results of this study were that both the patients and the staff found more satisfaction
with bedside reporting. The results are clear; both the nursing staff and the patients benefit from
this practice. The results answered the purpose of this study, which was patient and nurse
satisfaction increase. The results seem valid, but there are some threats to validity that arise.
The Hawthorne Effect may be a big threat to validity, as the nurses knew what was expected thus
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they tried to perform the task faster and more efficiently. A second threat to validity is the
pretest/posttest factor; the nurses knew already knew what was being asked. The findings of this
study are consistent with prior, similar studies.
Significance to Nursing
After reviewing the articles, it appears that bedside reporting is preferred by both the
patient and the nursing staff in terms of satisfaction. The patients are more satisfied with their
care (Maxson et al., 2012), (Cairns et al., 2013). The nurses are more satisfied (Maxson et al.,
2012), (Cairns et al., 2013), (Evans et al., 2012). There is strong evidence toward implementing
this policy, but the systematic review called for more high level research to be done. Riesenberg
et al. (2010) however, says that there is little harm that will be done if this practice is
implemented without the higher levels of research. Bedside reporting is the most accurate
technique for communicating information that will help improve safety in the hospital setting,
and enables nurse to be able to provide high quality care with accurate information.
Quality and Safety Education for Nurses (QSEN) uses six quality and safety standards
while incorporating knowledge, skills, and attitudes. The six standards are: patient-centered
care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and
informatics (Pre-Licensure, 2014). Bedside reporting helps to incorporate all six of the standards
into practice. Patient-centered care indicated that the patient is a full partner in care provided;
bedside reporting gives the patient a chance to become fully immersed into their plan of care.
Teamwork and collaboration is at the core of bedside reporting, as one nurse gives report to
another nurse acting as the patients primary care team. Evidenced-based practice is
incorporating the current evidence into the plan of care. Bedside reporting has many articles that
indicate that it is the best way to report. Quality improvement is looking at the bedside reporting
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and seeing if it is best for the floor that a nurse is working on. Safety can be achieved by bedside
reporting. The incoming nurse can visualize the patient and see if they have taken a critical turn,
right at the beginning of the shift. Informatics is, use information and technology to
communicate, manage knowledge, mitigate error, and support decision making, (Pre-Licensure,
2014). Bedside reporting is using all of the available technology and resources to mitigate error
in the handoff process.
There are many reasons that policy changes are both accepted and put into place or they
are declined. One important factor is nursing professional values. The ANA sets out standards,
one of which is ethics and another or professional practice evaluation (White & OSullivan,
2012). These standards are indicative of implementing practice change. The change must be
ethical and it must be evaluated to be sure that it is a useful and helpful practice. Relevant health
care policy must also be taken into consideration. The new policies must have guidelines that
are easy and practical to implement, while allowing the current practice time to be phased out.
There should not be a shortage of resources, as the only thing needed is the nurses themselves for
implementing bedside reporting. Bedside reporting must follow all of the ANA standards, but
bedside reporting is especially indicative of Standard 11, Communication (White & OSullivan,
2012). Communication is essential for all those involved in the care of the patient; it helps to
ensure no mistakes are made and that everyone knows the particulars of that patient. Bedside
reporting will help both the patient and the nurse to be more satisfied.

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References
Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Harrington, L., &
Heafey, C. A. (2009, August). AACN levels of evidence: What's new? Critical Care
Nurse, 29(4), 72. doi:10.4037/ccn2009969
Cairns, L. L., Dudjak, L. A., Hoffmann, R. L., & Lorenz, H. L. (2013). Utilizing bedside shift
report to improve the effectiveness of shift handoff. The Journal of Nursing
Administration, 43(3), 160-165. doi:10.1097/NNA.0b013e318283dc02.
Evans, D., Grunawalt, J., McClish, D., Wood, W., & Friese, C. R. (2012). Bedside shift-to-shift
nursing report: Implementation and outcomes. MedSurg Nursing, 21(5), 281-284, 295.
Retrieved from http://www.medsurgnursing.net/cgi-bin/WebObjects/MSNJournal.woa
Maxson, P. M., Derby, K. M., Wrobleski, D., & Foss, D. M. (2012). Bedside nurse-to-nurse
handoff promotes patient safety. MedSurg Nursing, 21(3), 140-144. Retrieved from
http://www.medsurgnursing.net/cgi-bin/WebObjects/MSNJournal.woa
PRE-LICENSURE KSAS. (2014). In QSEN Institute. Retrieved August 6, 2014, from
http://qsen.org/competencies/pre-licensure-ksas/#cite2
Riesenberg, L., Leitzsch, J., & Cunningham, J. M. (2010). Nursing handoffs: A systematic
review of the literature. American Journal of Nursing, 110(4), 24-34.
doi:10.1097/01.NAJ.0000370154.79857.09.
White, K. M., & O'Sullivan, A. (Eds.). (2012). The Essential Guide to Nursing Practice (p. 159).
Silver Springs, MD: Nursesbooks.org.
www.jonajournal.com
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www.medsurgnursing.net