Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Functions and Roles of Questioning during Nursing Handovers in Specialty Settings: An Ethnographic Study

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

The Functions and Roles of Questioning during Nursing Handovers in Specialty Settings: An Ethnographic Study

Article excerpt

(ProQuest: ... denotes formulae omitted.)

Handover is "the transfer of responsibility and accountability between one or more clinicians on a temporary or permanent basis" (Chin, Warren, Kornman, & Cameron, 2012, p. 2). Transitions in care, where handover acts as a bridge, are important sites for communication breakdowns that can lead to medical errors. Patient safety and quality of care can be affected by poor handover technique. Questions play diverse roles in handover, involving the transmission of information about patients and in constructing a comprehensive understanding of patients (Ilan et al., 2012). In this paper, through the presentation of research findings, we explore the interactional practices of questioning that occur between nurses during handover.

Questioning during handovers

Questioning is an interactional practice advocated for outgoing and incoming health professionals for effective handover communication. Questions have the enormous potential to improve the quality of handover interactions, and to reduce adverse events. In the I-PASS intervention study, a number of handover strategies were tested with medical residents situated in nine paediatric inpatient units in the United States and Canada. Following the intervention, there was a 30% relative decrease in preventable adverse events that could lead to patient harm. A key strategy was a standardised handover protocol based on the mnemonic I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency plans, and Synthesis by receiver). Asking questions was a major component of the protocol (Starmer et al., 2014). In regard to medical handovers, questioning by the incoming doctor offers new clinical insights and enables detection and correction of errors in the information communicated, such as in assessments and plans (Cheung et al., 2010; Ilan et al., 2012).

Specific benefits of questions during nursing handovers in regard to handover quality and patient safety have been infrequently articulated. Rayo et al. (2014) argued that incoming nurses' questions can detect erroneous assessments and actions and can therefore be beneficial to handover quality and patient safety. Drach-Zahavy and Hadid (2015) found that interactive questioning in nursing shift-change handovers had a positive impact on patient safety in that it significantly reduced the number of treatment errors in the following shift. Some authors recommend that the outgoing party should encourage questioning or provide an opportunity for the incoming party to ask questions (e.g. Cheung et al., 2010; Cohen, Hilligoss, & Kajdacsy-Balla Amaral, 2012).

Nurses also recognise questioning as a valuable practice in order to achieve an effective handover. O'Connell, Macdonald, and Kelly (2008) found that nurses viewed the strengths of handover as including being able to ask questions, being able to clarify information, and having the opportunity to seek details about things they did not understand. Carroll, Williams, and Gallivan (2012) found that nurses perceived a good handover report as one in which fewer questions are asked. An implication of this research finding is that nurses may have a fairly narrow perspective on the role of questions during handover, namely as being asked by incoming nurses for the purpose of verifying and completing the transmission of facts about a patient.

In previous work focusing exclusively on questioning during nursing handovers, Rayo et al. (2014) investigated differences in the frequency of questioning, with a specific emphasis on collaborative cross-check questions during handover across levels of training and between clinician types. Health professionals involved included attending physicians, resident physicians, registered nurses, and nurse practitioners. They found that collaborative cross-checks, which they defined as incoming health professionals' questions that challenge the accuracy or appropriateness of a patient's diagnosis, treatment plan, or prognosis, were used more frequently by health professionals with a higher level of training, namely attending physicians and resident physicians. …

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