Bedside Shift Reporting

In every profession there are changes that propel how tasks are done; nursing is no stranger to this. One of the biggest changes that have come into nursing’s daily events is how report hand-offs are being done. Gone are the days of taped report that each off going nurse must tape about each patient and the oncoming nurse must listen to. Nurses are now being encouraged to move their report to the bedside, in front of the patient (Trossman, 2007). It is very important to know how this can affect the patient and even the nurse’s schedule.

With every change, there are positives and negatives that can finalize the decision to keep or forego the change. Although change is hard when confronted with a new way doing something we are accustomed to it is important to know how it will change the flow of the floor. It is also important to have a plan. In changing end of shift report styles, there has to consistency throughout all nursing staff. As in Lefton’s (2007) article on change, she states that nurses and nurse managers need to have a plan but also be flexible in implementing it.

She also states that with a large change is it important “to be proactive, highly involved, and have an open door policy” (Lefton, 14) with any problems that may arise. On every floor, there may be resistance to any change and difficulties in adapting to it. Just like in life, nurses must be patient and know that it in the long run it may be better for the patient and continue to be a best practice for care. Patients who make frequent visits to the hospital may also notice the change with bedside reporting.

Nurses may help put the patient at ease by showing cohesiveness between the off going and the on coming nursing staff. Patients are also able to take part in their own care by asking questions and knowing what their plan of care is during their time in the hospital. After all, being in the hospital can be frightening and even worse when you feel clueless about what is going to be done. Every year the Joint Commission introduces or alters their long running list of National Patient Safety Goals (NPSG) for the upcoming year (Revere).

These goals are in place to help keep the patient safe and improve care throughout healthcare. The goals have helped propel healthcare to be more cognizant of how dangerous the hospital setting can truly be. In 2008, goal two was “improve the effectiveness of communication among caregivers” (Revere). As everyone knows, communication in everything is important, but it seems as if it is even of greater importance in the hospital setting. One wrong lab value or test result reported can be detrimental to a patient’s outcome.

Secondly, bedside shift reporting applies to goal 13 of the National Patient Safety Goals. Goal 13 encourages the patient and their family to be actively involved in their care as a safety measure (Revere). It is important for each patient to be fully aware of each test and procedure they will have done during their hospital stay, bedside reporting encourages this greatly by discussing it all in front of the patient. Comak (2009) states that goal two and 13 are now considered standards rather than goals.

Comak also states that when a goal is transferred to a standard there is less emphasis placed on the requirement during a survey because it is then thought of as an automatic practice. Although the NPSG’s change from year to year depending on completion or alteration of the goal, the goals should be incorporated into nursing’s everyday activities. Nurses my have a many reservations when altering a vital activity in their day. In changing traditional reporting to the bedside, nurses will be able to see their patients sooner rather than doing report in another room on all of their patients and then going to see them.

When bedside reporting was implemented at a hospital in Chandler, AZ, the time from when a nurse started her shift to seeing patients had been cut down to as little as 11 minutes (Federwisch, 2007). At times, it can take up to an hour to see a patient when nurses use traditional reporting. In thinking of safety or even treatment of pain when it comes to patients, seeing a patient that soon may cut down on patient falls and increase satisfaction with care. In looking at another hospital’s experience, Riley Hospital for Children in Indianapolis was able to decrease their lag between shifts by 45 minutes Trossman).

The article also goes on to state that children’s families felt that “call lights were not being answered promptly, and couldn’t get the nurses attention if their child needed a pain pill or other care” (Trossman). During report time, the healthcare staff can be far more engrossed in that part of their day rather than the call lights or a patients needs hoping that the nurse’s aides could take care of the issue until report time is over. Having the nurse at the bedside far sooner could show patients and their families that the on-coming nurse is readily available.

Bedside reporting doesn’t seem to be a new concept even though the research is fairly new. In an article from 1978, Pepper states “bedside report ensures better continuity of care by being more accurate and more complete than the conference report”. This is true in many ways, for example, how often are nurses in a rush to leave from a hectic day and forget about a dressing change or IV bags? If nurses are doing a bedside report rather than the traditional report they would be more apt to talk about IV’s, dressings changes, or even a patient’s level of consciousness because the patient is in front of you and those items are quite hard to miss.

Pepper also states that there is a professional advantage by being able to show the “less experienced nurses more exposure to other nurses’ techniques and approaches to patients”. Newer nurses for the first year of their career can be very uneasy about their newfound responsibility and by doing report together with the other nurses the newer nurse may feel more a part of a team. When an organization is trying to decide whether or not to change the end of shift report, it’s important to look at what the negative aspects are.

Of course it is easy to do what is easy and what has always been done, as it can be quite scary to go into uncharted territory. When looking into the research, it was noticed that confidentiality (Laws & Amato, 2010) was a large concern for nurses. Although most hospitals are trying to have more private single rooms, most still have semi-private rooms that two patients must share. When bedside report is taking place the nurse should ask the patient if he or she would prefer to have bedside report versus report not including them.

Nurses may even ask the patient’s visitors to please step out of the room if the patient is uncomfortable. These steps can help ensure the patients privacy and allows them the option of bedside report. Laws and Amato found among confidentiality there were bad test results, new diagnosis that a patient may not know about, issues about patients who are noncompliant with their care, or even the length of report. These items can be discussed before or after the bedside report takes place in order to prevent awkward situations.

Many nurses seem to have concern about bringing the patient into the report process, afraid they will ask too many questions or even take up too much of their time (Laws & Amato). Nurses have long thought of the individuals they care for as patients and not clients, when in fact if they were thought of like clients they would be far more involved. Healthcare is a team effort; patients need to be a part of the team rather than outsiders. Although it seems as if bedside reporting is a new to many wards, there have been quite a few studies done to understand the benefits and effects.

In a study conducted in Finland on eight surgical wards, both patients and nurses were involved to find the purpose and to find factors that encourage or prevent participation (Timonen & Sihvonen, 2000). Interestingly enough, out of the 118 nurses surveyed they all agreed on the goal of bedside reporting, and only 76% of the 67 patients agreed with the nurses (Timonen & Sihvonen). Although there are times that patients participated in the bedside report, some were found to think it was only information for the nurses, not for them also (Timonen & Sihvonen).

In another study in Mauritius (a small island south east of Madagascar), the 40 patients interviewed enjoyed the bedside report and wanted it to done on other wards and also that doctors should adopt this approach in communication (Kassean & Jagoo). Both studies used Lewin’s 3-step model for change involving unfreezing, moving and refreezing when bedside reporting was initially implemented. These studies prove that although there can be difficulty the positives outweigh the negatives greatly among patients.

Bedside reporting seems to be greatly encouraged in many healthcare environments all over the world. There seem to be times that nurses focus more on the tasks rather than the patient and bedside reports puts the focus back on the patient and even makes it where nurses spend more time at the bedside rather than at a computer. With every change there can be difficulty, but it’s quite easy to find the benefit in bedside reporting, ensuring patient safety and encouraging patients involvement in their care in critical times.

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