critically analyse the implementation of bedside handover system to illustrate good practise in the clinical environment

Critically analyze the Implementation of Bedside Handover System to illustrate Good Practice in the Clinical Environment
Introduction
Clinical handover is a significant element of safety in the patient care. Clinical handover refers to the shift of professional roles and responsibility for a portion or all components of a single patient or groups of clients’ care, to another professional group or individual on a permanent or temporary basis (Hughes 2010, p. 20). The handover transference between nurses usually takes place three times per day in many health care systems and offers a chance to enhance a patient-oriented technique of care. Several institutions and experts argue for the bedside handover with active client involvement. It is determined that the implementation of the clinical handover practices be completed in a universal staff environment rather than being executed in specific clinical context (Hughes 2010, p. 21). In other words, the clinical handover should be adopted in an environment that permits patients the opportunity to get what is being discussed, rectify any misrepresentation, and submit the queries about their care and treatment processes.
Despite the reports that nurses advocate the situation where patients are allowed to take part, the nurses influence the physical place for the bedside handover. Furthermore, they do not frequently carry out clinical handover at the bedside as required, but, rather, they place themselves outside the client’s room or where the nurses’ offices are located, which may hamper patient engagement (Parkin 2009, 13).

With the motivation to encourage clinical bedside handover, it is significant to grasp the enablers and obstacles to clinical bedside handover, as supposed by the patients and nurses. It is also important to identify the rationale of the change and suggested a scheme execute the systems, the origin of the change, the communication issues of the change processes, the leadership aspects of the change, the impacts of the clinical bedside handover as the proposed change.
Rationale for the Change
The clinical bedside handover is a change that comes with the benefits. As such, the rationale for a change is due to its benefits. Nurses must acknowledge that the clinical bedside handover speeds up more precise information sharing, and gives nurses the chance to operate in collaboration with their patients. The clinical bedside handover advocates for patients participation. As a result, the clients feel a sense of belonging in the handover procedure and contribute to their care. During the participation, the patients get a chance to share their views and problems affecting them. The information exchanged contributes to the accomplishment of their treatment and care processes. They also feel that they are valued in the hospitals as they are allowed to take part in the handover process. Moreover, the change is adopted for the communication of more accurate information and data. The handover process involves staying close to the patients and looking for the information about their diseases and challenges. The process appears to be a form of collecting firsthand information. Therefore, the closeness to the patients enables the nurses to acquire and come up with more accurate information that will be used improve the patient safety and care (Hughes 2010, p. 25).
Furthermore, the other rationale for a change is to gain a better understanding of the clients’ conditions. When the patients are involved in a face-to-face conversation, there is a chance for the patients to describe their problems and conditions in the hospitals fully. The nurses can, therefore, through the comprehensive descriptions from the patients, understand the problems and difficulties facing the clients. What is more, the rationale for a change is the improved continuity of care. The accurate data obtained through the handover process encourages the implementation of the change. The continuous communication between the nurses and patients contributes to the enhanced continuity of care for the patients. Ultimately, the change is initiated to improve the communication between the staff members during the shift and gain more openings for improving and educating constructive behaviors.
Implementation of Bedside Handover
A standard operating protocol (SOP) via the change management process strategy can be applied to implement the clinical bedside handover system. The approach involves first allocating the patients and patient. The system is reported to be successful in the hospitals where the nurses work in groups or as teams. The team nursing methodology offers care for a specific class of clients by selected group of nursing personnel, such as enrolled and registered nurses plus their assistants all taking their roles together (Hughes 2010, p. 29). No factors are considered for the patient and staff assignment when using the clinical bedside handover. The practitioners only need to observe the standard practice of a particular ward. The second activity to be accomplished during the implementation of the clinical bedside handover is the adjustment to the handover sheet. The handover sheet is generated through the computer and has the details of all the clients on the ward. The sheet is a vital instrument in the implementation of the clinical bedside handover system. The handover sheet enables nurses to attain knowledge about the patients on the ward that may not be achieved using the bedside handover. As a result, updates should regularly be made to the handover sheet. Some of the details and information about the patients contained in the handover sheet are the medical records, gender, age, transformation in condition, admitting diagnosis, confidential information like HIV status, discharge scheduling, social backgrounds, and awaiting tests and outcomes (Hughes 2010, p. 31). When designing and updating the handover sheet, it is important to customize it to the requirements and conditions of the specific ward.
Further, with the team nursing in practice, it is the team leader, rather than the shift planner, who should have the overall role of making sure that the handover sheet, is validated and precise. Again, it is significant to have elements of the medical history, including the care plan, observation record, treatment record, risk assessment procedures and fluid balance sheet, such as ulcers, pressure, or falls at the client’s bedside. Similarly, it is helpful to have the bedside chart put on a clipboard suspending from the foot of the client’s bed and should be assessed for fullness before the handover (Parkin 2009, 17). On the other hand, when implementing the clinical bedside handover system, the next step is to inform the clients. When approaching the handover period, team members need to notify the clients that the handover will initiate in a short while. This alters the patients that the nurse caring for them will shortly shift and enables patients to arrange for the handover in regards to the matters like their contribution to the process. Finally, the implementation process involves family members and other guests. The family members are permitted to remain at the client’s bedside during the process of the handover, with the client’s consent. However, other visitors ought to be requested to vacate the room during the process.
The clinical bedside handover change originates from the top leaders of the health care systems. Often, it is the top leaders that come up with the groundbreaking change in the most organizations. For the handover change, the top leaders first assess the challenges and new ways of improving the patient care process and quality of health care in the hospital. They involve all the concerned stakeholders, including the nurses and doctors, in the improvement process to come up with the change. The overall plan to initiate the change is done by the top leaders, who direct the followers to execute the change. Following the critical incident that took place on the ward, the top leaders opted to execute the bedside handover system. Specifically, the patients’ records were not accurate as nurses were not accomplishing the process as required, communication between the nurses and patients was also not effective, and patients were not also engaged, and their conditions were not well described (Hughes 2010, p. 37). These events resulted in the fall of the patients on the ward, advancement of the diseases, and inadequate care for the patients. Thus, it was determined that implementing the bedside handover would help nurses work as teams by sharing and transferring their responsibilities and get to know the exact problems affecting the patients. Moreover, the change was in all circumstances a great step forward towards the improvement of the patient care and safety. The incoming and ongoing nurses communicated with each other to ensure that all the medical records and other details of the clients were updated (Parkin 2009, 18). The change also involved working close to the patients to guarantee that their problems and conditions on the ward are addressed.
Overall, the change system was worthwhile as it did benefit the tasks involved. As discussed earlier, the change system brought a lot of merits to the nurses, patients, wards, and the whole health care systems. For instance, the process increased the nurses and patients’ satisfaction in regards to their performance and care, respectively. Furthermore, the change led to the effective and improved communication between the patients and nurses on issues of the patients’ safety, challenges, and conditions (Parkin 2009, 19).
Kurt Lewins Change Model
The change management concept is common in many health care systems and other organization today. The way change is managed, and its success differs immensely depending on the type of the organization, the chance, and the individuals involved. A critical factor for the success of any change management process is the extent to which persons within the change system grasp the change protocol. Kurt Lewin’s change model for understanding organizational change involves three phases. The stages are the Unfreeze, Change, and Refreeze.
Unfreeze Stage
In this phase, individual recognize that something will change and they are influenced by strong feelings, such as impatience, denial, doubt, and uncertainty. It is necessary for an organization to completely reveal the conditions and to clarify the reason for implementing the change process. Due to clear communication, workers or nurses are more ready to agree to the new change of operations, and they can drop the old approaches (Hughes 2010, p. 42). At this stage, it is important that the workers are involved so as to enable them to take an effective tactic to the change process. Furthermore, during this phase, the change management team first need to find out what should be changed. Here, the team should survey the institution to know the current conditions and understand the need for executing the change (Hayes 2014, p.59). Also, the top management should provide support for the change process. To gain the support, the change management team should apply the stakeholders’ management and analysis to determine and obtain the assistance of critical individuals within the organization. The change should be defined as an all-inclusive issue that affects the entire organization. Another issue that should be done in the unfreezing stage is to establish the urge for a change. This involves developing a convincing message explaining why the organization has to perform the change, utilizing the organizational strategy and vision as supporting proof, expressing the vision in regards to the change needed, and highlighting the term “why” the change has to happen (Parkin 2009, 23). Lastly, the change process should control and grasp the uncertainties and problems. The process should stay free to workers’ concerns and handle them in regards to the value of the change.
Change Stage
The change should be executed within the shortest period possible. When the change process consumes a long time to complete, workers tend to revert into customs and traditions. The phase is at times known as the moving stage since it leads to a ripple impact within a system. A faster implementation of the change enables a quicker understanding of the significance of the change by the employees (Hughes 2010, p. 51). During the stage, resistance to change is possible and communication is essential for the process, as well.
Resistance to Change
Employees can be resistant to the change that is about to take place in the organization. Employee resistance is an example of the refraining forces of the change process. The resistance can result from the doubt, failure to understand the need for change, lack of expertise and skills to implement the change, ignorance of the employees, improper communication, and limited participation of the employees in the change process (Hayes 2014, p.70). The change management should be aware of the likelihood of such resistance and identify ways of eliminating or controlling them. The resistance to change can be dealt with in many ways. The rumors that spread within the organization about the change should be dispersed. This should be done by responding promptly, honestly, and openly to the queries that come up, addressing the concerns instantly, and adjust the need for change to operational requirements. Moreover, it is important to empower the employees. This also involves offering several chances for worker participation in the change process. To avoid the resistance to change, the employees should be included in the change process by allowing them to contribute their efforts and opinions towards the accomplishment of the change (Parkin 2009, 27).
Furthermore, the line managers should give daily guidance and direction for the employees. They should clarify any issue that the workers may not understand and give instructions on how to execute a certain task. Ultimately, everyone should be involved in the change process while the human resource concepts like performance reviews are done. The top leaders in the change management should produce short-term achievements to strengthen the change. Every employee who meets the set targets at every stage of the change process should be recognized, rewarded, praised, and reinforced to facilitate the accomplishment of the change and deter any resistance (Parkin 2009, 30). The reinforcement also increases the employees’ morale in undertaking their assigned roles because they feel motivated at work. The external stakeholder should also be involved in the change process. The shareholders and employees unions should be involved, and any issues between them negotiated to streamline the activities in the change process.
Communication in Change Process
Communication is one of the essential activities in the change process. Communication serves several roles in the process, including updating the employees on the milestones, giving feedback and clarification, and other coordination processes. Communication should not only be done in the change stage of the change process, but also during the planning, execution, and controlling phases of the change (Parkin 2009, 31). Again, communication should be regular and touches on the issues related to the benefits and disadvantages of the change. The top leaders should outline the gains associated with the change. For example, there should be a description of how the bedside handover will improve patients’ safety and care together with the nurses’ satisfaction with their roles (Hayes 2014, p.73). What is more, the team should communicate the demerits of the change as a result of its implementation. However, the demerits should not be more than the merits attained from the change being implemented. Other aspects to be considered when communicating include the milestones, achievements, and the objectives attained for a given period. Finally, the executive team in the change process should explain how the change will impact everyone in the organization and any impending issue during and after the change process.
Refreezing Stage
This stage is concerned with solidifying the change. After the execution of the change in the transition or change phase, workers tend to relapse to their old rituals and habits. Consequently, it is significant that the top leaders develop appropriate arrangements and conduct provisional assessments, monitoring and make modifications where required (Hayes 2014, p.75). This will stabilize the situation, and the workers will not consider turning back. They will at as per the new ways of doing things and accept that there are merits to the change. The focus of this phase is to introduce the changes into the organizational culture by determining what supports it, the obstacles to sustaining the change, how to sustain the change, creating a reward and feedback systems, implement the organizational structure, and guarantee leadership support. The ultimate activity in this stage is to offer training and support, keep every person informed, and celebrate the achievement.
Leadership and Change
The success and failure of the organizations, including the healthcare systems, depend on the ability of the top leaders to initiate, implement, and sustain beneficial change in these systems. Effective change management and completion are possible with appropriate change leadership personalities. The following are the leadership qualities for a change. Firstly, the change leader must show low anxiety level. Anxieties are beliefs and emotions that can inhibit a leader to cope effectively with his or her current conditions. Anxieties can originate from the past negative experiences, which may influence the current change process. A leader’s behaviors can be influenced by anxieties by responding to the circumstances by either establishing strong defensive mechanisms for any shock in the change or attack the potential cause of the anxiety (Hayes 2014, p.77). Nevertheless, a leader should have a feeling of security and be unencumbered by the anxieties. A leader should also develop a situation in which each person involved in the change process has a sense of security, instead of being intimidated.
Moreover, a change leader should be action oriented. Change leaders should lead by action rather than simply learning oriented. Learning should just act as a road to taking action and attaining the objectives of the change. Successful change leaders tend to move forward and take part in the activities of the change (Parkin 2009, 40). They feel strengthened and inspired by the action and advancement. Furthermore, another quality of a successful change leader is dependability. Dependability has several dimensions in the change management. As such, a leader should be reliable when making a move in the change process. The followers should trust a leader’s decisions, and ways of thinking of the leader should also be dependable. When the change process is encountering a crisis, the leader should be reliable in steps he or she makes to address the situation. A leader should depict an atmosphere of calm as he or she pushing forward concrete action. Delegation is also an important quality of a change leader. A successful change leader should be courageous and free of delegating the change process tasks to the change team (Parkin 2009, 42). He or she should permit others to take control of the activities they perform, own solutions they make, and allow them to keep oversight and focus on the things they undertake solely. Further, a change leader should motivate persons with whom he or she works. People in the change process should be motivated to increase their morale in the activities they are assigned to do. Motivation can be enhanced by creating different practices that act as a stimulus that encourages individuals to work. Accordingly, people should be rewarded for jobs well done, an individual should be recognized for improved performance and meeting the set targets, and people should be periodically promoted.
What is more, a change leader should be decisive. They should be ready to take tough decisions and be responsible and accountable for the choices they make. They should have the capability to listen keenly to different thoughts and compare and evaluate them before making conclusions. Ultimately, a change leader should exhibit adaptability quality. Adaptability is mainly concerned with the ability to preemptively making steps to remain in front of the curve to change. A leader needs to know how to deal with the changing circumstances emerging in the change process and identify approaches to tackling the fluctuations (Parkin 2009, 45).
The nature and pace of the change influence the key qualities of the change leader that are required to execute a change in the organization. The nature of the change, such as a complex change, a change that affects the entire organization, and involves the restructuring of an organization, require a leader to possess all-inclusive qualities that would enable him or her achieve the change goals. On the other hand, when the pace of the change is fast, such that the change has to be executed quickly, the change leader need to be adaptable, decisive and should motivate the people involved in the change process, to achieve the goals with the shortest time available.
Evaluation of the Change
The clinical bedside handover system has considerably worked. The change has reduced the time wasted in the office chats, thereby allocating more time to communicate with and care for the patients. Further, the change has worked because it has improved the accuracy of the information obtained from the patients. Patients and nurses can work together, making the nurses get the right information they want from the patients concerning their conditions and diseases. The bedside handover has also improved the safety and care of the patients because the approach is patient-centered and entails collaborative patient care (Parkin 2009, 55). The system is in practice in several hospitals and other healthcare systems. Nurses have reported the change to be of benefits because it allows clients to participate and their thoughts to be taken into consideration. While the system has benefited the patients, nurses, and the entire healthcare organizations, it has been determined that there are some other problems that still exist. Some nurses perceive that the process is time-consuming and take up a lot of resources for its sustenance. Also, when conversing with the patients, it is reported that the clients experience communication difficulty in regards to the complicated medical terminologies, which may be scary to them (Hayes 2014, p.78). Besides, when the conversation is conducted carelessly at the bedside, the confidence of the clients may be disturbed as they will not be free to give responses.
Conclusion
As a recommendation, the clinical bedside handover practice can be improved through different ways. The practice can be improved by educating and training the staff on how to carry out the process, incorporating the continuous healthcare improvement techniques into the system, and urging the top management level to take part in the practice and offer their support for the sustenance of the handover system. Ultimately, the practice can be improved through setting up proper communication channels where patients and nurses can share information relevant to the set goals.

References
Hayes, J., 2014. The Theory and Practice of Change Management. Palgrave Macmillan.
Hughes, M., 2010. Managing Change: A Critical Perspective. CIPD Publishing.
Parkin, P., 2009. Managing Change in Healthcare: Using Action Research. Sage.