Communication refers to the exchange of ideas, thoughts, feelings, or emotions between people. It is a fundamental skill for nurses that enables them to interact well with their colleagues, patients, families, students, public members, and significant others. Berman et al. (2014) assert that nurses obtain assessment data through communication, initiate plans of care, evaluate the effectiveness of interventions, and build good relationships with their clients or patients. Misunderstandings and misperceptions always arise when the communication process is faulty, leading to errors in patient care and professional practices. Change-of-shift reports are essential for nurses to share information pertaining to aspects of care of a patient. Despite the proven benefits of the bedside reports, research shows that nurses do not fully embrace this practice (Bryand, 2018). This paper will review nurses' perceived barriers towards performing bedside reports in acute care settings.
Handoff communication refers to the process through which information about a patient or client shared with another healthcare worker to ensure the continuity of care. Effective handoff reports should be up to date, interactive, and concise. Change-of-shift reports should also provide means for verifying the information, with minimal interruptions, follow a particular order, include the client’s present information and significant changes in their condition (Berman et al., 2014). The reports should also address the need for holistic care for patients such as emotional support. For nurses, change of shift reports or handoff communication always occurs between a departing and oncoming nurse.
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There has been an increased adoption in the bedside shift report (BSR) practice among nurses in recent years. Traditionally, nurses used to give shift reports at the nursing stations. Bedside shift reports imply that outgoing nurses pass the necessary information to the oncoming nurses at the bedside in the presence of the patient (Palumbo, 2015). Bedside shift reports increase involvement of patients and their family members, improve the nurse-patient relationships, and the overall satisfaction of nurses and patients (Principe, 2018). Additionally, patients also feel that they receive high quality care and their right to information respected.
One of the issues with the practice is the relaying of sensitive information about the patients. Privacy and confidentiality are considered to be absolute rights of a patient. Nurses should not disclose their patients’ details to third parties without the consent and permission of the latter. Nurses cannot always discuss the progress, medical diagnosis, special needs, laboratory results, and diagnostic findings at the bedside. Nurses opt to discuss whatever information they find sensitive in private rooms or areas to respect the patient’s privacy (Tobiano et al., 2017). Furthermore, patients would not like their information to be disclosed to some people, including other patients in the ward. Therefore, patients’ privacy, confidentiality, and sharing of sensitive information are among nurses' perceived barriers towards full adoption of bedside shift reports.
More time is taken when handing over patient data at the bedside. To ensure patient integration in the process, information has to be relayed at a slower pace. Moving from one patient’s bed to another to hand over their report also consumes some time. Involving patients and relatives in the handing over also consumes more time (Tobiano et al., 2017). Family members may ask a lot of questions, some even not related to the patient's condition. A study conducted by Tobiano et al. (2017) showed that nurses were concerned with the issue of time spent with this practice of BSR. According to Dorvil (2018), adopting bedside shift reports may be time-consuming, and nurse leaders should critically review the practice and come up with well-laid implementation plans. Nurses felt that they would save more time were the reports to be handed over at the nursing stations. Reports given at the nursing station are also effective. Consequently, nurses could utilize the extra time spent with BSR in other areas of nursing care. Therefore, the perception that more time is spent with bedside reports is also a contributing factor towards the nurses’ reluctance to constantly adopting the process.
In basic terms, the communication process is an ongoing one that involves a sender and a receiver. For the method to be effective, it should have minimal to no interruptions. However, communication is interrupted as nurses give reports at a patient’s bedside. Interferences in communication flow could arise from environmental noise, disruption by nurses involved and not involved in the handover, questions from relatives and their patients, and a language barrier between the nurses and patients. Communication disruptors also increase the concern for time. Therefore, the nurses’ perceived interferences that disrupt information flow are another deterrence towards the consistent adoption of bedside shift reports.
Also, patients fail to understand medical jargon. It may lack relevance using some medical terms patients do not understand, while the terms may be the most appropriate to pass the information. Patients may also not fully participate in the process due to their medical conditions or literacy levels (Tobiano et al., 2017). It may also be boring for patients to keep on hearing the same things at the end of nurses' shifts. All these factors make nurses uncomfortable with BSR, which may hinder them from fully implementing the practice.
Bedside shift reports provide an opportunity for improving handoff communication and providing patient-centered care. However, the earlier discussed factors influence the intended goals, adoption, and overall success of the practice. Institutions should carefully evaluate perceived barriers and develop innovative ways of addressing them to increase the efficiency and effectiveness of the BSR practice. Bedside shift reports should be used to complement handover reports given at the nursing stations.
References
Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., ... & Parker, B. (2014). Kozier & Erb's Fundamentals of Nursing Australian Edition (Vol. 3). Pearson Higher Education AU.
Bryand, E. (2018). Identification of Barriers to SBARB at the Bedside in an Acute Care Setting.
Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and sustainability. Nursing management , 49 (6), 20–25. https://doi.org/10.1097/01.NUMA.0000533770.12758.44
Palumbo, J. (2015). Implementing Bedside Shift Report: An Evaluation of Change in Practice.
Principe, I. C. (2018). Examining nurse satisfaction with a bedside handover report process.
Tobiano, G., Whitty, J. A., Bucknall, T., & Chaboyer, W. (2017). Nurses’ perceived barriers to bedside handover and their implication for clinical practice. Worldviews on Evidence‐Based Nursing , 14 (5), 343-349.
