NURSING COMMUNICATION

Nursing Communication

Nursing Communication

1.Introduction

Implementing a standardized approach to hand-off communication is a key component of one of the 2007 National Patient Safety Goals for Hospitals established by the Joint Commission (2006). This goal was established to improve the effectiveness of communication among caregivers and emphasize the importance of allowing caregivers the opportunity to ask and respond to questions during hand offs, including change-of-shift reports. The Joint Commission (2000) has identified communication failures during shift reports as a leading cause of sentinel events in the United States.

Providing adequate information during change-of-shift reporting is essential to promoting patient safety; however, information is often lost during traditional audiotaped reports. Oftentimes, repetitive and irrelevant information is passed on while key information is left out. Although patient safety is the focus for nursing staff, involvement in the plan of care is fast becoming an expectation of healthcare consumers. With massive amounts of information available on the Internet and provided by television and radio, patients are more knowledgeable about their health and want to be involved in the process of planning their own care. Nursing staff are faced with the challenge of providing an efficient change-of-shift report that records essential information to promote patient safety, while including the patient in the care-planning process. The purpose of this article is to discuss how a stroke rehabilitation unit was able to implement a bedside change-of-shift reporting process to meet both of these goals.

2.Importance of the communication failure

Traditionally, change-of-shift reporting has been performed away from the bedside either with an audiotaped or verbal report. Shift reports have often been unstructured, repetitive, and lacked consistency in the type of information provided by each individual nurse. Johnson and Web (1995) found that nursing report assessments are frequently subjective in their content and accompanied by value judgments and labeling of patients. In addition, shift reports often lack care planning (Mosher & Bontomasi, 1996), which leaves nurses without a focus for how to best assist in meeting patients' goals during their shift. In a study by Jordan (1991), only 12% of change-of-shift reports included care planning and 2% included evaluation of nursing care. These issues often left nurses with insufficient information to provide patients with the best possible care and limited patients' input into their own plan of care.

Shifting from an audiotaped or verbal report to a nontraditional bedside report can be a difficult transition for nurses. Issues of concern that make the transition difficult include confidentiality; length of report; and discussion of sensitive items such as a new diagnosis, test results, and issues surrounding difficult or noncompliant patients. In a study done by Anderson and Mangino (2006), concerns regarding confidentiality were a major issue when attempting to shift from a change-of-shift report in a private conference room to a report at the bedside. Caruso (2007) also identified confidentiality as an issue in her hospital, where change-of-shift report was conducted in private rooms. Another concern among nurses was that a bedside report could lengthen rather than shorten a ...