Change of shift in the nursing profession is unique (Caruso, 2007). Information is transferred between nurses verbally and through written communication. In many facilities shift report from one shift to another involved sitting down and getting all your orders from a caredex and then talking with the previous nurse face to face going over pertinent information regarding their patients. This type of report usually happens in a report room or sometimes in the hallways or other common gathering areas where others may over hear your conversation. The patients are the center of communication but are seldom involved in the process (Caruso, 2007).
The importance of an informative and effective nurse-to-nurse report has been highlighted most recently in the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goals (NPSGs) (Caruso, 2007). The Joint Commission included managing hand-off communications among its 2009 national patient-safety goals (Trossman, 2009). The goals recommend that as part of high quality, patient centered care, hospitals implement a standardized approach to hand off communications, including an opportunity to ask and respond to questions (JCAHO, 2009).
JACHO states the primary objective of a hand-off is to provide accurate information about a patient’s care, treatment, and services; current condition; and any recent or anticipated changes (2009). The predominant goal of bedside reporting is for better communication among staff, greater patient safety, and time efficiency (Webster, 1999). The process for bedside reporting needs to be standardized. A pilot study was started on a medical/surgical unit at hospital X in 2011 before expanding to other units.
In anticipation of the change to bedside reporting, staff members were informed ahead of time and were made aware of what information should be shared at the bedside with the nurse and patient. Founded on evidence based research, I feel it is a necessary action that needs to take place for the benefit of the patient and nursing staff to improve communication between the patient and healthcare team members. According to Byers, Friesen & White (2009), effective communication has been shown to decrease medical error, increase patient empowerment, and increase teamwork among medical professionals.
In addition, bedside reporting has been shown to increase patient self-efficacy and just enhances patient centered care (Greaves, 1999). The Institute of Medicine (IOM) worked to identify what was causing errors in hospital care. They released a report called Crossing the Quality Chasm (2001), from this report six fundamental changes were recommended for the delivery of health care in the 21st century based on six key dimensions. The first dimension is to provide safety and avoid injury to patients from the care that is intended to help them.
The second dimension states the issue of timeliness and reduces the amount of time and harmful delays. The third dimension noted is effectiveness of care. Providing actual care services based on scientific knowledge to all that can benefit will be the most effective. The fourth dimension listed is efficiency. We need to avoid waste. The fifth dimension is equitability; provide care that does not vary in the quality because of personal characteristics such as gender, ethnicity, geographical location, and socioeconomic status.
The final dimension is patient centeredness; provide care that is respectful of and responsive to individual patient preferences, needs and values. (Madhok, 2002). By practicing these principles, healthcare professionals can reform the healthcare system with every patient care experience. The integration of bedside report addresses all of these dimensions. Bedside reporting provides patient centered communication and it has been shown through evidence based practice.
A patient centered approach is an important element in promoting self-efficacy as it encourages patients to participate in their care and become part of the decision making (Eich, Kiss, Langewitz & Wossmer, 1998). When the patient is excluded from the discussion and decision making of the nursing staff it makes room for a loss of opportunity by the patient for health promotion and self-efficacy. Patients’ perceptions of their level of self-efficacy could either augment or interfere with their health teaching learning abilities. As cited by Kas? kc? , M. 2011) a central concept in Bandura’s theory (1997), self-efficacy is defined as the degree of confidence that individuals have in their ability to perform specific activities successfully.
Nursing theorist, Imogene King’s theory of goal attainment can be applied to bedside reporting. One major concept of King’s theory listed by McEwen & Wills (2011) is nursing; a process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation. The nurse and client share specific goals, problems, and concerns and explore means to achieve a goal (p. 63). When mutual goals have been identified, means have been explored, and nurse and client agree on means to achieve goals, transactions will be made, and goals achieved (Lane-Tillerson, 2007).
Once the patient’s goal(s) are achieved then satisfaction occurs. If goals are attained then effective nursing care has been followed. A second concept of King’s theory is communication. Communication is a process by which information is given from one person to another either directly in face-to-face meetings or indirectly.
Communication involves intrapersonal and interpersonal exchanges (McEwen & Wills, 2011 p. 163). Individuals interact to form dyads, triads, and small and large groups. These comprise yet another type of system called interpersonal systems. Effective communication must exist between the client, nurse, and other members of the health care team. Effective communication is critical for an accurate handoff (Bonacum, Graham & Leonard, 2004). King’s model is general and universal and can be the umbrella for many midrange and practice theories (McEwen & Wills, 2009 p. 65).
Bedside reporting consumes this concept directly with the patient. Borrowing change theory from administration and management theories as the motivation to change at any organization is important. Kurt Lewin developed a change management model. When Lewin’s model is used correctly and in its entirety by a group or a system, effective change is implemented (McEwen & Wills, 2011 p. 337). I feel the most important steps listed by Kotter (1995) (as citied by McEwen & Wills, 2011) are the following. The initial step is to create a reason for the change to occur.
Because of the growth of the healthcare system and the demands of the patients, the transition in bedside reporting is absolutely needed. Another step necessary is to communicate the purpose of the change to the organization and patients. Positive reinforcement is needed when the organization begins the change phase. An example of positive reinforcement was when nursing administration brought in lunch for nursing staff as a reward for being a part of the pilot study. At hospital X multiple teams were formed to identify the positive and negative aspects of the change and the costs involved.
Kurt Lewin describes two forces involved in change, driving forces and restraining forces. The driving force facilitates movement to a new direction, goal, or outcome and a restraining force has the opposite effect; it blocks or impedes progress toward the goal (McEwen & Wills, 2011 p. 337). Kurt Lewin (1951) describes three phases necessary for change to occur (McEwen & Wills, 2011). The three phases are unfreeze, change, and refreezing phases. During the unfreeze phase individuals need to be informed about the need for change.
In the unfreeze phase you should seek to unlock the present way of doing things or status quo, establish a new vision for the organization, as citied by Alistair website (http://www. absolutelypositive. co. uk/2011/10/we-love-kurt-lewin-model-of-change-management/). The way nursing staff has been giving shift report to the next nurse has never really brought the patient into the picture. Bedside reporting will allow the patient to take part in their care, and can clear up any misconceptions that may be lingering.
The second phase is moving towards the new desired change. During this phase, the changes are being planned and executed and we need to monitor to see the benefits of this changed practice. The process of planned change, execution of the change, and outcome measurement was started in 2011 as a pilot study on a medical/surgical floor at hospital X. The final phase is the refreezing phase. This phase is when stabilization occurs. When stabilization is successful, the change is assimilated into the system (McEwen & Wills, 2011).
At hospital X, Unit 6 South is very close to the refreezing phase because most staff members feel established on the unit with new staff members and the new process of our workflow. Support from administration is important to provide staff with adequate staffing, resources, and training to make the change successful. We still need to get rid of old habits and try to focus on the patient and goals at hand during this time of change. Carusro (1997) believed using Kurt Lewin’s planned change theory provides evidenced based practice.