The usage of bedside shift reports comprises a process that incorporates information transfer after 12-hour shifts have concluded, so facilitating the transition from one shift to the next. The bedside shift reports ensure that vital information is communicated in an efficient and secure manner. The use of bedside shift reports has the potential to save lives. There have been numerous recorded incidences of patients dying or experiencing complications as a result of errors and blunders that may have been avoided if a complete beside shift reporting system had been implemented. While there are multiple reasons of patient death, medical errors have been identified as one of the top culprits, alongside cancer and cardiovascular disease. The aim of developing and implementing a bedside shift report is to ensure that patient safety and quality of care standards are significantly improved while giving patients a clearer picture and understanding of their health and treatment process. This evidence based report will carefully examine the need and significance of bedside shift reports in enhancing patient health outcomes and improving nursing efficiency and productivity. An evaluation and emphasis on the significance of implementing a comprehensive bedside shift report is needed. An assessment of current literature on bedside shift reports will delineate the benefits of the bedside shift reports.
The project parameters are described in five chapters. Chapter one includes a description of the project and the problems statement. A background analysis of the problem is presented with a view to provide stakeholders with the needed information to understand the problem, project solution and its potential benefits towards the realization of organizational objectives. Chapter two entails an examination literature that investigates evidence-based practices with respect to the proposed project. Chapter three examines the implementation phase including the challenges that were faced in the realization of the project. Chapter four entails the post capstone considerations that were made including realized successes, challenges and potential project impacts for the future. Chapter 5 delineates the reflection that examines the link between MSN program outcomes and the project.
Problem definition
There is a low compliance rate with bedside shift reporting policy among the nurses and the charge nurses have done little to enforce compliance with the policy during shift-to-shift reporting. This problem is prevalent among the entire nursing staff in the hospital and has affected the delivery of qualitative health care to patients. There is inadequate capture of patient information and data that needed for effective healthcare interventions.
Background
During the shifts, the nurses are not performing their roles as required since they do not fill in the bedside shift reports and charge nurses are nor reinforcing it when it becomes clear that t is not being done. This has resulted in errors and mistakes occurring in the delivery of care to patients. The problem began after the new bedside shift reporting system was introduced replacing the older traditional shift-to-shift reporting criteria. Resistance to change and a lack of understanding of the current system are among the factors that are attributable to observed resistance among employees.
The bedside shift reports have the impacts of enhancing patient satisfaction and improving the relationship between nurses and the patients. It reduces the incidence of patient falls while increasing patient discharge rate, promotes teamwork and enhances accountability in nursing functions and aiding in the determination of which processes must be prioritized in delivering patient care (Sherman, Sand-Jecling & Johnson, 2013).
There are various challenges that cause changes to be made at the nursing station without the patient seeing it or being included in the process. This occurs throughout the shift until the next shift beings. Making changes to the bedside shift report at the nursing stations poses a number of problems. In most cases information that is entered in the report without the involvement of the patient often include redundant, and unclear information that could result in varied complications. Additions and omissions to the report could prove to be catastrophic since it contributes to wrong medical and clinical interventions being made; hence, complicating an already existing health problem or creating a new additional problem.
Nurses should be requiring developing and enforcing bedside shift reports without fail in accordance with set best practices. It is necessary to encourage such reporting since it has the potential to improve patient satisfaction through (i) enhanced care quality and patient safety, (ii) improve the patients’ experience in the care environment (iii) improve satisfaction of the nurses as their roles are discharged effectively and (iv) improve individual and organizational accountability with respect to the quality of care being delivered to patients (Agency for Healthcare Research and Quality, 2013).
Though the benefits of bedside shift reports are numerous, the policy is yet to be adapted and implemented across the board; hence, there are gaps in policy implementation causing increased disparity in the quality of care being delivered to patients. According to Gregory et al. (2014) an examination of existing literature on bedside shift reports indicated that “nurses continue to recognize the evidence supporting this practice and adopt bedside report into practice” (pp.54). In an economic perspective, it is in the best interest of health care organizations to ensure that care services add value to patient outcomes while reducing costs in the process. Therefore, improvement of patient safety, quality of care and satisfaction has a financial benefit that is also linked to Medicare reimbursements. Reinbeck and Fitzsimons (2013) emphasize that healthcare institutions must be vested in promoting patient safety and enhancing effective communication that allows patients to become actively engaged in their care. Therefore, bedside shift reports aims to enhance patient experiences and augment care delivery standards within a care institution. In addition, bedside shift reports promote enhanced communication among nurses that ensures handoff procedures are effective and safe while at the same time engaging the patient. However, there are challenges in the implementation of evidence based research in practice.
Among the problems that inhibit the implementation of the bedside shift report include education of nurses and adoption of the practice at bedside in order to effect changes to pre-existing practices. The effective implementation and success of the bedside shift report policies in only realizable if direct health care providers continue to be engaged in the process. As such, gaps and laxity in the preparing bedside shift reports should not be allowed. The commitment of leaders in healthcare institutions and progressive program evaluation have the impact of promoting greater compliance and assimilation of bedside shift reports to normal care delivery practices (Hagman et al., 2013). For the bedside shift report program to succeed, it is prudent to ensure nurses’ satisfaction with the practice in order for it to be sustainable in the long term.
Literature Review
Best Practices Identification
The examination of the dynamics within which clinical practice change has evolved from the “traditional nurse-to-nurse” shift report to the bedside shift report is critical. Evidently, the implementation of bedside shift report directly aligns with the recommendations and provisions of the Nursing Alliance for Quality Care towards the engagement if patients in their respective care (Sofaer & Schumann, 2013). The existence of handoffs between various health care providers has been identified as a major drawback that contributes to ineffective communication in the care setting (Evans et al., 2012). It was recommended that healthcare institutions should develop and implement a standardized communication strategy for communicating the change of shift reports through interactive engagement, discussion and provision of opportunities to query the program (Maxson et al., 2012).
The traditional shift change reports often included tape recordings, written and verbal reports that are made face-to-face (Jeffs et al., 2013). The shift-to-shift reports have been defined as “occupational rituals” that were undertaken by nurses during the end of one shift and the beginning of another (Evans, 2012). This denoted a period when nurses and doctors discussed critical information with respect to health and treatment plans for the patient. Boshart (2016) observes that in the modern health care dynamic, it is prudent to establish effective communication to ensure that high quality and safe care is provided to patients. Nurses often face communication challenges especially with their patients and it is a major contributor to low satisfaction levels (Tobiano, Chaboyer & McMurray 2012). The improvements in organizations occasioned by the shift to end of shift reporting have often resulted in an emphasis towards the involvement of patients and enhancement of safety standards.
The implementation of a bedside shift report is among the methods that can be used to enhance patient satisfaction and including enhancement of overall satisfaction rates with the quality of care delivered, enhance nurse and family perceptions (Gregory et al., 2014; Jeffs et al. 2014; Racco, 2014; Tobiano, Chaboyer & McMurray 2012; Ferris 2013). Various literature have indicated that a patient-centered care model is largely supported by the implementation of bedside shift change reports; since it promotes accountability among health care staff, patient safety and documentation of treatment process and patient progress (Dempsey, Reilly & Buhlam, 2014). In addition, bedside shift reports enhance communication among health care staff especially during shift reporting (Radtke, 2013). The implementation of bedside shift reports is based on evidence based research; hence, it is among the critical factors that promote change in nursing practice with a view of enhancing quality.
The reviewed literature on the impacts of bedside shift reports indicated that the a significant number of available literature described the benefits accruing to the patients, nurses and the health care institutions after the implementation of bedside shift reports. There are numerous benefits that accrue as a result of developing and implementing comprehensive bedside shift reports (Dempsey et al., 2014; Tobiano et al., 2012). Shift reporting can be construed as a period within which patients and nurses can share information and socialize while sharing intimate personal information. The application of bedside shift report allows the information regarding the patient to be exchanged in a more concise, objective and relevant manner. According to Boshart (2016) the successful implementation of bedside shift reports has financial implications that often result in cost savings. Incidents that result from poor shift reporting have been linked to higher operational costs as hospitals must cater for the damage or costs incurred in the additional treatment that may be required (Howard, 2016; Liu, Manias & Gerdtz, 2012). In some instance, poor shift reporting results in gross negligence leading to the deaths of patients causing the healthcare institution to face litigation and liability for damages (Tidwell et al., 2012). However, the implementation of bedside shift reports eliminates the incidence and prevalence of costs and liability associated with poor shift reporting; hence, the institutions experiences financial savings. According to Maxson et al., (2012), patients and their respective families have found that bedside shift reports are significantly beneficial since their can track the progress that is being made and the nurse responsible for the patient for any given period. Furthermore, patients feel that they are never alone and are being monitored throughout their stay in the hospital (Tidwell et al., 2012). A common theme that was identified in the literature regarding the implementation of bedside shift reports suggested that it enhance communication between nurses, patients and their respective families.
The general review of literature focused on the examination of strategies for organizational change with respect to the development and implementation of bedside shift reports and the perception of the nursing staff towards the change. While it is critical to implement the bedside shift reporting policy, a number of measures must be undertaken to ensure that the process does not become redundant and ambiguous. For instance, the training of nurses is necessary to ensure compliance and adherence to bedside shift reporting standards and protocols. In the absence of adequate training, there implementation process would be ineffective and result more complications in the delivery of care to patients.
Clark and Persuad (2012), suggest that changes are often accompanied by resistance which can be mitigated through provision of feedback and responding to questions during the change implementation process. Further, Lavoie et al., (2014) examine the significance of communicating the need and rationale for implementing change to staff that are directly or indirectly involved in the change process. It is prudent to ensure that the process is optimized after the implementation process has been completed through the inclusion of the need for assessing staff attitudes before and after making the change from traditional end of shift reporting to bedside shift reporting (Wakefield et al., 2012). It may be necessary for interventions to be made on a periodic basis to ensure that the change is integrated into the organization’s culture (Rutherford, 2014).
The implementation of bedside shift report is often an integral component of the “wired” healthcare system. The existence of Electronic Health Records (HER) in the institution makes it easier for bedside shift reports to be created and implemented. The efficiencies in bedside shift reports could be significantly enhanced through the use of HER/EMR since they improve the reporting protocols (Park et al., 2012). In addition, these electronic systems include change of shift templates that improve and sustain progressive development of bedside shift reporting (Park et al. 2012). Though bedside shift reporting is relatively new concept, various literatures have indicated its benefits in enhancing efficiencies in the management of patient treatment processes (Staggs & Dunton, 2012). However, healthcare institutions face diverse challenges in the implementation of the change into practice. Nurse education and training has been identified as among the viable solutions to problems that may arise from the adoption of bedside shift reports (Gregory et al., 2014). Progressive support and encouragement of the nursing function is needed especially during the early phases of the bedside shift reporting implementation considering it is likely to face resistance (Sullivan-Havens, Jones, & Carlson, 2014).
Theoretical Framework
The implementation of the bedside shift report requires a systemic process that is guided by Lewin’s change theory in addition Kotter’s change Model. Further, the project implementation will utilize Paplua’s interpersonal relations theory. Radtke (2013) observes that “Paplua’s theory defines the relationship between nurse and patient as one that is therapeutic; is based on trust, mutual understanding and communication”; hence it fosters the development of mutual goal setting paradigm.
Lewin’s Change Theory
This theory can be traced to social psychology since it emphasizes on changing behavior and attitudes towards acceptance and assimilation of change through a three step process. The three steps prescribed by Lewin’s theory are appropriate for the transition from a traditional shift-to-shift reporting to the bedside shift reporting system. The three steps include unfreezing the current system, movement to the new change and refreezing in the new bedside shift reporting dynamic. Hagman et al., (2013) observes that Lewin’s change model has been applied successfully in change from traditional shift reporting systems to bedside shift reporting.
The first phase of the change process involved challenging and confronting prevalent attitudes among nurses with respect to the new bedside shift reporting system. The second phase entailed provision of information, education and training of nursing staff with respect to the processes that are involved in the management of bedside shift reports and its implementation. The third phase involves incorporation of bedside shift reporting into the routine care delivery processes in the hospital (Vines et al., 2014).
Kotter’s Change Model
The prediction of success of the bedside shift reporting will depend on the extent within which the people that the change will affect become involved. Kotter examined the various obstacles that hindered change in organizations. These include failing to articulate the change with respect to key factors such as time frame, rational and required process for the change. As such, he developed an eight step model for change that included; “(1) create a sense of urgency, (2) form a powerful coalition, (3) create a vision, (4) communicate the vision, (5) remove obstacles, (6) create short-term wins, (7), build change and, (8) Anchor change in corporate culture” (Zaccagnini & White, 2015). The work of Lewin and Kotter is instrumental in the development of a change model for the bedside shift reporting implementation processes.
Literature Review Findings
The literature review emphasized on the benefits accruing to healthcare institutions through the implementation of bedside shift reporting. A significant percent of the examined literature supported a shift from traditional shift-to-shift reporting to the bedside shift reporting system (Boshart, 2016; Evans, 2012; Feldman, 2015). It was found that there are numerous benefits accruing from the engagement of patients in the reporting process especially through enhanced accountability among medical professionals, improvements in safety in the care environment and increased satisfaction among patients with the efficiency and quality of care being delivered. Nurses often face communication challenges especially with their patients and it is a major contributor to low satisfaction levels (Howard, 2016; Tobiano, Chaboyer & McMurray 2012).
The implementation of bedside shift report directly aligns with the recommendations and provisions of the Nursing Alliance for Quality Care towards the engagement if patients in their respective care (Liu, Manias & Gerdtz, 2012; Sofaer & Schumann, 2013; Tan, 2015). the implementation of a bedside shift report is among the methods that can be used to enhance patient satisfaction and including enhancement of overall satisfaction rates with the quality of care delivered, enhance nurse and family perceptions (Jeffs et al. 2014; Tobiano, Chaboyer & McMurray 2012; Ferris 2013). Various literature have indicated that a patient-centered care model is largely supported by the implementation of bedside shift change reports; since it promotes accountability among health care staff, patient safety and documentation of treatment process and patient progress (Dempsey, Reilly & Buhlam, 2014; Radtke, 2013).
Poor shift reporting results in gross negligence leading to the deaths of patients causing the healthcare institution to face litigation and liability for damages (Manias & Watson, 2014; Rutherford, 2014; Tidwell et al., 2012). Changes are often accompanied by resistance; however, it can be overcome through comprehensive sensitization, training and education of nursing staff (Clark & Persuad, 2012; Racco, 2014; Wakefield et al., 2012). Though bedside shift reporting is relatively new concept, various literatures have indicated its benefits in enhancing efficiencies in the management of patient treatment processes (Staggs & Dunton, 2012; Park et al., 2012; Sullivan-Havens, Jones, & Carlson, 2014). Kotter and Lewin’s change models are equally applicable in guiding bedside shift reporting implementation processes (Radtke, 2013; Hagman et al., 2013; Vines et al., 2014; Zaccagnini & White, 2015).
Conclusion and Recommendation
The identified problem was that there is a low compliance rate with bedside shift reporting policy among the nurses and the charge nurses have done little to enforce compliance with the policy during shift-to-shift reporting. the evidence in practice suggests that full implementation of bedside shift reporting enhances the quality of care delivered to patients, improves nurse accountability and promotes patient satisfaction. The practice change will involve comprehensive training and education of nursing staff to ensure that they understand and appreciate the significance of full compliance with bedside shift report. Progressive training is needed to ensure that nurses are informed in current nursing practices with respect to bedside shift reporting. In addition, period evaluation processes will be required to ensure that the practice change meets expected organizational goals and objectives in improving health care.
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