See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/8231343

Challenging the handover : recommendations for

research and practice
Article in Collegian Journal of the Royal College of Nursing Australia August 2001
Source: PubMed

CITATIONS

READS

38

497

2 authors, including:
Beverly O'Connell
University of Manitoba
58 PUBLICATIONS

612 CITATIONS

SEE PROFILE

All in-text references underlined in blue are linked to publications on ResearchGate,

letting you access and read them immediately.

Available from: Beverly O'Connell

Retrieved on: 11 October 2016

[REFEREED ARTICLE]

Copyright of Full Text rests with the original

copyright owner and, except as permitted under the
Copyright Act 1968. copying this copyright material is
prohibited without the pemtission of the owner or its
exclusive licensee or agent or by way of a licence from
Copyright Agency Limited. For information about such
licences contact Copyright Agency Limited on (02)
93947600 (ph) or (02) 93947601 (fax)

'-.J <:> \/'

"

<>:

"'---

"

.~ . //

-.../

/'

."
\\

the
11IE1i1\ultJ':W~'t~~~I;WJIa."'*';''':.4I~'

.:II; _

Communicating nursing care during the patient's total hospital stay is adifficult task to
achieve within the context of high patient turnover, a lack of overlap time between
shifts, and time constraints. Clear and accurate communication is pivotal to delivering
high quality care and should be the gold standard in any clinical setting. Handover is a
commonly used communication medium that requires review and critique.
This study was conducted in five acute care settings at a major teaching hospital. Using a
grounded theory approach, it explored the use of three types of handover techniques
(verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semi-

structured interviews with nurses and participant field observations. Textual data were
managed using NUO.IST. Transcripts were critically reviewed and major themes identified

from the three types of handovers that illustrated their strengths and weaknesses.
The findings of this study revealed that handover is more than just a forum for
communicating patient care. It is also used as a place where nurses can debrief, clarify
information and update knowledge. Overall, each type of handover had particular
strengths and limitations; however, no one type of handover was appraised as being
more effective. Achieving the multiple goals of handover presents researchers and
clinicians with a challenging task. It is necessary to explore more creative ways of
conducting the handover of patient care, so that an important aspect of nursing practice
does not get classified as just another ritual. By Bev O'Connelland Wendy Penney.
Associate Professor Bev O'ConnellRN PhD FReNA School of Nursing, Deakin
University. Email: bevoconn@deakin.edu.au

and Wendy Penney RN BN MN, Lecturer,

School of Nursing, Deakin University.

Background
COMMUNICATING NURSING CARE
throughout the patient's total hospital stay is a difficult task to achieve within the con-text
of high patient turnover, a lack of over-lap time between shifts, and time constraints. This
process is further exacer-bated by 'the use ofpoor documentation strategies that contain
patient information
that is usually out of date (O'Connell 1998,

2000). In support of this argument, a grounded theory study conducted on the way in which
nurses determined and com-municated care revealed that nurses experi-enced a basic social
14 Collegian Vol 8 No 3 200 I

problem of being in a state of "unknowing" in

regard to specific patient care needs. This
state of "unknow-ing" was in part due to the
use of inconsis-tent methods of determining
and communicating patient care. These
findings should be of concern to the profession
as one could assume that a lack of knowledge
about the patient is likely to impact nega-tively
on nursing care. Clear and accurate
communication is pivotal to delivering high
Quality care and should be' the gold stan-dard
in any clinical setting. It is therefore

-,
.'!- '

/
/
\

incumbent upon all professionals to cri-tique

communication strategies that are used and to
determine their appropriate-ness and efficacy.
Handover is one commu-nication method that
is essential to the continuous provision of
Quality care.
Work constraints such as reduced shift
overlap times and shorter shifts have required
nurses to develop new methods of
communicating patient care. As a conse-quence
of this, a number of different mod-els of
handover have been considered. These
different handcver models are in need of
critical review as the literature reveals
anomalies with current handover techniques
(Cahill 1998, Miller 1998, Webstcr 1999),
I'vIcKcnna (1997) high, lights a number of
problems with the tradi-tional handover, such
as [he length of time it takes and the lack of
quality of the infor-mation given. Wcbsler
(1999) states that al though tape-recorded
handover hJS reduced time, it has limited face
to face dis-cussions and is devoid of patient
input. In principle, the use of bedside handover
facilitates patient involvement; however, the
way in which it is implemented GIn

replicate the same problems of the tradi-tional

office handover (Timonen & Sthvo-nen 2000).
Timonen & Sibvonen (2000) report that nurses
tended to concentrate on the charts and did not
involve the patients as expected. Additionally,
nurses experi-enced difficulties involving
patients who were acutely ill or unable to
participate due to psychosocial reasons. Calull
(1998) fur-the I'adds that patients felt
inadequate con-tributing to these discussions
due to a lack of knowledge about their
conditions. Moreover, handing over at the
bedside has been problematic due to patient
confiden-tiality issues (Miller 1998, Williams
1998) and from the patient's perspective
nurses' use of professional jargon can be
frighten-ing and alienating for them (Cahtll
1998).
A more comprehensive review of handover techniques is necessary as it is cstimated that the handover period Costs
approximately $33,000 a year for a 20-bcd
ward (Miller 1998). This figure, multiplied by
the number of wards across hospitals, Can
potentially equate to millions of dol-lars.
Based on data gained from a grounded theory
study, this paper will discuss the

strengths and limitations of three common-ly

used handover methods, relate these to the
literature, and make recommendations for
future research and practice.

Method
Using grounded theory method (Claser &
Strauss 1967, Claser 1992), the primary study
was conducted to discover how nurs-ing care
is determined, delivered, and com-municated
in acute care hospital settings. Data were
collected using semi-structured interviews with
mainly nurse clinicians, patients, and relatives
(n = 27), field obser-vations of handover (5
sttes) and informal interviews conducted
during observations (n > 40 nurses). Textual
data were managed using NLlD*IST and the
secondary data analysis was performed using
constant comparative method identifying the
major strengths and limitations of three types
of handover techniques. The handovcr tech.
niqucs that were reviewed included face to
face handovcrs in the office, tape recorded
handovcrs, and face to face handovcrs conducted at the bedside. The study COIll-menccd
after approval had been grunted

Collegian Vol R No J 200 I

15

(REFEREED ARTICLE]

from the University's Human

Research

Ethics Committee, and the

Hospital's

Research and Ethics Committee, and after

julillg sh( didll't really klloIP what was goiug 011.

Another problem with handover was

related to

the type of

it had the potential to lead to undesirable

outcomes.
He came ill lasl WWiHg. [SIt/ItS Iht raliwls agt

information given.

m,d ""dical diagllOsis] be; a NIDDM, fdl m,d

registered nurses in the wards had consent ed

For example, some nurses used this time to

to participate in the study.

give an account of the activities they had

jractured IJis ril,s, [givts tlJt mtdical trtdtmwtbe '}Od

011 Ihe prtvious ward] ... 110 ditl he Cel/lIlol swallow,

Findings

performed on a shift. This information had

little relevance to other nurses who were

Data revealed that the

information handed

over varied from nurse to nurse, and that

the handover process was influenced by
many contextual. patient and nurse factors.

Some of the contextual factors were

the

more interested in the patient's progress

and future care.
Th0'dOIl'1 look at Iht patitllt 011 a cOlltilluum,

IIl1so-gasfric luht rt-iJlmied, jteds w;l/ hI.' comillg lip,

dopa mint i,rjusioll

20 IIlI

per hOllr, also IVfluids, "1.'5

dthydraltd OIlCt juds slmt IV call stop, his unue

ot/tpul is Vtry poor, two /'ourly ml.'t1surmlwl, SIlC-lio'lill!

PRN, 1)( Iluds luaps and luaps oj moull) cart his

you hlOW, tl,ty dOll't ~ort oJ look at tVI,allwpptlltd

maybt yesttrday. SO I/J0' don't givt you allY oj the

lIlouth looks Vtry bad. Ht gol vtry agi/altd whtl1

1passed the nasa-gastric lubt, I don't kllOll' he seens

cOlljustd. Oxygtll sats artfil1t, oxygw COI1-

TihliS 1Lrraidliil:oolf1lal lface to lfaCiS handovers OD1l 11:ihle

oihfoce wiStre appralsed as !beong Uen9l11:lhly. time
COI11JSIUIMOI11J9I al11Jd ofteD1l cOI11J11:a1oll1ingj
subjective lPa1LOiSl11J'IJ:ol11J1totrmatioll1l. e-aowiSvetr.
11:lhiis type of ihlall1ldloviSlr served another purpose as they
WiStre IUIsedl SlS a1111J avenue 11:0 eu:clhlSlll1l9le
o01l11.oll.ma1l:ioll1l.idle!bll.ie1i. all1lidl as a time il'Otrsociat
cihloil:cihlail: fdhla11: was em011:DOl11JalUy ClImll sociallUy
omlP0tr1l:al11J'IJ:lfol1'111JIl1ltrses.

time available to conduct handover and the

pace of the ward at the time. Additionally,
patient information that was handed over
varied due to the nurse's knowledge levels of
the individual patient's condition and their
personal understanding of the patient. Nurses
who had returned from days off, and agency or
casual nurses who had only worked on the
ward for a short period, had limited
information about the patients and were
unlikely to be able to handover infor-mation in
a substantial way. Consequently, information
handed over tended to be incomplete. The
increasing use of agency and casual nurses and
the large numbers of nurses involved in each
patient's care exac-erbated the problem. It
seemed that due to the changing context of
practice, nurses felt more comfortable
communicating:
infcnua-tion
verbally.
However, this information was more prone to
being lost when held and handed over in the
oral culture. The following excerpts from
interviews illustrate these points.

hislory oJ l/lhat's harrmcd, or whats going to hap-

f Ill('(/IJ sOllle oJ I/.ll' pcople [mulC5] 1 lPo,.k (pith

Ilrc sldflilJ~ off find some illo:perituad, ... like slart-

No, you'pe gal to dJlIse I/JCIlI [referrill~ to the

doe/ors], sOmttimfs you jj"d Ollt fr01l1 II)t Pflliwl,

ifl!l offdt coon/i/llltiltg /lnd Ihry mill rillxr boud oper loo

1/,0' SIlY "01"

llIudJ J<!IJorllldlioH or cist' somdiml's lIJcy dOli'I hi/lid OPl'''

t/nd t/lllls lhc first lilUe you'Pt' Ildl!ll/1y 1,Ct'tJ lold.

wOllgl,. Ana Ifml you htlllt' SOUlt' propit', / kllOIP 11,1ms

There were many instances where nurs-es'

knowledge about the patient remained
"uncertain". fvloreover, lllln;es' acceptance of
uncertainty and "not knowing specifics about
palierlt care" left them vlllner"ble as

Ollt' lady [rrIerl'il/51 10 a colll'dgut'], s/,l'

Il'dS 11 !ollely lady, /'lll slJC rcally, yOll (lWIt' oul [of
tht hlludol'l.'r room]lIIra you rl'dlly I,dd, s/il/ 110 itlcd

of ll'/JIII

'.lI1d IJllppwt'd, l'tTl/HSC you I1lmosl !lot

lIlt

16

CnllcMiilJl Vul R No I }OOO

tillllOllS

milh tJJt

Hudson

mask, CVP rtadillgs art

ceased. Hes 1101 jorilltubalioll if be armis.

[AnolherI'll/masks a qlltS/ion:} "W/1al, do Ult
jllst givthim cardiac massagd'
[The sl1ifl coordinalor allswm..] "[ aptcl 50."

[The handovtr COlltiIlUtd.]

As a consequence of receiving inade-quate
handovers, many nurses spent con-siderable
time chasing accurate information from a
number of sources. This time-con-suming
exercise reduced the time available to deliver
care. Overall, analyses of the data indicated
that each type of handover had particular
strengths and limitations, however, no one
type of handover was appraised as being more
effective.
Face to face handovers

p,,_ Tbry t"d to fo"" on tb,fact tbat of all tb,

in the office

thillgs that thO' did that day ... 50 this has bttll a

The traditional face to face handovers in the

office were appraised as being lengthy, time
consuming and often containing sub-jective
patient information. However, this type of
handover served another purpose as they were
used as an avenue to exchange information,
debrief, and as a time for social chitchat that
was emotionally and socially important for
nurses. New staff, especially new graduates,
found this type of handover useful as they used
it as an opportunity to confirm information and
were often given an impromptu educational
session.

major fVt'JIt oJ the day, like melanlll, tJ1t'l1

1/11115

IVI)al thry'lI Jocus 011. Ytah, and Ihry'lI jorget to tell

yOIl Ihe ntdoscopy happelltd yl.'5/trday.

The findings revealed that regardless of the

type of handover that was used there were
consistent gaps in information due to a number
of reasons.
"Ntl/l

admissioll, don't know /IIuch I1bout him,

bes jusI COIUC up from casualty. l've 110t dOfle Ihe

ohs."
"[SIatl.'5 his a!1e mid IIltdical diagnosis] ...
IJt IJas alcohol p"oHc1Us, Ilefds a sputum. We
dOll't knoll' Il'IJtrt IJt is 510illg to, I)/It tht social
UJorktr ;5 invo!lletl. "
"[SldtCS his l1!1t mrd lIIl'diml diagJlosisJ ...
1dOll'l k"oll" IJtS come from mlOl/m Ulard
mrd the pmo1r (pho /lookcd him ill did Hot bt01P
(pIJ"t opem tioll JJt llJl15 coming injOI:"
sorry

Additionally, the fragmented communication between nurses and doctors added

to this problem.

rill

going '}oIIlt' ill IIJr 1Il0nrillu"

AllotJm unrseasks her 11 qUl.'5lioll 'Dots s/)t

gtl up for /m S/'OIPtO' The a.m. co-ordilll1tor
mlSIPm 'Yl.'5'. Furl/uro:pllliHS howslu is
alllbuldliJlg. Wil/,hold ber meals, sbe is !'l1villg double /lIeals, s/,t says
I/,eJl1mily 1Jrill~ /Jcr ill mCl/ls fllld tlmJ she rats our
meals l1S wdl. Num 3 Sl1ys '51)(5 Pl'ry IJUIl!1ry', tlJt
lUll. co-ordinalor t'xplaills wlJy s/Jt is hUlIgry

hmwse she is 011 sleroids.

Individual nurses also had different
approaches to handing over patient information. Some methods were thought to he less
helpful and retarded the communica-tion
process.
Aud if II)ty USt /l s/Jecl oj PIIPtJ' IIJty lIs1wily
rcad dOIPIt Iwd follolP l/ formlll IIUtl it IMS somr

1f t/,cy dOIl'1 IIsr 11 sl)ul oJ pc/prr Iwd

they're hmhliug ollr/" off the lOp oj dId/" helld, 1/)(11
it seetlls 10 llld/llia /'lefr. lhcfr mid CllClyll'lJl.'l"C. Quill.'

slruclufe.

Jmnkly, ... IP/ml il twds la (pmldn "tre, dJere alld

weryllll,m 1don 'Imm 10 be able 10 remew/m' it

[patient details] at al/.

This type of hand over was important as it
provided an avenue for the transference of
information within the oral culture. There were
many patient care issues that were held in nurses'
minds and only hand-ed over verbally. These
included either confidential issues or instances of
misman-aging care. An excerpt from the field
notes illustrates this point.

On some occasions, nurses would have to

replay the tape in order to determine what was
said. However, if the message was not clear it was
difficult to confirm or deny information, as the
person handing over may not have been
accessible. The follow-ing taped handover is an
example of an unclear message.

PAT/ENT C] [states the patients name,

age, medical diagnosis] borderliHe sleep apllOtil,
ambulanl, self-care, IV bllllgtd, iJhe is IlIIllletl Jast

JJim Jrom ! 2.00 lIIidnigl" md call the lealll.

TIJis patieut was

all

alcol,olic alld they

IPm

(messing "illl Jar lI'ifhdrall'aJs. He was prescribed

1.1(I/;UIll

iJ he IPas displaying certain wUIJdrallJal

siglls. TI,e ll11m handed over tlJat Ihis palit,lt called

a 1St year RN dJal night and said Ihat "he had IUdrd
an explosioll" Ihe nurse instantly gave him 5111gs oJ

Valilllu as si" thouglJt tl'at he was !pith-dmming alld

hallucinating. Apparently, tl}(re was all explosion at
a nearby vwue alld tht patiellt was nothallucinating
at all. Several days later the HurS(S continued to
hand this over alld ,,,tVe a little chuckle at 1/" same
time. BtSides signing 11" medicatioll chart this

Within this context, it was difficult to

determine with certainty what "unwell" meant,
and the nursing response that was expected if the
patient was unwell after 12.00 midnight. In
addition, as these han-dovers did not provide an
opportunity for nurses to clarify patient details or
fill in the gaps in information, some knowledge
about patient care got lost. This occurred more
frequently with agency nurses as they often did
not return to the ward.
The at/m Jrustrating tl,illg linked to that [tl'e

episode IPas notdoclllllellted.

tape-recorded /Jmdover] is somdimes tlJe staff t!

A summary of the strengths and weak-nesses

of verbal office handovers is listed in

1ember oJtm

Table 1.

lot oJ timeJillding out thal i'ifonnatioll Ihat's lost tl'at

Tape recorded handovers

For a summary of the strengths and limitations of the tape recorded handovers see

Due to the rostering system and lack of shift

overlap time, tape-recorded han-dovers were
introduced to communicate patient information.
While this type of handover had practical
benefits, as no face

iSI1"

lime allY mort to Jilld out IIll,al's

gOlle on, 50 YOll're somdimes losl and have 10 spelld a

was-11 't011 11" tape ... but oJtell inJonnation isjust losl.

Table I.

Face to face handover at

the bedside
Face to face handovers at the bedside were
introduced in many wards to try to over-come the
weaknesses of the traditional office andtape-

recorded handovers. This type of handover

seemed useful, as nurses were able to check
documentation and clar-ify information with the
patients and each other.
As this IW1dover is cOllducted at the bedside, 11)

( patimts lislell in all the IWldovers. QlIile oJI(II tlJe

IlllrSe asks the patiel1llPhal /,as I,appaltd. For exam-

ple, have

yOIl

had

YOllr

X-ray loday] Has Ihe doc-lor

seal YOII] Whal did he say] ... Ouceagaill Ihere is

emplwsis all tlu medication clwrt IOI'ich is reviewed,

alld drugs that are nolsiglled offare looked at and the

lIurse lookillg after the patialt, if sI" isstill all duty, is

asked to clarify wlJell"r shthas give" t"e

drug or 1I01.
While handovers that were conducted at the
bedside involved the patient in dis-cussing their
care, it also posed specific problems, as it was
difficult for nurses to handover personal and
confidential infor-mation in front them.
11,e nurses qualify thillgs u,jl/J edelJ other ie. does
he call yOIl wlml he needs a bottle or does he w(/himself. This nllrse had berfl Oil days offalld the patimt
IPas quite sick allhe lime. Because rbe IJaJldover5 are
conducted

at

11" bedside

ifthm

is allY private alld

awkward illJonnatioll to halldover the nurse points to

Im writttH cres 011 her I,a"dover sheet Jor I/Je other

to face contact is required, it also hindered

communication, as its use tended to modify and
alter the efficacy of the handover process. More
specifically, nurses found that they tended to
handover information in a more impersonal way,
focusing on tasks rather than on patient progress.
This type of handover tended to be brtefer and
did not reveal fully the patient's overall condition.
Additionally, some nurses used abbreviations that
were not understood by other staff. Due to the
time lapse between recording the information and
listening to the handover some patient
information was out of date. A nurse's account of
the effec-tiveness of hand over provides an
example

TABLE 1: STRENGTHS AND LIMITATIONS OF THE THREE TYPES OF HANDOVER

Strengths
Limitations
Verbal Office

Collective narrative (less gaps

Handovers

in information)
Opportunity for staff to debrief
Opportunity to clarify information (learning opportunity
especially for new staff)

Does not require shift overlap

Handovers

Less time consuming

It is more factual
Some nurses like this
matter-of-fact approach

Face to Face

Involve the patient

Difficult to clarify information

Cannot check patient and/or
documentation
No teaching opportunity
Acts as a filter (some nurses
are awkward and are cautious
tape recording information)
Some information is not handed over and is not processed
formally or informally
Public forum - difficult to dis-

Bedside Handovers

(individualised care)
Check the charts and
medications
Remedy errors
Assess patients and clarify
information at time of
handover

cuss personal patient issues

Confidential information is
sometimes revealed
Time consuming:
- Nurses prone to being
interrupted by ward issues
- Some patients like to chat

Tbey do it all llJpe [refnring la tbe I,mtdoper]

lire

comillg all 1111 aJtemooll shifl, tI'lll's ttlpea at J I. ]0

12.00 o'clock

md 1Jilld tbt maiH Ihillgs an: really

hllppmiug aroulld r.oo o'e/ock, after 11I1IrJJ, so thlll

aoes/l't get l'llllaed over all tJJe tllpe dJld if they dOIl't

sec yOll - verbally yOll don't gd it at ,,11, mId it's

lIs11dlly lJy Iril11 alld error thlll you fiutl it 0111. I
kllOl/l myself, it's slld, a rush "Oh, fpe gal to I,mldOllet" on the t"pt", ,p/,erws it wOllld he /Jeller to do it
vcrIJ'llly, 1tlJillk yOll remelll"n more ,PfJCJI YOl/'rt /lot

subjective and judgmental}

consuming
Some information is
superfluous
Some nurses switch off especially when the
information is subjective
Information can be out of date
e Tirne

Tape Recorded

of the problem.
dud Iht limildtioJl 1 suppose, especially if you

More story like (prone to being

so flIs/Jtd.
Collegian Vol 8 No J zno [

17

!REFEREEDARTICLE]

HUtSI' 10 mill. For (xl/mp/t, 11,"5 rlltifHIll'd5 " IlIlmic

r!errmiuc dHJlIIWhd d 10/ oJ (fl(OllrogelUcul md tl.l(
HUfSt' did /lol/pl/lll to 51ly 11J1l1 0111 aloud.
Additionally. nurses were constantly

interrupted during the handove r. This

made these

lengthy.

t ype

s of ha ndover-s

very

1999, Webster 1999).

The results of the current study support

the literature

identifying the

positive

aspects of the bedside handover, those

being its immediacy and inclusiveness,
allowing patients to
participate in
the
problem solving process (McKenna
1997).

develop ward specific pro forma to

structure handovers focusing on patient
progress rather than on tasks;
use tape-recorded handovers as a last
resort and then only as an adjunct to
other verbal communication methods;
include doctors in the handover process
for a brief period, this will
enhance
communication and accuracy of patient

Tilc0 'J5Tilrc10IJ1lBjS<DV ii:ihos sft:lUldlV 8'e'\!ea~edl ft:ihlal'll:

ihamiliDviSlJ' OS miDIJ'8ft:lhall1l DlUlsii: a ifo IJ'IUlm
1(011" :J:iDmmIUl1l1l0:caiio:ro'l!P'aiioell1l'il:care. filt OS also
used 81~ el iPJace wilce!l'0II1llUll1'SeScan d1efoJlJ'oeif,c~alJ'o1(V
5I11l']D:rmaJ'il:oiDlI1laJll1lrc1 IUll)lldla'il:e nmow~ei!JI'le.
Dud"!} lI'tfield ol'Stn)flliOH !,triod, f obstn)l'd cl
nurse btiH!J illtl'rruplrd six tiJllfS, ill /1 tllleJIly-minult
period, [I'Mlc tryiJl!J 10 /JrIl1dovcr ill I!JC IPard arm.

Time

ifllerruptiollS

uvrc

I/ue 10 /hcfollomirl!J rmsous.

lIisilors mkiu!Jassislmlrt for tlJtir rr/ali/1t5; " sludwt

llUrst askifl!J a/Joul pa/itut care, on II#tllCy nurse

!JOill!J offduty alld IJlTlldiu!J O[Ier Ihekeys; 1/ Pl/tieu!
(IIC/P admissioll) [Pho arrillcd from tile Clllcr'ilCHCY
depl/fhl1f11t dud thc orderly Ilecdhlg Ilssislmlcc 10 se/-

Ill' tlJf Pllliwl; ptllirlll /Jells ri"gillgcOllstdnlly.

For a summary of the strengths and limitations of the face to face bedside han-dove-s
see Table I.
Discussion
To answer the question of which is the most
appropriate type of handover, one must first
reflect on the handover's pur-pose. In this
study, handovcrs were used fJS torurns to
communicate patient informa-tion, to provide
staff with avenues to infer-mally debrief,
clarify and exchange patient information. New
staff including graduates found these informal
educational sessions very helpful. This finding
is supported by Parker, Cardner and Wiltshire
(1992) who state t hat talking to other nurses
and debriefing is;;111 important aspect of
nursing practice that is difficult to achieve in
patient areas and occurs within the context of
the verbal office handover.
Regardless of the type of handover method
used, their efficacy as a communi-cation
medium is questionable. Specifical-ly, the
results have highlighted a number of problems
with each type of handovcr, and there does not
appear to be one method that is more effective.
The findings of this study confirm what many
authors state: that the traditional verbal
handovcrs con-ducted in the office 'Ire lengthy
and rime consuming. Furthermore, they are
often lacking in structure and concentrate on
the nurses' tasks rather than the patients' needs
(\X'illiall1s 1~)9~, Mclvcuna 1~)97, Crcavcs

18

C(lllq.~i;lfl Vul x N(l.~ 2001

However, it also presents other problems, such

as maintaining confidentiality in a public
forum, and it is time consuming. This is
supported by Miller (1998) who states that the
bedside handover appears to have fallen out of
favour, for despite the documented
advantages, confidentiality still remains a
major concern.
What remains clear is that nurses do not
endorse one type of handover over another
and there is a need to develop an appropriate
and succinct method. The issue of developing
a more appropriate handover strategy requires
urgent attention as the inefficiencies in the
current han-dover system are costly and
unsustainable within a system that can ill
afford waste.
It must be recognised that comrnunicaring patient care over the patient's total hospital stay is a complex phenomenon, as this
information is constantly changing and held in
a collective memory 'with the patient, their
carers and the health care team'. Handover is
only one component of the overall
communication process. The study findings
have revealed some anom-alies with this
process and hence a need to review the
process.
Based on the findings of this study and
current literature the following recommendations are made, to;
review the contextual factors that impact
on haudover and try to minimise or
alleviate them. For example, increase
consistency in assigning nurses to the sarnc
patients over a number of shifts including
casual or part time nurses;
implement streamlined verbal hall-dovcrs
preferably at the bedside so there is face to
face contact with the patients and nurses.
This bedside han-dovcr should be
combined with a short verbal office
handovcr to enable the communication of
sensitive and con ri-dcntial information;

care information;
think creatively
and combine the
strengths from the different styles of
handover to develop a communication
strategy that meets the needs of individual patients and ward situations.
The findings of this study revealed that
handcver is more than just a forum for
communicating patient care. It is also used
as a place where nurses can debrief, clarify
information and update knowledge. Given the
pressure cooker conditions under which nurses
work these supportive and debriefing forums
are necessary and need to be scheduled as part
of a ward routine. They are important for
quality patient care and nurses' well being.
Achieving the mul-tiple goals of handovcr
presents researchers and clinicians with a
challenging task. It is necessary to explore and
evaluate more creative ways of conducting
handover, so that an important aspect of
nursing prac-tice does not get classified as just
another ritual.

References
Cahtll J 1998 Patients' perceptions of bedside
handovers. }oum,1! of (/illiclIJ NrlrsiH9 7( 4), 351 359

Glascr U & Strauss A 1967 Tlu discolJrry Dj !

jrouullrd I/){()ly. Aldine, Chicago
Claser B G 1992 l1.si(oj growrdol tlJtOry 11II1I1ysi5.
Thc Sociology Press, California
Creaves C 1999 Patients' perception of bedside

handover. Nllr~ill!J 5tmlll,mI14( 12): 32-35

McKenna L 1997 Improving the nursing handover report. Projrssiou,,1 Num 12(9): 637-639
Miller C 1998 Ensuring continuing care: <;tylc<;
and efficiency of handovcr. Auslr"Iimr .Ioumill Dj
Adll,urrr,I NUI'siug 16( I): B27
O'ConnellB 1998 The clinical application of
the nursing process in selected acute care settings: a
professional mirage. Aush<l!illll ./oum,,1 DJ A,/i'dfKc,1

NlIrsiu!J IS{t): 22-32

O'Connell B lOOO Enabling care: working
through obscurity and uncertainty. A theory of
clinical practice. Amllilli<llf .Iounlorl oj A/p,U1a,{ NursiH!J
17(3): 3239

Parker J, Cardncr G, Wiltshire J 1991 Handovcn the collective narrative of nursing practice.
Au,/r,rJilllf ./of/nIdl of A.ll"lIfm/ NlIlsiu!/9(3): 31-37

Timnncn L Si Sihvnncu r..t 2000 Patient oanlctpiltion ill bed-adc reporting on surgical wards. '/(1l1r-

11,,1 or Clinic,,1 NUI,ill!J 9(4), Sn-5lx

Wehst<:r J 1999 Practitiollercentred research.

<In evaluation or the lmplcrneruanon of hcdeidc

handovcr. .I'll/m,,1

oJ Adl"Uf(r,/ Nlff",iu!J

30(6): 1375-

1.~H2

Wiltiilllls A 19'18 r..lilllilging change in nurcing

horulovcr. Nur,illll SI'lIfd"nJ 12(1H): 39-42