Translational Research

Current Nursing Practice in the Healthcare Setting Requiring Change

There are numerous areas within nursing that demand change in everyday healthcare practice. More often than not, irrespective of the healthcare setting, an inventive group is required to conduct research and facilitate change. I presently work as a clinical educator in my hospital. There are numerous practices that require change or upgrading. Subsequent to conducting a review and research analysis, my decision is to include bedside reporting, which is lacking within the hospital. Bedside report occurs between the outward-bound and inward-bound nurse alongside a patients bedside while conducting a shift change. The meeting is purposed to facilitate patient engagement in trade of real-time information during shift change. This provides both the inward-bound nurse and the patient the prospect to ask questions and authenticate significant information regarding the history of the patient and care plan prior to the outgoing nurse leaving (Rush, 2012). Most importantly, bedside reporting is in alignment with patient-centered procedures in contrast to provider centered-care medical system and is anticipated to have a positive impact on the organizational nursing output together with patient satisfaction.

Justification for Bedside Reporting as a Proposed Practice Change

At the present moment, the hospital provides in-patient nursing services to several patients. Nurses are expected to change shifts at least two to three times every single day. The problem being faced at the moment is that plenty of time is wasted in recording information of the patient medical history, diagnosis and medical status. In addition, the prevailing system of recorded hand-off results in several medical errors and mistakes within the organization. Some of the medical mistakes that are presently being experienced in the hospital include patient blood incompatibility, air embolism together with catheter-associated urinary tract infections. In addition, there is the major problem of collapses in communication amidst nurses and between nurses and patients. There is a significant need to introduce bedside reporting within the hospital as it will generate significant benefits (World Health Organization, 2013).

The proposed practice change will enhance patient safety and quality. In particular, bedside reporting is a prospect to make certain there is efficacious communication between the nursing personnel, patients and their immediate families. This new practice change within the hospital will augment patient safety together with service delivery. In addition, the enhanced level of communication in the course of the shift report can aid in pinpointing and dealing with medical errors. Secondly, bedside shift reports will aid the hospital in having better patient experience of care. In accordance to a report by the World Health Organization (2013), subsequent to carrying out bedside reporting, hospitals demonstrated a rise in patient satisfaction scores and enhancements in the relationship between the nurses and patients. In addition, it is expected that the proposed practice change will give rise to a significant decrease in the average number of call lights that are turned on by patients at the change of the nurses shifts.

The proposed practice change will also have a constructive impact on the hospital at large owing to increased nursing staff satisfaction. This is for the reason that nurses are able to visualize their patients in a faster manner, improved practical learning between the older and newer nurses together with an increase in accountability. In addition, nurses are able to communicate more often and in a faster manner thereby resulting in lesser medical blunders. For instance, in accordance to research conducted by Anderson and Mangino (2006), bedside shift report had numerous positive results for the healthcare facility including the recovery of numerous hours of incidental time in the initial two-pay periods of the study, increased personnel satisfaction from the visualization pf patients within the 20 to 30 minutes of the beginning of the nursing shift, increase in physician satisfaction owing to the feeling of having more informed and conversant patients, increased patient satisfaction and medical diagnosis and status insight and a general sense of patient safety.

Another justification of the proposed practice change in the hospital encompasses time management as well as accountability between nurses. In accordance to a report by the World Health Organization (2013), subsequent to executing bedside report, hospital nursing staff have relayed a better capability to place priorities on their cases or responsibilities in the course of their shift and a general decline in staff time. For instance, one research study demonstrated a decline in over-shift time by 100 hours within the beginning 2-pay periods on a general surgical unit comprising of 32 beds. Another research study demonstrated a decline of $8,000 that is directly linked with a decline in time for reporting in shifts. This indicates the major need for instituting bedside report within the hospital to not only increase the accountability of nurses and the time spent during shifts but also generate cost savings across different medical departments.

Key Stakeholders who are Part of Current Nursing Practice

Determining the key stakeholders involved in the nursing practice can be simple and also challenging. The aspect taken into consideration in pinpointing the stakeholders include the parties directly influenced by the change and the parties with the authority to carry out and implement such change within the healthcare setting. In that regard, the following persons within the hospital have been determined as being the key stakeholders in the proposed practice change of bedside reporting: clinical operators, clinical educators, nurses directly dealing with patient care, facilities rendering treatment to the patients and the organization as a whole.

To begin with, clinical operators will be impacted by the proposed change for the reason that they are the supervisors and managers responsible for oversight of the clinical personnel. In this regard, the clinical operators are liable for embracing such change and thereafter carrying out such change within the entity.

Secondly, clinical educators within the healthcare setting are liable for teaching new and prevailing personnel to the newly proposed change practice and also offering guiding principles to facilitates its effectiveness. In essence, the clinical educators will give instructions regarding the tools ascertained by the research study. Clinical teaching and education deals with the attainment of the several skills and capabilities to facilitate efficacious practice in healthcare professions. Changes in curricula or practice for healthcare professionals institutes a progressively more significance of methodical learning of key sklls and demonstration of how to acquire such skills and become fully competent. Being a new practice introduced into the hospital setting, clinical educators will be liable for such patient-based and patient-centered teaching and learning, which necessitate being cognizant of not only the nurses learning but also the welfare of the patient (Eta et al., 2011).

Third, the nurses are the stakeholders that will be significantly impacted by the proposed change practice. This is for the reason that they will be tasked with the main duties of espousing and practicing the beside report change on an everyday basis. Nurses are responsible for the safe hand-off of the patient between each other and also including the patient and family. Essentially, nurses are the party responsible for explaining the process, appealing the patient and family to be part of the bedside shift report, and handing the form of the bedside report to the patient. It is imperative to note that devoid the nurses, it will be problematic to assess the efficacy of the change.

Other key stakeholders within the healthcare setting who will be influenced by the practice change are patients. Bedside reporting places patients at the core of care providing them with a more active role within the care being rendered to them. Thereby, the patients will largely profit from the proposed change by experiencing increased patient safety and also being included in their plan of care. With regard to bedside reporting, patients are positioned at the center of care. By carrying out bedside reporting during the change in nursing shifts, both the patient will have the chance to ask questions, demonstrate their apprehensions and worries, and to communicate objectives of the care, all which are phases that increase patient safety.

Evidence Critique Table

Full APA Citation

Evidence Strength

Hierarchy

Types of Studies

Ofori-Atta, J., Binienda, M., & Chalupka, S. (2015). Bedside shift report: Implications for patient safety and quality of care.Nursing2017,45(8), 1-4.

IV

Non-Experimental

Descriptive

Spinks, J., Chaboyer, W., Bucknall, T., Tobiano, G., & Whitty, J. A. (2015). Patient and nurse preferences for nurse handoverusing preferences to inform policy: a discrete choice experiment protocol.BMJ open,5(11), e008941.

IV

Non-Experimental

Descriptive

Bradley, S., & Mott, S. (2014). Adopting a patient?centred approach: an investigation into the introduction of bedside handover to three rural hospitals.Journal of clinical nursing,23(13-14), 1927-1936.

III

Quasi Experimental

Case Controlled

Achrekar, M. S., Murthy, V., Kanan, S., Shetty, R., Nair, M., & Khattry, N. (2016). Introduction of situation, background, assessment, recommendation into nursing practice: A prospective study.Asia-Pacific journal of oncology nursing,3(1), 45.

III

Quasi Experimental

Prospective

Salani, D. (2015). Implementation of shift report at the bedside to promote patient-and family-centered care in a pediatric critical care unit.Journal for nurses in professional development,31(2), 81-86.

VI

Qualitative Study

Qualitative Studies

The first study discussed the need for carrying out bedside reporting in an effective and evidence-based practice manner. The key is that numerous patients are provided with medical care in hospitals in an everyday basis, which includes several shift changes. Therefore, through bedside reporting, medical errors are prevented and in overall the quality and safety of care is improved. This study indicates the implementation of the situation, background, assessment, and recommendation (SBAR) communication tool that facilitates the restructuring of reports in a significant manner. However, the study presents the SBART tool, which includes thanking the patient at the culmination of the process. The tool is delineated as follows:

1. Situation

The outgoing nurse makes an introduction of the oncoming nurse. Subsequently, the oncoming nurse conducts a greeting of the patient whilst checking the wristband for verification of both the name and the date of birth. This also includes the provision of diagnoses and the nurse makes sure the patient information board in the room is up to date.

2. Background

This segment encompasses involvement of the patient in the report for changing the shift. The patient is requested to listen and subsequently ask questions or provide additional information. A succinct but pertinent information on the health history of the patient is given, circumstances that resulted in hospitalization and the anticipated length-stay in the hospital.

3. Assessment

This section includes momentarily conducting an assessment of systems comprising of vital signs, all tubes and invasive lines. Pain assessment is also conducted together with substantiation of the accuracy of medication pumps especially with regard to the rate of infusion.

4. Recommendation

This takes into account social and communication needs, objectives for the patient, any incomplete orders, and the plan for providing patient care. The patient and the oncoming nurse are given the opportunity for questions.

5. Thank

The final phase is giving thanks. The nurse should thank the patient at all times.

The SBART tool is a material and simple context for communication that is employed for setting any conversations, instituting prospects and communicating any imperative information to patients (Ofori-Atta, Binienda, & Chalupka, 2015).

Bedside reporting enhanced the teamwork of the staff by providing nurses the chance to work in tandem at the bedside, guaranteeing responsibility. Through the use of a standardized format such as the SBART tool diminishes the risk of miscommunication for the reason that it successfully deals with dissimilar styles of communication. In addition, improved communication aids the oncoming nurse to rank assignments based on need and makes certain that the nurses are in sync and informed. The adoption of bedside reporting guarantees patient satisfaction scores mirroring the increased positive experiences of the nurses. The study indicates that through the assimilation of the SBAR tool, there was a decline in overtime by a period of 100 hours in the initial period owing to the succinct reporting.

In this study, the researchers sought to espouse the SBART tool to facilitate concise reporting and substantiate that the information is understood by both the patiet and oncoming nurse and patient information is up-to-date (Ofori-Atta, Binienda, & Chalupka, 2015).

The second article delineates bedside report as a chance to attain patient engagement and promotion of patient-centered care. Moreover, it lays emphasis on the need to take into consideration the inclinations of both nurses and patients when carrying out bedside shift report to capitalize on the efficacious uptake of this practice. Spinks et al. (2015) make use of...…additional time to teach nurses the manner in which they can effectively carry out bedside reporting, which is will be a new practice. Another barrier is that despite the fact that patients will be involved and engaged in the bedside shift report, this can result in increased time wasting. This is linked to the apprehension that the oncoming nurse would be considerably held up by the several wishes and questions posed by the patient. Moreover, there is also the challenge that change in behavior is not simple. This is for the reason that nursing workshops undertaken in a day or two are not likely to bring about sustainable change. It is necessitated for nursing leaders to position sufficient EBP mentors that can work in tandem with clinicians to assist them in learning the newly required skills and practices and how to execute them incessantly. The key lies in generating a framework together with a support system where new evidence-based practice can be maintained (Wallis, 2012).

Lack of motivation is another barrier that is expected to hinder the implementation of the practice change. It is imperative for in-patient direct care nurses to have personal determination and motivation to improve themselves in order to render better professional health care to patients. However, the obstacle to this is that nurses who have worked within a certain healthcare environment for a long-time period would not be interested or enthused to embrace a new change in practice. Stagnation is usually a key determining factor together with the time-period between current employment and official academic training. Most of them forget the necessity of remaining current, their accountability to the profession and to their patients (Tacia et al., 2015).

Time management is another barrier to implementation of organizational-wide changes. Time is a significant factor within the healthcare setting as it is necessary to ensure that all patients receive proper medical assistance instantaneously as required. More often than not, nurses consider bedside reporting to take considerably more time as compared to recorded handover. There is the concern that nurses feel pressured and also face a lack of sufficient time to undertake bedside reporting especially when they have several number of patients to take care of within the ward regardless of whether the information is succinct and efficient (Spinks et al., 2015).

Ethical Implications

There are a number of ethical implications that may arise while planning or carrying out the proposed practice change of bedside reporting. One of the key ethical issues is confidentiality that takes place when the patients being treated have visitors or a roommate in the handover process from the outgoing nurse to the oncoming nurse. This is for the reason that sensitive information regarding the patient may be communicated or leaked which is unethical. There is also the apprehension that bedside reporting approach may be in violation of the Health Insurance Portability and Accountability Act (HIPAA), which outlines that potentially sensitive and private information should not be leaked. At times, the patient or the patients family may not be cognizant of particular medical information or a diagnosis. It is imperative to note that beside shift report is not deemed a suitable setting for deliberating on negative news. For instance, the physician may not had had any initial opportunity to convey the results of test with the patient, or a parent may not know that his or her child has cancer. More often than not, this kind of sensitive information should not be talked about during the change in shift by the nurses. In the event that it should, the data or information can be interchanged between the nurses prior to entering the ward or patient room, or the nurses can point to pertinent information on the patients chart in the course of the bedside shift report. Patients have the right to be guaranteed that their nurses, physicians, together with other healthcare professional to hold all medical data and information regarding them in stringent confidence and reveal it to solely those who need or are legally entitled to the information (World Health Organization, 2013).

There is also the implication of significant costs and also time-consuming processes. It is imperative to note that bedside reporting is a practice that consumes a lot of time. At times, a great deal of time can be taken up by nurses while conducting bedside reporting filled with personal conversation, which is unprofessional. While implementing the practice change it is expected that the hospital will incur substantial cost savings owing to patient safety, declines in medical mistakes and blunders and also decrease in any aspects of treatment delays. There is also the implication of cost of time incurred by the nurse. This is in the sense that funds will be necessitated to finance the education required in carrying out the project. In addition, the nurse will have to spend more time in order to finish the new bedside report practice to the point where they become competent and specialists.

Conclusion

One of the key practices lacking in the hospital that I work in is the introduction and implementation of bedside reporting. Changes in shifts for nurses necessitate the efficacious transference of information between the outgoing nurse and the oncoming nurse to evade adverse occurrenes and medical errors. Bedside shift report is a clinical countenance of engaging patients and families as indispensable partners in the health care team. This proposed practice change for the hospital will facilitate proper communication in the course of transitions in medical care, for instance nurse shift changes, which is considerably imperative for making certain that patient hand-off is both safe and efficacious. Permitting the involvement of the patient during the bedside reporting process grants them the opportunity to learn and gain insight on what has taken place all through the shift and the subsequent steps in their plan of care. Moreover, this proposed practice will give patients the chance to ask questions and give input into the healthcare process. In overall, this proposed practice change will significantly benefit the hospital through improved patient safety and quality, patient experience of care, nursing personnel satisfaction, and moreover time management and responsibility between…