Collegian (2011) 18, 19—26
available at www.sciencedirect.com
Patients’ perspectives of bedside nursing handover
Anne McMurray, PhD, RN, FRCNA
, Wendy Chaboyer, PhD, RN, FRCNA
Tel.: +61 04
1322-7696/$ — se
ne Wallis, PhD, RN, FRCNA
, Joanne Johnson, MHS, RN
Gehrke, MHS, RN
Chair in Nursing, Murdoch University, Mandurah Western Australia
rofessor of Nursing, Research Centre for Clinical and Community Practice Innovation, Griffith University,
Research Centre for Clinical and Community Practice Innovation, Griffith University, Queensland, Australia
st Health Service District and Research Centre for Clinical and Community Practice Innovation, Griffith University,
eton South Burnett, Health Services District, Ipswich Hospital, Queensland, Australia
evelopment Facilitator, Ipswich Hospital, Queensland, Australia
9 January 2010; received in revised form 14 April 2010; accepted 16 April 2010
Background: Patient participation in handover is one aspect of patient-centred care, where
patients are considered partners in care. Understanding the patient perspective provides a
foundation for nurses to tailor their bedside handovers to reflect patients’ thoughts and beliefs
and encourage their active involvement in decision-making.
Aim: This study examined patients’ perspectives of participation in shift-to-shift bedside nursing
Methods: A descriptive case study was conducted with 10 patients in one Queensland hospital
who had experienced bedside handover during their hospitalisation in 2009. Participants were
asked their views about bedside handover including its benefits and limitations, their existing
and potential role in handover, the role of family members, and issues related to confidentiality.
Data were analysed using thematic content analysis.
Findings: Four themes emerged from the analysis. First, patients appreciated being acknowl-
edged as partners in their care. Second, they viewed bedside handover as an opportunity to
amend any inaccuracies in the information being communicated. Third, some preferred passive
engagement rather than being fully engaged in the handover. Fourth, most patients appreciated
the inclusive approach of handover as nurse—patient interaction.
onding author at: Research Centre for Clinical and Community Practice Innovation, Griffith University, Queensland, Australia.
09 587 850.
ddress: A.McMurray@murdoch.edu.au (A. McMurray).
e front matter. Crown Copyright © 2010 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on behalf of Royal College of Nursing, Australia. All rights reserved.
20 A. McMurray et al.
Conclusions: Bedside handover provides an opportunity for patients to be involved as active par-
ticipants in their care. They value having access to information on an ongoing basis, and although
not all choose the same level of interaction, they see their role as important in maintaining
accuracy, which promotes safe, high quality care.
Crown Copyright © 2010 Published by Elsevier Australia (a division of Reed International Books
llege of Nursing, Australia. All rights reserved.
form of com
safe care (
in Health C
dover is a m
reflects a p
Berry, & De
ber of nur
tive case st
each of two
in press). T
dover to m
events in h
(Haig et al
ing or dehumanising to patients (Cahill, 1998; Martin
Australia Pty Ltd) on behalf of Royal Co
munication plays a critical role in patient safety,
mmunication contributing to a large proportion
events (Haig, Sutton, & Whittington, 2006). One
munication, shift-to-shift nursing handover, has
earch interest for three reasons. The first is a
the worldwide safety agenda, recognising that
t and process of handover can either promote
n the quality of communication, and therefore
former Australian Council on Safety and Quality
are, 2005; Australian Commission on Safety and
Health Care (ACSQHC), 2008; Arora et al., 2009;
& Turner, 2008; World Health Organization (WHO,
nd, as a critical process for transferring account-
patient care from one team of providers to
ustralian Medical Association (AMA), 2006), han-
anagement tool to maintain continuity of care.
ing handover conducted at the bedside provides
nity for engaging patients in their care, which
rofessional commitment to patient-centred care
et al., 2009; Kelly, 2005; Robinson, Callister,
aring, 2008; Wiggins, 2008).
nursing handover has been the subject of a num-
sing research studies (Chaboyer et al., 2009;
McMurray, & Wallis, in press; McKenna & Walsh,
urray, Chaboyer, Wallis, & Fetherston, in press;
Penney, 2001). In 2009 we conducted a descrip-
udy of bedside nursing handover in three wards in
Australian hospitals; one in Queensland and one
Australia (six wards in total) (Chaboyer et al.,
he study was part of a national initiative by the
Commission for Safety and Quality in Healthcare
a standard operating protocol for bedside han-
inimise the threat of miscommunication-related
ents. Our analysis indicated that the patient per-
as a missing element in the research. Thus, a
study of patients’ perspectives of bedside han-
undertaken to better understand their role in
er process, and the benefits and limitations of
dicates that up to two-thirds of sentinel adverse
ospitals are related to communication problems
., 2006). Miscommunication during clinical han-
also lead to service discontinuities, evident in
y presentation to emergency departments, sub-
tient flow through the system, readmissions,
of services, and patient dissatisfaction (Alem,
thers, Steele, & Wilkinson, 2008; Anthony &
rr, 2004; Bomba & Prakash, 2005; VanWalraven,
et al., 200
Fang, & Austin, 2004). Verbal handovers at
g station can be unreasonably lengthy, include
ial and irrelevant information, and may provide
or inaccurate information, often focusing on sub-
eculative, sometimes vague information (Davies
, 2006; O’Connell & Penney, 2001; Philibert &
5). They can also be confined to ritualistic, ret-
treatment oriented information (what the nurse
ather than providing focus and direction for for-
ing that includes information on how patients are
ping (Cahill, 1998; Dowding, 2001; Fenton, 2006;
2002; McKenna & Walsh, 1997; Webster, 1999).
fessionals’ variable engagement with handover
Street, 2000), and their style of communication
layed a part in miscommunication-related med-
(IOM, 2003; Shortell & Kaluzny, 2006). Attempts
these problems have led to the need for standard
rotocols for handovers (Arora et al., 2009; Botti
9; Chaboyer et al., 2009, in press; Yee, Wong, &
9), ward-based whiteboards to chart patient sta-
gress (Chaboyer et al., in press; Riley, Forsyth,
Iedema, 2007), and implementation of bedside
ndovers (Anderson & Mangino, 2006; Broekhuis
p, 2007; Cahill, 1998; Chaboyer et al., in press;
Walsh, 1997; McMurray et al., in press).
handover and patient-centred care
ndover was developed to improve the accuracy
ess of information transfer by including patient
adding the type of visual information that can
at the bedside (Broekhuis & Veldkamp, 2007;
8). The patient-centred approach also reflects
of patients to be partners in their care, and the
n that their participation in care may lead to bet-
es and greater satisfaction with care (Anderson
, 2006; Cegala, Street, & Clinch, 2007; Coulter
007; Coulter, Parsons, & Ashkham, 2008; Kravitz
, 2001; Robinson et al., 2008; Sidani, Epstein,
, 2006). Sidani et al. (2006) also report that
volvement in treatment-related decision-making
e their sense of control, improve functional and
comes, and reduce rates of referral and diagnos-
the attraction of a patient-centred approach
number of contentious issues related to bedside
ome claim that it is time and resource intensive
; Cahill, 1998), and that clinical jargon may be
7; Rutherford, Lee, & Greiner, 2004). Studies
a fear by nurses, of breaching patient confiden-
aves, 1999). Cahill’s (1998) study of 10 surgical
Perspectives of Bedside Nursing Handover 21
patients’ opinions of bedside handover found that confiden-
tial disclosure was not a concern for 9 of the 10 informants.
Instead, their concerns surrounded nurses maintaining pro-
fessional distance between themselves and the patients, a
lack of comprehensiveness of information, and the need for
not an ove
it was eas
Two more r
be due to
sis of nurse
ity, and cit
2002). In t
as a reflex
ment of p
on the con
reliable measure of patient-centredness (Robinson et al.,
to ensure their physical and psychological safety
98). Greaves (1999) interviewed four patients,
that they wanted greater involvement, access
tion and assurance of continuity of care. As with
98) study, issues related to confidentiality were
rriding concern, with participants reporting that
y to just ‘shut out’ conversations about others.
ecent studies in the UK found that patients were
ith bedside handover, and, as in Cahill’s (1998),
es’ (1999) studies, they had no concerns about
lity (Kassean & Jagoo, 2005; Kelly, 2005).
k of widespread use of bedside handover may
the structure and function of most practice
hich reinforce the expert model of practice
n partnerships between nurses and patients
William, & Ward-Griffin, 2006; Gallant, Beaulier,
le, 2002). Gallant et al.’s (2002) concept analy-
—patient partnership revealed that the term has
iated with collaboration, participation, mutual-
izen involvement. They report that a shift from
onal, hierarchical, expert model of practice to a
nt-enabling, participative approach, has created
ring environment for the patient (Gallant et al.,
his context, the nurse is engaged with patients
ive, critical listener to build a trusting relation-
n et al., 2006). Patient-centred care is therefore
powering, with patients choosing the extent of
ement in care according to their knowledge, abil-
rences and rights (Brown et al., 2006).
(2004) review of the literature on patient part-
onfirmed nurses’ professional valuing of the
g attributes defined by Gallant et al. (2002),
shared decision-making and patient autonomy.
er analysis revealed an absence of theoretical
s between the concept of partnership and the
nursing care (Hook, 2004). To advance this body
ge Hook (2004) recommended evaluating clinical
hat would benefit from partnerships.
, nursing research into partnerships and patient-
s has focused on partnerships in community
ston, Meagher-Stewart, Edwards, & Young, 2009;
pacis, & Martin, 2008) or in home care or aged
n et al., 2006; Pajnkihar, 2009). One Australian
on patient-centred care analysed influences on
rs to developing partnerships, confirming com-
as the greatest barrier to genuine partnerships
et al., 2002). Pajnkihar’s (2009) study also can-
views of nurse leaders on partnerships, revealing
ugh nurses declare support for active involve-
atients and families, practice remains focused
dised routines, predictable patterns and profes-
archies. In Australia, the patient focus is also
ussed as part of a national safety and quality
nt strategy (Baggoley, Curtis, Dunbar, & Jorm,
research reported in this paper contributes one
in advancing this body of knowledge. It is based
tention that patient perceptions are the most
the study was to interpret patients’ perceptions
shift bedside handover in nursing. The findings
ded to provide a foundation for tailoring nursing
ndovers to better reflect patients’ thoughts and
encourage their active involvement in decision-
ptive case study explored Australian patients’
s of bedside handover. Case study, which is a per-
oach in nursing research (Anthony & Jack, 2009),
an idiographic, intensive study of a single case
rpose of understanding a larger class of similar
2003). The basic goal of case study method is
a case bounded by a definable context, which
, was the situation of bedside nursing handover.
ata from participants were analysed in terms of
rocesses, the context, the issues of concern, and
situations unique to each. As Yin (2003) suggests,
of analysis is contextualised to features of the
uation, then subunits of data are integrated in
case to illuminate and compare both unique and
dings. This involved iterative content analysis of
interviews, and ongoing comparative analysis of
rom other participants. In seeking convergence
from the analysis, there was no expectation of
ble findings, but rather an intention to extrap-
ingful information that could be useful in other
nce sample of 10 patients admitted to one of two
its in one Queensland hospital was recruited dur-
clusion criteria included English speakers having
talised on the ward for at least overnight, and
erate a 30—60min interview. Patients who were
l or infectious or those unable to consent were
atients were approached by the nurse unit man-
s) or their designates on each ward and asked to
or the study.
dentified all patients who had agreed to partici-
three researchers conducting the interviews (AM,
terview appointments were made at a time con-
the patient and held in a private office on the
l but two cases, which were conducted at the
cause of a lack of patient mobility. In all cases pri-
aintained without interruption. Interviews were
d, semi-structured, about 3/4 to 1 h in duration,
y the following:
22 A. McMurray et al.
1. What do you think about nurses undertaking their shift-
to-shift handover at your bedside?
2. From your perspective, what are some of the benefits of
3. What are some of the limitations of bedside handover?
4. What do
5. What d
6. What ro
7. To what
8. Are the
9. Is there
after all ind
study at an
ing codes i
bers of the
tion of the
the logic fl
the findings with the participants as a way of completing
our argument for fittingness, or transferability of findings.
Instead, we conducted a consensus conference between all
members of the research team to peruse our initial findings
and confirm their meaningfulness with respect to ongoing
ck from the two wards where bedside handover is
s is [
. it m
you think your role as a patient is in the bedside
r (i.e. how do you currently participate)?
o you think your role as a patient could be
bedside handover (i.e. how do you think you
le do you think your family members might have
extent to you think that bedside handover com-
s your privacy or confidentiality (please explain)?
re topics you think should be excluded from the
handover? If so, what are they?
any extra information you think should be
d in the handover that would help you and your
nce you are discharged home?
oval was granted by the University and the Health
trict. Potential participants were informed about
verbally by the NUM. They were given a writ-
ation summary sheet by the interviewer prior to
ew, explaining the aim of the study and how the
n would be used. Written consent was obtained
ividuals were given assurances of continued care
of participation, confidentiality, and the right of
answer any questions and to withdraw from the
were tape recorded, transcribed, and analysed
atic content analysis. Analysis was iterative,
ne by line analysis of transcripts, refining emerg-
nto themes or units of meaning, which were then
and coded through pattern matching (DeSantis
, 2000; Miles & Huberman, 1994). Themes and
ps were re-examined and recoded by two mem-
research team (AM, WC) in a recursive manner
first level coding involved reading responses to
major similarities or themes. A second level of
ded the major themes into subcategories and
ps. A third level further analysed the organisa-
mes, categories of response, and relationships
the data for consistency (Miles & Huberman,
n, 2002). Analysis continued until no new themes
nd there was agreement on themes.
iness of the data was maintained by appropriate
ection to ensure credibility, and by creating an
to illustrate systematic documentation and show
ow of the data collection and analysis (Lincoln &
). Because of the transience of the patient pop-
were unable to conduct member checks to verify
s included six females and four males ranging in
2 to 74 years (median 68 years). They had been
d on the study wards for 1—17 days (median 4
ll had experienced bedside handover. Four main
erged from the data: ‘acknowledging patients as
‘amending inaccuracies’, ‘passive engagement’,
ver as interaction’.
edging patients as partners
owledged as a partner reflected patients’ per-
at by sharing professional information, nurses
nising that patients were knowledgeable and had
e right to information on their condition. This
feel that care was personalised and that they
son first, and a patient second, particularly when
ntroduced at handover. They believed this helped
how their care was progressing, and gave them
n of who would be caring for them in the upcom-
statements included the following:
get the feeling of at least being wanted, you’re
a patient in a bed ... it’s better than the way
used to do their rounds — the ease with which
, in simple language ...’’
don’t introduce you as a patient or a number,
.. alienates you straight away. They actually say,
name] and [name’s] problems are this’. So it actu-
gs you involvement with the oncoming staff.’’
akes you feel like you’re involved ... like at the
station they wouldn’t have a clue who they were
o or about.’’
s had a common view that the handover was an
y for them to gain information about their medi-
n, and to understand staff expectations for their
nd upcoming plans for their care. Some believed
role was to ensure the accuracy of information
anged, such as whether or not the doctor had vis-
dications or treatments had been given. A number
ts illustrate this.
got anything wrong you could always put them
if they explain that you’re on insulin you can tell
at you’re on two lots of insulin ...and oh yes, but
umarsol as well.’’
Perspectives of Bedside Nursing Handover 23
‘‘I actually had to correct them this morning. I had my
drain in and the nurse said ‘one’ and I said ‘no, four’!’’
One patient explained that she was quite forthright in
correcting any misinformation being transmitted at han-
to the exch
person, it m
In many c
sit. I thi
way or a
it and ..
others, he understood the time pressures of handover, which
was a common limitation identified by participants.
We had expected that confidentiality of information and
privacy would be an issue for most of the patients. How-
ever, only two expressed any concern about the sensitivity
ere may be somebody coming [on shift] who
know anything about you and doesn’t know ...
eds you have or anything else, so I think it’s a
ing. Also, a number of times in here I’ll say ‘that’s
t, that didn’t happen you know, you’ve got it all
cipants preferred a less participative approach,
ir role as passive listeners. They paid attention
ange of information between nurses but did not
information unless they were expressly invited.
ted that when staff members talked in the third
eant they were not encouraging patients’ input.
formation depends on who is giving the handover.
uld be more inclusive.’’
r, others simply wanted to gather whatever
n they could from what were relatively short han-
you should just be there and just listen.’’
would be rude, the height of ignorance because
doing their job the way they’ve been taught and
interfering aren’t I?’’
r as interaction
ases the nurses handing over actively encour-
nt engagement. Participants thought this was a
sive approach, especially those who declared they
know everything about their condition. They were
pleased to be asked for input, especially when
clarify their expectations or misunderstandings.
case the nurses know I like to enter into the
on and they invite me to ask questions.’’
you let them know where you stand ... it might
by the manner you look at them or the way you
nk every patient does give body language ...one
nother, so it lets the staff ...know basically what
ou’re the subject aren’t you? I mean you’re the
conversation in the handover ... they’re talking
u so if you’ve got anything to say by all means say
.they can sort of discuss it. You can get involved,
speak to them and get involved in it.’’
h this was a typical perception among partici-
person did not wish to interact, and another felt
no encouragement to interact during handover
ere was no invitation to ask questions. Another
ented that he would have liked to have discussed
is of heart failure at handover. However, like most
to be s
ion being shared in a four bed room. Their com-
e not about the handover process, but rather
sues about having both males and females in the
. The others were unequivocal that it was not an
ave never yet been invasive of my privacy ...
not delving into private parts of my illness or
anything else, you know. They’re just more or
ing on the information that I’m a COPD person.’’
ants indicated that the language of communica-
propriate, which may be a feature of the clinical
t, as reflected in the following comment:
remember a few years ago the doctors used to
rounds and talk to their subordinates as if you
there ... the bedside manner of the nurses is
n entirely different thing.’’
ata collection was confined to a convenience
study findings are not generaliseable. Further
include the lack of validity and generalisability,
e to the small sample size. However, the analy-
s a useful insight into the way patients perceive
ndover. Despite the single Australian context, the
in clinical care in other settings suggest a level of
y elsewhere. These findings exemplify the type
hat may arise in other institutions changing to
ings reflect a move to patient-centred care in the
ere the study was undertaken. Patient-centred
ents one ‘pillar’ of a broader Transforming Care
ide initiative, which had been introduced at the
years prior to the study (Chaboyer et al., 2009;
et al., 2004). Clearly, patients appreciated this
of clinical practice. It was interesting to find that,
studies of patients’ perceptions of bedside han-
ill, 1998; Greaves, 1999; Kassean & Jagoo, 2005;
), patients were not overly concerned with pri-
ad, they all expressed a desire to be involved
r and, as such, have access to information. This
at privacy of health-related information may be
issue to nurses than patients. Participants’ com-
cted a desire to be engaged with nursing staff,
as a partner in their care.
t systematic review of bedside handover con-
Arora et al. (2009) found that including the
be empowering, which is one of the goals of
ary nursing practice (Robinson et al., 2008). This
a shift in the nurse—patient relationship over the
es. Almost two decades ago, Australian research
e handover concluded that it was an inefficient
e, as handover consisted of a simple recitation
arker, Gardner, & Wiltshire, 1992). Our study
perception that nurses were more inclusive in
24 A. McMurray et al.
their handovers, moving beyond a mere status report, and
making a conscious effort to engage patients. This res-
onates with a suggestion by Burnard (1987) that a more
comfortable patient-centred atmosphere would actually
increase the effectiveness of bedside handover. It also chal-
ing and nu
the basis th
to care (Ba
Quality in H
of trust be
ment in p
steps to en
scan at the
how all of
tions of ac
tioned as a
care they w
ate and sa
racies or m
ical and social information, and this was a shortcoming found
in other research (Cahill, 1998; Dowding, 2001; Fenton,
2006; Hopkinson, 2002; McKenna & Walsh, 1997; Webster,
1999) and in a recent report of the Special Commission
into public hospitals in New South Wales Australia (Garling,
o a s
expert model of practice, instead supporting the
ll of nursing research recommending power shar-
rse—patient partnerships (Anderson & Mangino,
n et al., 2006; Gallant et al., 2002; Keatinge et
Robinson et al., 2008; Wiggins, 2008). A parallel
is also gaining popularity in medical circles on
at closer alignment with patient preferences not
ves satisfaction with care but enhances adher-
treatment (Cegala et al., 2007; Young, 2008).
al trends in health service delivery also reflect a
patient-centredness and a partnership approach
ggoley et al., 2009; Bruni et al., 2008; Coulter et
In fact, the Australian Commission on Safety and
ealth Care identifies patient-centred services as
clinical redesign strategies and the development
tween service providers and patients (ACSQH,
dings are also consonant with Anderson and
2006) findings identifying information (how well
kept you informed) as the most significant ele-
atient satisfaction with bedside handover. The
and processes of bedside handover, articulated in
rdised operating protocol, included a number of
sure congruence and comprehensiveness of infor-
aboyer et al., in press). These included a safety
bedside, integrating information from the han-
e, which was updated regularly throughout the
access to clinical information contained in the
tient chart. Clearly demonstrating to the patient
this information was used in care planning may
to their reassurance and therefore their percep-
curacy and safety.
e of communication used by the nurses was men-
positive aspect of bedside handover. Patients
at by using language familiar to them, nurses
ing to a more mutually trusting relationship,
owledge. Clearly, when patients are given an
y to gain a greater understanding of their plan of
ill be better equipped for input into collaborative
imed at ensuring that their care is both appropri-
fe. As Williams (2002) suggests, one of nursing’s
s should be decision-making at the point where
is greatest, and this requires an organisational
ere staff empowerment becomes an antecedent
empowerment. From this type of synergy there is
ial to advance both patient outcomes and clinical
nt (Williams, 2002).
ractive nature of bedside handover was another
the style of communication. A non-linear, trans-
proach to communicating reflects a process in
ages are sent and received simultaneously (Adler
2009), and where participants are constantly and
fluencing each other (Miller, 2002). Patients were
icipants in the handover, and were able to not
bute information, but also correct any inaccu-
isinformation. What was not achieved in these
ndovers was the opportunity to discuss psycholog-
is an id
in a co
as a m
eased time pressures on a workforce that is strug-
e with staff shortages make it highly unlikely that
on will change (Preston, 2009).
is demonstrated that bedside nursing handover
vehicle for implementing a partnership model of
nts believed they were being treated in a trusting,
way, and felt welcome to correct any inaccura-
saw handover conducted at their bedside as an
y for interaction, even though some adopted a
sive engagement. Although the study was con-
ingle group of patients in one setting it was clear
ts perceived bedside handover as a tool to pro-
ate communication. This type of communication
a fundamental building block for patient empow-
ich is the essence of nurse—patient partnerships
porary model of care.
ings suggest a number of recommendations for
anagement and further research. First, clini-
hould consider the adoption of bedside handover
nism to promote patient-centred care and as a
ety measure. Second, there is a need for ongoing
nt of communication skills. Although these skills
undergraduate curricula, communication is not
sidered a priority in orientation and staff devel-
ograms. Content would include an emphasis on
patients at handover, being inclusive in the con-
nsmitting information, and assessing whether or
nt wishes to be actively or passively involved in
ver. For managers the implementation of bedside
hould be incorporated in a change management
at is collaborative to facilitate quality improve-
agers and staff development personnel should
are of the need for staff to discuss the changes,
a level of comfort with disclosing information
ave previously been withheld from patients. This
include addressing nurses’ concerns about con-
and justifying the need for a greater focus on
tred care and its benefits.
y suggests a need for further research into other
f Transforming Care At the Bedside to determine
ents of this approach are most effective, and
ethods of implementation. Ongoing research is
d into strategies that foster patient-centred care,
lationship of different types of information and
cision-making. Additional studies should address
d facilitating factors influencing the adoption of
ndover and other aspects of patient-centred care
timate aim of providing robust evidence for policy
Perspectives of Bedside Nursing Handover 25
Our study was funded by the Australian Commission on
Safety and Quality in Health Care. We would like to acknowl-
edge the Commission, and the generosity of staff and
time and t
Adler, R. B.
Alem, L., Jo
of care f
Arora, V., Ma
Aston, M., M
Botti, M., B
of a refle
Brown, D., M
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