Nursing Handover

Background and Significance The purpose of this of this experimental study “Investigate transfer of information at nursing handover” (Boyd, Cumin, Devcich, & Lee, 2015, p. 161) is clear and concise. The dependent variable of this study is the nurse’s confidence in the truth of information and independent variables is the way the information is presented. The sample population is clearly defined, and the result “ adds to the literature because it is one of very few studies done using an experimental design to investigate nursing handover” (Boyd et al., 2015, p. 165).
Research question and hypothesis The research question clearly identified, “Can participant nurses’ confidence in the truth of information be influenced by the way the information
is presented” (Boyd et al., 2015, p. 162)? The researchers hypothesized that participants who received an expression of concern plus written summary would have higher confidence in the truth of that piece of information that participants who received the information than participants who received the information with only the affective qualifier or the written summary or with neither affective qualifier nor written summary (Boyd et al., 2015, p. 162). The research question and hypothesis is appropriate to the study as it specifies the expected direction of the relationship between the independent and dependent variables. Previous studies were descriptive in nature and only a very limited experimental study on information retention was available.
Review of literature Unfortunately nurses are not trained to give formal reports.
As a result, the nursing end of shift report to incoming nurses is susceptible to errors. With no policies and guidelines addressing handover in the healthcare system, nurses develop their own ways of delivering report at handover and this practice has not been proven to be effective. “There is information loss at every point in the continuum of care and discrepancies between handover content and patient’s actual conditions” (Boyd et al., 2015, p. 161). According to Brierly, psychology literature suggests that affective aspects of communication can enhance retention of information (Boyd et al., 2015, p. 161). However, there is no research study that shows how affective aspects affect delivery of nursing report. In most hospitals, nurses use both verbal and written report at handover. Based on observational study, verbal and written approach has been supported to increased efficacy of handover. However, the study does not evaluate the recollection of information and the availability of experimental study on the different elements does not exist.
Sample The study used a convenience sample of one hundred fifty-seven of registered nurse and final year nursing students.
Nurses were recruited from two different units (PACU and surgical ward) at three metropolitan hospitals. The participants were appropriate for the study as it was identified in the research question. Sample was appropriately calculated, “with an α value of 0.05 and a β value of 0.2, we estimated we would need 24 in each group to demonstrate the effect using ANOVA” (Boyd et al., 2015, p. 162). There were approximately equal numbers of participants for each of the four experimental conditions: control, affective qualifier, written summary and combined (Boyd et al., 2015, p. 164). Simple randomization was utilized to place the participants in one of the four groups. Participants were not aware of the distribution process, hypothesis, and differing videos. Although it is a convenience sample, the study applies to nurses and nursing students and the findings can be generalized within the nursing
community.
Threat to internal and external validity The study included the testing environment and selection bias. The experiment was conducted in a quiet room away from distractions and from the busy clinical environment that nurses typically encounter during handoffs. This could have skewed the data as less interruptions and more focus for the nurses could have led to the high overall transmission of information across all the groups. Selection bias could be a problem in studies “where individuals themselves decided whether to participate in a study” as was the case in this particular experiment (Wood-Haber, 2014, p.174). To minimize this, participants were randomly assigned to the four groups without them knowing the differences to their allocation. They also did not know that the videos shown were different among the four groups.
The experiment was conducted with 157 participants, which is too small a sample size to validate the generalizability of the results. It also included a convenience sample where the participants are either PACU or surgical ward nurses or nursing students. This is not representative of the nursing as a whole as it limited data to two units in the hospital. Also, including nursing students in the study could significantly skew the results of the data.
Research Design The study has level II evidence because the study was a randomized, single-blind, controlled experiment. The assignments of the participants among the four groups were random to minimize selection bias and they were also concealed. The participants did not know which group they belonged in. Control was achieved by not only through the randomization of the participants but also through the preparation of the interventions and its consistency for all the participants. The type of design they used was appropriate for what they were trying to measure: the effect or noneffect of the use of affective words or written notes or both for better retention of information when it comes to nursing handoff communication. They were able to manipulate the effect of each dependent variable to the independent variable.
Data Collection Methods The researchers used questionnaires to measure and test their hypothesis that using affective words and written notes improved the transmission of information during nursing handoffs. The participants across the four groups watched a two minute video with identical information related to nursing handover. Manipulation was done on how they presented the information regarding the tumor embolus. All other factors were kept the same to maintain consistency. The questionnaires were then given after the participants watched the video and it consisted of six questions that measured the participants’ confidence to the truth of information provided in the video. A 2 (affective, nonaffective) x2(written, nonwritten) anova analysis was used to determine the retention of information among the four experimental groups. A separate subgroup analyses was also used to differentiate the results between the groups according to levels of experience: students, 0-2 years, 2-5 years, and 5+ years.