Bedside clinical handover

Do Bedside Handovers Improve Nurse-Patient Relationships? A Research Proposal
Introduction
Background
The nurse-patient relationship is the foundation for effective nursing practice (Kitson et al., 2014, p. 1234). This is because existing evidence suggests that improved nurse-patient relationship ensures patient-centric care (Bolster & Manias, 2010, p.244). In practice settings, different factors influence the development of nurse-patient relationships. Kitson et al. (2014, p. 1234) pointed out that nurses should be competent in motivating, integrating and sensitizing patients with an empathetic approach. According to Kitson et al. (2014, p. 1234), successful nursing is accomplished through three vital components. These components include; I) capacity to integrate care as per the needs of a patient, 2) establishment of a relationship with the patient and 3) making sure that the wider context of healthcare framework is achieved through commitment and accountability (Kitson et al., 2014, p. 1241, Toccafondi et al., 2012, p.58). Bedside-handover handover demands all the three vital components that were specified by Kitson et al. (2014, p. 1234).
Bedside- handover is one such approach that purportedly integrates patients in the process of planning and extending care interventions (Philpin, 2006, p.87). Different types of nursing handovers are evident across clinical settings. Examples of nursing handover include verbal handover, written handover and bedside-handover (Nasrabadi & Emami, 2006).

Bedside-handover is a type of nursing handover that integrates care as per the needs of a patient. Moreover, bedside-handover aims to provide autonomy to patients for deciding on their care interventions. This is because bedside-handover involves a patient in the decision-making process. Hence, by integrating and involving patients in the process of care bedside-handover might influence nurse-patient relationships (Philibert, 2009, p. 261). Hence, the proposed research would explore the role of bedside-handover in improving nurse-patient relationships in relation to care provisions in a specific nursing shift.
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The importance of nurse-patient relationship in influencing health outcomes has been acknowledged over the past three decades (Bolster & Manias, 2010, p.244). Peplau (1989) defined nurse-patient relationships as an interaction between nurses and patients for enhancing health outcomes. Peplau (1989) contended that “nurse-patient relationship helps to ensure transfer of knowledge, thoughts, needs and feelings.” Addressing the needs and apprehensions of patients leads to better healthcare outcomes (Peplau, 1989). Transfer of knowledge, thoughts, needs and feelings between nurses and patients is essential to extend patient-centric care (Maben, 2008, p. 336, Trossman, 2009, p.308, MacKinnon & Hanna, 2010, p.27, National Institute for Health and Clinical Excellence, 2009). Patient-centric care leads to positive health outcomes (Bolster & Manias, 2010, p.244). Hence, stronger nurse-patient relationships help to involve patients in planning and extending care interventions.
Kitson et al. (2012) draws upon Peplau’s (1989) work and states that “nurses should be competent in motivating, integrating and sensitizing patients through an empathetic approach. Hence, a sympathetic approach may be considered as a part of patient-centric care. Nursing handovers are one way that is routinely witnessed across clinical settings (Caldwell, 2012, p. 86). Nursing handover is a type of clinical handover where the responsibility of a patient is shifted from one nurse to another (Caldwell, 2012, p. 86). Handover refers to the transfer of professional responsibility and accountability for every aspect of healthcare for a patient or a group of patients (Vines et al., 2014, p. 166). Similar to other healthcare professionals, staff nurses should be competent in exhibiting appropriate handover to ensure continuity of care for their patients (Caldwell, 2012, p. 86). In an appropriate handover, the patient is involved in the decision-making process in relation to the care provisions that are planned for them (Philpin, 2006, p.87).
Nursing handovers are intended for an appropriate transition of care and for extending accurate care interventions (Nasrabadi & Emami, 2006). Vines et al. (2014, p. 166) explored whether bedside-handover could be implemented as an effective handover practice during a change of shift. The study also explored whether bedside-handover promotes the safety of patients and facilitates nurse-patient satisfaction (Vines et al., 2014, p. 166). Hence, bedside-handover has been acknowledged as a type of nursing handover across practice settings (Philpin, 2006, p.87). Bedside-handover is the process of involving patients in the communication process during the transition of care between adjacent nursing shifts (Anderson & Mangino, 2006, p.114, Sexton et al., 2004. p. 42). Bedside-handover has been recognized to support communication between nurses and allied healthcare professionals regarding the health, healthcare plan and progress of a patient (Sexton et al., 2004. p. 42). Effective bedside-handovers helps to make patients aware about the care that is being extended to them. Moreover, bedside-handoversit raises the awareness of those individuals who are involved in the care process (Sexton et al., 2004. p. 42).
Bedside-handover is an effective mechanism for engaging and involving patients in the decision-making process during healthcare delivery (Sexton et al., 2004. p. 42). The process of handover implicates the importance of communication and information exchange for planning and extending care interventions (Sexton et al., 2004. p. 38). Such approach provides the necessary time for observing and understanding the personal/clinical needs of patients (Sexton et al., 2004. p. 40). Hence, the Sexton et al. (2004) study examined different dimensions of bedside-handover. Sexton et al. (2004) stated that effective bedside-handover helps to sensitize patients and integrates them in planning and extending care interventions. Hence, bedside-handover is a critical process in nursing practice that has the potential to integrate and involve patients in planning care interventions. Different authors have endorsed the benefits of bedside-handover across practice settings (Philpin, 2006, p.87, Sexton et al., 2004. p. 42, Broekhuis & Veldkamp, 2009). This is because these authors reflected that bedside-handover might ensure improved clinical outcomes (Philpin, 2006, p.87, Sexton et al., 2004. p. 42, Broekhuis & Veldkamp, 2009). Broekhuis & Veldkamp (2009) reported that bedside-handover improves the accuracy and timeliness of information transfer. This is because bedside-handover ensures that the concerned stakeholders are appropriately appraised and sensitized regarding the care provisions. The authors indicated the importance of integrating patients in the handover process (Broekhuis & Veldkamp 2009). Evidence suggests that involving patients in the care process could aid in clinical decision-making (Rush, 2012, p. 42). Bedside–handover emphasizes on an inclusive approach where patients are considered as healthcare partners (Broekhuis & Veldkamp 2009). Patients deserve the right to be included in the process of care and should be provided the autonomy of accepting or rejecting healthcare interventions (Fitzpatrick, 2010, p. 347). Involving patients in the handover process reduces the risk of fragmentation of care and adverse events (Schaller, 2007, p. 12). Rush (2012) speculated that bedside-handover could improve the continuity of care and lead to safe health outcomes.
Bauman (2003, p. 256) asserted that there are different perspectives that result in patient-centred care and improved nurse-patient relationships. For example, communication and relationship that exists between physicians and allied healthcare professionals or between nurses and their patients (Drenkard, 2010, p. 271). Bedside handovers have the effect of involving and engaging the patients during the provision of healthcare. Hence, the central focus in bedside-handovers is to integrate patient in the process of care giving (Greenhalgh, 2009, p. 631).
Bedside handover has been acknowledged to take into consideration the needs and preferences of patients (Nuss, 2013, p. 29). For example, verbal or taped handovers do not mandate the integration of a patient during change of shifts. McGee (2007, p. 408) indicated that nurse-patient relations are enhanced when needs and preferences of patients are taken into consideration.
Gibberson et al. (2012, p. 77) have argued for the implementation of bedside-handover across clinical settings because it provides the opportunity to understand the needs of the patient. Goodrich & Comwell (2008) contends that bedside-handovers play a vital role in ensuring patient safety. The authors stated that integrating a patient in the care giving process would help to unfold the apprehensions and needs of a patient. The Australian Commission on Safety and Quality in Health Care [ACSQHC] (2012) and the World Health Organization [WHO] (2006) have also acknowledged that bedside-handover is a significant initiative for improving the safety of patients.
Various studies have argued whether bedside –handover is the most effective means of ensuring nursing handover. For instance, Rutherford et al. (2004) asserted that the bedside handover usually enhances patient-centric care compared to other forms of nursing handovers because it provides the opportunity to understand the needs of the patient. Rutherford et al. (2004) contended that bedside-handover not only improves the safety of patients but also establishes satisfaction of the nursing professional because effective handovers leads to improved clinical outcomes. This is because such inclusive approaches provide an opportunity to the patient to be involved in the decision-making process and contributing to the process of healthcare planning (Keller et al. 2013, p. 175). Such communication ensures better planning and might enhance compliance of patients with the planned therapeutic interventions (Keller et al. 2013, p. 175). Different authors have recognized the importance of bedside-handover across the nursing practice.. Kitson et al. (2014, p. 1234) endorsed the importance of nurse-patient relationships in ensuring positive health outcomes. Chaboyer, McMurray & Wallis (2010, p. 27) stated that nurse-patient relationships could be established by bedside-handovers. Caruso (2007, p. 17) implicated that bedside-handovers are practiced across cardiology units.
Effective nursing handover could improve patient satisfaction and might lead to improved health outcomes (Robinson et al. 2008, p. 602). Nurse-patient relationships could be established through effective communication, enhanced information exchange and increased involvement of a patient in the decision-making process (Goodrich (2012, p. 112, Chaboyer, 2009, Kitson et al., 2013). Shared decision-making might be a determining factor in influencing nurse-patient relationships by ensuring patient-centric care (Barry & Edgman-Levitan, 2012, p. 780). Improved patient-centric care might translate into greater therapeutic compliance and improved clinical outcomes across concerned stakeholders (Carver & Jessie, 2011, p. 4, Jeffcott et al., 2009, p. 256).
Problem Statement
Bedside handover is recognized for its socialization and educational role (Kassean & Jagoo, 2005, p. 1). Keller (2013) further endorsed that effective bedside-handover improves nurse-patient relationships. Nursing handovers are heterogeneous in action. The nature of bedside-handover depends on the location, method, structure, and content of handover. The effectiveness of bedside-handovers is regulated by the cultural context of the clinical setting and patient’s culture, demographics of the patient and the geography of the setting. Exchange of appropriate information between nurses and patients is a key feature of bedside-handover. Information exchange occurs through verbal, recorded or written documentation. The ACSQHC (2012) Standard VI contends that inappropriate information exchange leads to negative health outcomes. ACSQHC (2012) standard six on clinical handover (ACSQHC, 2012) is underpinned by the knowledge that inappropriate clinical communication accounts for 70% of hospital sentinel events. Such statistics endorses the importance of appropriate communication for ensuring effective handover
Purpose of the Proposed Study
The proposed study seeks to explore if the nature of the nurse-patient relationship is enhanced by a nurse conducting bedside-handovers and if so how and if there is any impact on improving patient outcomes. The overarching research question is “Can the conduct of bedside handovers by nurses improve the nurse-patient relationship and if so, how?’
Assumptions of the Proposed Study
The study is based on the assumption that the nature of the nurse-patient relationship is critical to improving patient outcomes. The proposed study might also elucidate the importance of nurse-patient relationships in improving person-centric care. Hence, the proposed study would aid in evidence-based practice.
Research design
The proposed study would be undertaken as an integrative review. Torraco (2005) defined integrative review “as a specific review method that summarizes past empirical or theoretical literature to provide a more comprehensive understanding of a particular phenomenon or healthcare problem” (p. 356.) Integrative reviews are considered as the broadest and comprehensive type of research reviews that provides an opportunity for integrating experimental and non-experimental research. Hence, integrative reviews have the potential to appraise different qualitative and quantitative end points with reference to a specific research question (Torraco et al., 2005, p. 357).
Framework of an Integrative Review
Different steps are associated with conducting an integrative review. The steps for conducting an integrative review are as follows (Torraco et al., 2005, p. 359):
Problem Identification: This phase represents the research question or the clinical problem that needs to be addressed through the review. Theoretical and empirical data are essential for identifying a specific research question or a specific clinical problem.
Literature Search: This phase represents the integration and collection of different research articles that have been published in the past with reference to the specific research question. Different clinical websites and online journals are visited for selecting the appropriate articles.
Data Evaluation: This stage represents the viability and reproducibility of the articles that were collected through the literature search strategy. In other words, data evaluation helps to appraise published evidence based on its reliability and validity. The evidence is broadly appreciated according to their “levels” or “types.”
Data Analysis: The findings of different experimental and non-experimental research are collated and are subjected to appropriate statistical analysis. In most instances, a pooled analysis is undertaken for reporting the end-points of a research question or a clinical problem.
Presentation: This phase represents the synthesis and discussion of findings from the studies. This phase provides an opportunity to specify future research directions and for making recommendations on a clinical problem/research question.
Implementation of the Framework
The process of concept mapping would be vital in conducting the proposed study. This is because the concepts would help to develop various themes in relation to the context of bedside-handover. The context and content of bedside-handover could be divided into different themes (like bedside-handover and clinical outcomes, bedside-handover and nurse-patient relationship, bedside-handover and patient-centric care). Hence, concept mapping would help to analyse the different dimensions of bedside-handover in a holistic manner. First of all, studies meeting the inclusion criteria would be retrieved. Secondly, the concepts reported in the studies would be explored with respect to the research question framed for the proposed study. A concept map will then be constructed where the various concepts would be identified. Thirdly, the concepts or variables would be identified and defined to understand the broader perspective of the reported concepts. Understanding the concepts and variables is extremely essential for framing the concept map.
Conceptual Framework for the Proposed Study
The study will employ a conceptual framework by Kitson et al. (2014, p. 1229) to guide the discussion of the study’s findings. This conceptual framework has been chosen because Kitson et al. (2014, p 1229) contended that the hallmark of successful nursing care involves three vital components. These components include; I) capacity to integrate care as per the needs of a patient, 2) establishment of a relationship with the patient and 3) making sure that the wider context of healthcare framework is achieved through commitment and accountability. The Fundamentals of Care Framework by Kitson et al. (2014, p. 1230) emphasize the ways through which a nurse can empower a patient for assessing and executing their healthcare needs.
Kitson et al. (2014, p.1231) stated that a nurse could associate with a patient and help the patient to meet their healthcare needs. Kitson et al. (2014, p. 1242) suggested that the guiding ideology of such framework is the dedication and association of the nursing professional with their respective patient/s. From the perspective of Kitson et al. (2014), it is evident that dedication and association are subjective traits that vary across concerned stakeholders. Hence, it is important to acknowledge the importance of adopting bedside-handover in routine nursing practice. Implementation of effective bedside-handovers helps to integrate patients in planning and extending care interventions. Bedside-handover requires competency and skills in a nursing professional for integrating a patient in the care provisions. Integrating a patient requires the skills of dedication and association across nursing professionals for their patients. Hence, the Kitson et al.’s (2014, p.1231) philosophy would be the guiding framework for analysing the proposed study.
Hence the conceptual framework would contend that bedside-handovers may jeopardize or stimulate nurse-patient relationship, which might impact clinical outcomes in patients. Hence, it would be appropriate to explore the role of bedside-handovers in ensuring the nurse-patient relationships (Nuss, 2013, p. 36).
Proposed Procedure and Rationale
The methodology for addressing the specific clinical problem would be based on an integrative review approach. The integrative review would be conducted as per the framework specified by Toracco et al. (2005). Toracco argues a need to answer some critical questions – these questions and my answers are displayed in Table 1.
Steps of the Integrative Review Areas to be considered Implications for the Proposed Study
Before Writing the Review
(Preparatory Phase) What type of review article to be written? The review would be written on a mature topic “Role of bedside-handovers in improving the nurse-patient relationship.”
According to Toracco – a mature topic “addresses the need for a critical review and potential re-conceptualization of the expanding and more diversified knowledge base of the topic as it continues to develop.”Toracco (2005) reported that various authors had conducted integrative reviews on mature topics. These reviews have resulted in “fresh, new understandings, and, in most cases, a significant re-conceptualization of the mature topics reviewed.”
The proposed study would explore a mature topic as because data is available on different perspectives of bedside-handovers and nurse-patient relationships. The mature topic is “improvement in nurse-patient relationship.” The concept and domain of bedside- handovers and nurse-patient relationships have been elaborated in various studies. Hence, according to Toracco’s (2005) criteria, proposed study supports the objective of writing the review as a mature topic.
Toracco (2005) suggested that re-conceptualization would lead to the genesis of new and fresh understandings. Indeed, new and fresh understandings would help to generate evidence-based concepts for improving nurse-patient relationships. The evidence-based concepts would be based on the proposed integrative review. This is because the integrative review would explore highest levels of evidence for drawing conclusive recommendations on the content and context of bedside-handover. It is already acknowledged that improved nurse-patient relationship leads to patient-centric care and improves health outcomes across concerned stakeholders. Therefore, the proposed research aptly focuses on exploring the impact of bedside-handovers during change of nursing shifts in influencing nurse-patient relationships.
Is an integrative review most appropriate to address the research problem? An integrative review would be most appropriate to address the research problem. This is because Toracco (2005, p. 358) stated that “the need for the review article should be supported by discussing the importance of the problem or topic to be examined and by justifying why an integrative review is an appropriate way to address the problem.” Toracco (2005) also indicated that an integrative review should lead to the development of significant and value-added contributions to the identified problem or topic of study. Since there is robust literature on the topic, and both pros and cons against the concept are available, it could be possible to generate value-added evidence that might translate into positive health outcomes across concerned stakeholders. Integrative reviews are also helpful to address the omission or deficiency in existing literature.
Although the importance of bedside-handovers and nurse-patient relationships are well recognized across clinical settings, there is a deficiency of literature on the correlation between them. Identifying such deficiencies would help to define the content and context of bedside-handover. Toracco (2005, p. 358) further went onto state that “omission or deficiencies are confirmed in the literature review section of a larger empirical or theoretical study.” Hence, an integrative review would be helpful in holistically appraising a specific problem or topic. Moreover, integrative reviews are also appropriate when contradictory evidence appears. The proposed study would try to appraise and address the contradictory issues through the evaluation of qualitative and quantitative articles. Hence, an integrative review would be most suitable for the proposed study.
Would the review article have a significant impact/value addition to the new thought process in the specified field? Yes, the review would help to structure the content and approach of effective bedside-handovers in the future.
The review would help to extrapolate whether nurse-patient relationships and patient-centric care are ensured through bedside handover. Similar to other healthcare professionals, staff nurses should be competent in exhibiting appropriate handover to ensure continuity of care for their patients (Caldwell, 2012, p. 86). In an appropriate handover, the patient is involved in the decision-making process in relation to the care provisions that are planned for them (Philpin, 2006, p.87).
The proposed review would have a significant impact or value addition to the field of care transitions. This is because, the proposed study might implicate the content and context of bedside-handovers.
Organizing an Integrative Review
(Organizing Phase) Is the review article organized around a coherent conceptual structuring of a topic? Kitson et al. (2014) conceptual framework has been chosen because the authors stated the need for improved nurse-patient relationships in ensuring clinical outcomes. According to Kitson et al. (2014), patients should be involved in the decision-making process during planning and execution of care. Kitson et al. (2014, p.1231) endorsed that a nurse should associate with a patient and help the patient to meet their healthcare needs. Kitson et al. (2014, p. 1242) suggested that the guiding ideology of such framework is the dedication and association of the nursing professional with their respective patient/s. Such issues could lead to increased empowerment in patients. Bedside- handover is one such approach that purportedly integrates patients in the process of planning and extending care interventions (Philpin, 2006, p.87).
Are the methods for conducting the literature review adequately described A search strategy has been elaborately detailed in the literature search section of this proposal. The detailed search strategy would be used to access different nursing and medical websites, online journals, and libraries. The literature search would be based on the PICO question. The articles were/would be selected through keyword search strategy with the use of Boolean connectors.
The inclusion criteria – (why articles will be included in the integrative review) are as follows:
It must contain the structure and nature of bedside-handovers or,
It must evaluate the role of bedside-handover in influencing patient-centric care or
It must explore nurse-patient relationships based on nature of nursing handovers
The criteria would be explored from the study design and the reporting of the findings that would be evident in different articles that would be selected for the review.
It must explore the impact of nurse-patient relationship developed through bedside-handover in influencing health outcomes across patients.
What keywords and procedures are to be used to select the literature? The keywords and Boolean connectors used for the selecting the relevant articles were “Bedside- handover” or “Nursing-handover” or “taped-handover” or “verbal handover” or “written handover” AND “Nurse-patient relationship” or “Patient-centric care” or “Person-Centric care” AND “autonomy” or “decision-making” AND “ safe” or “quality care” AND “positive health outcomes”.
What/which databases will be used to access literature? The different websites that would be visited include Pubmed Central, Cochrane database, MEDLINE, CINAHL, EMBASE, OVID online, Research Gate, BMJ & AJN. These websites provide exhaustive and extensive literature on nursing, medicine and surgery.
What criteria would be used to retain or reject the selected literature for the integrative review? Inclusion Criteria
The published articles will be limited to English language and
Must be published between 2006-2016 and
Must be peer reviewed
Should include bedside-handover as the intervening variable and outcomes should be patient-centred care, nurse-patient relationship, the safety of care and quality of care.
Exclusion Criteria
Articles that were not published in English language and
Articles published beyond 2006-2016.
Articles that were not peer reviewed
Articles where bedside-handover/clinical handover was not used intervening variable and outcomes that did not include patient-centred care, nurse-patient relationship, the safety of care and quality of care.
In which form the evidence will be reviewed (Full text/Abstract)? Both text and abstracts would be reviewed. However, either the abstracts or the full-texts would be evaluated based on the inclusion criteria and end-points. Preferably, the full-text of publication would be reviewed because it would help to analyse the problem situation, experimental design, sampling, methodology, statistical end-points, strengths, and limitations of the given publication and scope of future studies and recommendations (if any). The future directions would help to synthesize or modify the methodology or analysis protocol of the proposed study.
How were/would be the main ideas and themes from literature review would be identified? The themes of search would be based on the research questions and the sub-research questions that are proposed for the present study. The publications included in the proposed study should address the following questions either as qualitative or quantitative end-points:
Impact of bedside-handover on nurse-patient relationships.
Impact of bedside-handover on person-centric care.
Role of bedside- handover in reducing the apprehensions of patients regarding their clinical and its role in providing autonomy to patients
Positive health outcomes developed due bedside-handover ensures nurse-patient relationship
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Writing an Integrative Review
(Final Phase) How the analysis of the literature would be done? (Critique) Torraco et al. (2005) reported that any piece of evidence or publication should be critically analysed before appraising or drawing a conclusion. The appraisal should start from reviewing the inclusion and exclusion criteria of a research study. Moreover, the study design should be appraised for exploring the chance of bias in the study. Studies where sampling is conducted in a non-randomized manner, could lead to subjective or experimental bias (Ezzo et al., 2001, p. 457). Publications with RCT (Randomized control trial) design should be preferred in preference to a non-randomized trial. Such study design should be applicable for both qualitative and quantitative studies (Ezzo et al., 2001, p. 457). The sample size of the study o publication should be critiqued for ensuring viability and reproducibility of the findings. The next criteria for critique should appraise the methodology adopted for the study. The methodology should deploy standardized questionnaire or instruments for evaluating the end-points of the trial. Finally, the endpoints of the study should be appraised based on its statistical inference.
As per standard convention, the studies should contend either to retain or reject the null hypothesis. The null hypothesis contends that there is no significant difference between two sets of observation. Any observed difference would be attributed to chance factors of random sampling. The null hypothesis will be retained if the p-value for the statistical test of significance is greater than 0.05 (p>0.05). On the other hand, the experimental hypothesis contends that there is a significant difference between two sets of observation. Any observed difference would not be attributed to chance factors of random sampling. The experimental hypothesis will be retained if the p-value for the statistical test of significance is less than 0.05 (p<0.05) (Kline, 2004).
What forms of synthesis would be used to stimulate further research? (Research agenda, meta-theory, conceptual model or alternative model? A research agenda will be proposed. The research agenda would be formulated based on the strengths and limitations of the articles appraised in the integrative review. The research agenda should specify the research design and the study parameters that would be instrumental to provide the framework for future studies. Hence, the research agenda that would be synthesized would aim to explore the models of bedside-handover that would be effective in improving nurse-patient relationships.
How will the literature be synthesized? The literature for the proposed integrative review would be synthesized under different sub-sections. These subsections would preferably include the domain and approaches of bedside-handover, the role of bedside-handover and nurse-patient relationships, and the content of nurse-patient relationship that translates into patient-centric care or positive health outcomes across concerned stakeholders and the impact of poor nurse-patient relationship on clinical outcomes or the probability of medical errors.
Detailed methodology for the integrative review
Problem Identification: Studies have indicated that improved nurse-patient relationship is essential for ensuring safe and quality healthcare. Bedside care or bedside handover promises improved nurse-patient relationships. However, preoccupation and time constraints amongst staff nurses limit delivery of safe and quality healthcare. Moreover, lack of person-centric increases the risk of medical errors and reduces therapeutic compliance across the patient population. Based on these problems the following research questions would be explored in this review. The primary research questions that would be explored in this review would be:
Whether bedside-handover impacts nurse-patient relationships?
To explore the primary research question in detail, secondary research questions would be explored. The secondary research questions framed for the study are:
a. Whether bedside-handover improves person-centric care
b. Whether bedside- handover is effective in reducing the apprehensions of patients regarding their clinical conditions?
c. Whether bedside handover provides greater autonomy and ensures improved decision-making skills amongst patients?
Literature Search and PICO Question
A standardized format PICO (Population, Intervention, Comparison, Outcomes) would be used to answer the research question and for finding out the key words. The Population included staff nurses; Intervention will refer to bedside – handover, Comparison refers to the nurse-patient relationship with or without involving patients in bedside-handover process (therefore studies where different types of handovers are used would be selected for comparison and Outcome will include patient-centred care, nurse-patient relationship, the safety of care and quality of care.
The literature search for the present integrative review would be based on “Keyword Search Strategy.” Different keywords would be connected with Boolean connectors for selecting the appropriate articles. The keywords and Boolean connectors that will be used for selecting the relevant articles are “Bedside handover” or “Bedside care” or “Clinical Handover” AND “Nurse-patient relationship” AND or “Patient-centric care” or “Person-Centric care” AND “compliance” or “medical errors” or “medication errors” AND “autonomy” or “decision-making” AND “ safe” or “quality care”. Different clinical and nursing websites would be visited for selecting the relevant articles. The different websites that would be visited include Pubmed Central, Cochrane database, MEDLINE, CINAHL, EMBASE, OVID online, Research Gate, and NICE guidelines.
The studies will be tabulated in a chronological order and sorted under various headings. The tabulations would include the objective of the paper, the methodology used and the statistical analysis of the end results. Such details will be collected and stored for the analysis part of the proposed study. The data would be used to answer the research questions that are framed for the proposed study. Google Scholar would be used for verifying different articles selected through the other websites. The articles would be selected based on certain inclusion and exclusion criteria. The detailed inclusion and exclusion criteria would be matched while conducting the search through the specific search strings (Appendix-1).
Inclusion Criteria
The published articles will be limited to the English language
Must be published between 2006-2016 and
Must be peer reviewed
Should include bedside-handover as the intervening variable and outcomes should be patient-centred care, nurse-patient relationship, the safety of care and quality of care.
Exclusion Criteria
Articles that are not published in English language and
Articles published beyond 2006-2016.
Articles that are not peer reviewed
Articles where bedside-handover/clinical handover is not used as the intervening variable and outcomes that do not include patient-centred care, nurse-patient relationship, the safety of care and quality of care.
Data Evaluation
Articles collected through literature search will be evaluated based on the level of evidence. The level-1 evidence is considered the highest piece of evidence, while Level-VII evidence is considered as the lowest level of evidence (Table 2). Levels of evidence are appraised based on the study design, sampling procedure and the quality of data analysis (Ezzo et al., 2001, p. 457).
Article (Literature search) Level of evidence Type of evidence Whether considered for the Integrative review (Y/N with reasons)
Search articles with keywords and Boolean connectors Explore whether the article/publication is a meta-analysis or systemic review or individual study. On the other hand, explore whether the study is based on RCT or non-randomized Systemic Reviews and Meta-analysis denote the highest levels of evidence along with RCT design (Level 1 evidence). On the other hand, an independent study without RCT design is considered the lowest level of evidence (Level 7). The initial plan would be to accommodate the articles or publications based on their level of evidence:
Systemic Reviews and Meta-analysis (Yes)
Individual study RCTs (Yes)
Individual study without RCT (No). Such screening would help to increase the viability and reliability of the integrative review.
Table 2: Criteria for data evaluation
Data Analysis
Research Questions
The present study would be further segregated into different sub-questions. The sub-questions were framed to explore the domain of the various research questions. The research questions and assumptions that would be explored in the proposed study are:
Sub-Research Questions and Assumptions
Whether bedside-handover influences nurse-patient relationships?
This research question would explore the necessity of implementing bedside-handover for improving nurse-patient relationships. This is because there could be other confounding variables that might impact nurse-patient relationships. Hence, the contextual question would explore the correlation between bedside-handovers and nurse-patient relationships after controlling for the confounding variables.
Whether the development of nurse-patient relationships through appropriate bedside-handover leads to improved patient-centric care?
Patient-centric care is a very broad perspective. There are different aspects of patient-centric care like psychosocial aspects, physical aspects, and social aspects. Hence, it would be interesting to explore the role of bedside-handovers in influencing patient-centric care through the development of nurse-patient relationships. In other words, the research question would explore the importance of nurse-patient relationships developed through bedside-handovers in influencing patient-centric care.
What are effective mechanisms and approaches for aiding appropriate bedside-handovers that ensure nurse-patient relationships?
This research question would help to address the structure and approach of bedside-handovers. Studies have indicated that bedside-handovers are both resource-intensive and time-intensive. Hence, if bedside-handovers are not effectively extended, then it could jeopardize nurse-patient relationships. The research question also has the potential to explore the personal and professional variables of both nurses and patients which stimulate or inhibits the genesis of nurse-patient relationships.
How does bedside-handover compare with other types of nursing handovers with respect to the development nurse-patient relationships?
This research question would help to identify the most effective type of nursing handovers in developing nurse-patient relationships. It might be possible that literature review could indicate that other forms of nursing handovers like video-based, audio-based or written documentation handovers are better than bedside handovers in influencing nurse-patient relationships. Once again, the nurse-patient relationships based on other forms of nursing-handovers would be measured as objective and subjective outcomes (like those that would be used to explore bedside-handovers).
Whether bedside-handover influences healthcare outcomes in a patient?
This research question would explore the necessity of implementing bedside-handover in improving clinical outcomes across concerned stakeholders. If there is no relation between bedside-handovers and improvement in clinical outcomes, then the impact of bedside-handover on nurse-patient relationship might seem imperative.
Whether positive health outcomes developed due bedside-handover provides the basis for improved nurse-patient relationship?
This research question would explore the objective parameters of bedside-handover that influences nurse-patient relationships. It is contended that effective bedside-handover might translate into positive health outcomes. Hence, the positive health outcomes might provide the basis of improved nurse-patient relationship. This question would help to explore the perceptions of concerned stakeholders regarding their expectations from being involved in the handover process. Appraisal of this question would help to design the content and objectives of bedside-handover shortly.
Ethical considerations
According to NHMRC, (National Health and Medical Research Council, 2013), the proposed study would be considered as a ‘low risk’ project. The proposed study would be based on secondary data analysis. This means the study would explore various studies and relevant articles that have been either documented by other researchers or the reports are available as interim publications. Since the data is not directly collected from the target population, it would be considered as secondary data. Hence, the proposed research would not impose direct or indirect risks to the study participants or the study population. The ethical issues in different studies would be appraised based on the philosophies of beneficence and non-malificence. Data collected will be stored on a USM memory stick and in the personal computer of the proposed researcher. The ethical considerations that will be taken into consideration include the issue of plagiarism whereby the work of the various authors would be cited and properly referenced in the course of carrying out the research through the integrative review. Studies that would be explored for the integrative review would be referenced, and the works of the original researchers will be duly acknowledged.
Resources and Timeline
The resources that will be required will be the internet as the integrative review. This is because the integrative review would be mostly based on online articles and electronic journals. In addition to that books and articles in hardcopy would be required. A synopsis of the resources and budgetary implications are provided in Table 1.
Resources Utility Estimated Budget (AUD)
Internet access Literature Review 0
Electronic databases (Paid)
(Full-text if not available through library database) Literature Review 300
Editorial Support Quality of articles appraised 1200
Electronic databases (unpaid) Literature Review 0
Transportation Library access 700
Miscellaneous Pen drives, USB stick 200
Printing and Binding Costs Final Thesis Preparation/submission 100
Writing software Thesis preparation 150
Total 2650
Timeline
Project activity Start Date End
Approval of the project after the oral presentation Initiate Search Strategy 12th February 2017 13th February 2017
Preparing the guiding question 14th February 2017 15th February 2017
Searching the literature 20th May 2017 20th June 2017
Sampling the literature 20th May 2017 20th June 2017
Data collection 20th May 2017 20th June 2017
Analysing data 20th June 2017 20th July 2017
Discussion of the results 21th July 2017 12th August
Writing the first draft 12th August 29th august 2017
Submission of the draft Minor Thesis 30th August Editing and modifying the draft report as recommended 7th September 14th September
Submission of Minor Thesis for Examination 15th September Concluding Remarks
Australia is leading the international efforts for improving the process of clinical handovers (Jonhson & Barach, 2009, p. 110). The WHO has designated Australia to lead and develop standardized solutions for implementing effective bedside-handovers (Jonhson & Barach, 2009, p. 110). This global initiative is imposed for ensuring patient safety (Jonhson & Barach, 2009, p. 110). Patient safety is related to handover errors, surgical errors, and medication errors and for ensuring hygienic principles at clinical settings (Shaller, 2007, p. 2). Nursing handovers (including bedside-handover) are a part of clinical handover that is witnessed and implemented across practice settings. The proposed study would unfold the strengths and limitations of bedside-handover in influencing nurse-patient relationship. Hence, from a larger perspective, the proposed research is aligned with the vision of the World Health Organization (World Health Organisation, 2006). This study has the potential to identify the key features and structures of bedside-handover that translate into improved nurse-patient relationships. It is already recognized that improved nurse-patient relationship is strongly correlated with improved patient safety. Hence, the proposed study would help to develop evidence-based guidelines for designing the structure and approach of bedside handover across practice settings.
Definition of Key Terms
Nursing handover: Nursing handover is the process of transferring responsibility and accountability of care from one nursing professional to another during the change of nursing shifts (Chaboyer et al. 2009).
Bedside-handover: It is a type of nursing handover where patients are involved in the communication process during the transition of care between adjacent nursing shifts (Goodrich & Comwell, 2008).
Clinical handover: It refers to the transfer of professional responsibility and accountability for every aspect of healthcare for a patient or a group of patients (Drenkard, 2010).
Nurse-patient relationships: Refers to the interaction between nurses and patients or their family members for ensuring the well-being of a patient (Kitson et al., 2014).
Person-Centric care: Care that is directed or oriented as per the personal and clinical needs of a healthcare consumer (Sexton et al., 2004).
Decision-making process: Refers to the process of taking decisions in situations of dilemma or problems (Fitzpatrick, 2010).
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Search string for PUBMED, CINAHL, MEDLINE, EMBASE, and COCHRAINE Library
PUBMED streach Number of Hits
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CINAHL Search String
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MEDLINE search string
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EMBASE search string
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