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Title:

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Abstract:

Record: 1

Patients experiences of bedside handover: findings from a meta‐
synthesis.
Bressan, Valentina; Cadorin, Lucia; Stevanin, Simone; Palese,
Alvisa
School of Nursing, Department of Medical Sciences, University of
Udine, Udine Italy
Continuing Education Centre, Centro di Riferimento Oncologico di
Aviano (CRO) IRCCS, Aviano – Pordenone Italy
Agency for Health and Social Care, Veneto Region Italy
Scandinavian Journal of Caring Sciences (SCAND J CARING SCI),
Sep2019; 33(3): 556-568. (13p)
Article – research, systematic review, tables/charts, meta synthesis
English
Patient Attitudes — Evaluation
Shift Reports
Hand Off (Patient Safety)
Human; Meta Synthesis; Quality Assessment; Thematic Analysis;
Qualitative Studies; PubMed; CINAHL Database; Psycinfo; Nursing
Care; Patient Rights; Consumer Participation; Nurses; Patient
Safety; Systematic Review; Clinical Assessment Tools; Male;
Female; Middle Age; Aged; Aged, 80 and Over; Adult; Emotions
Background: Bedside shift reports have been recently
recommended to ensure handovers. However, no evidence
summarising studies designed to determine the qualitative
approaches capable of better understanding patient experience
have been published to date. Aim: The aim of this study was to
acquire a deeper understanding of the experiences of patients
regarding bedside shift reports. Data sources and review methods:
A systematic review of qualitative studies followed by a meta‐
synthesis method based upon Sandelowski’s and Barroso’s
guidelines was performed. Four databases were systematically
explored (PubMed, CINAHL, Scopus and PsycINFO) without any
limitation in time and up to the 31 August 2018. A total of 10 studies
were included and evaluated in their methodological quality; then, a
thematic synthesis was developed to synthetize the findings.

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Journal Subset:

Special Interest:
Instrumentation:

ISSN:
MEDLINE Info:

Entry Date:
Revision Date:

DOI:
Accession Number:

Database:

Results: Three major themes reflect patients’ experience regarding
the bedside shift reports: (i) ‘Being involved’; (ii) ‘Being the centre of
nursing care processes’; and (iii) ‘Experiencing critical issues’.
Patients are supportive of bedside shift reports as a right, as an
opportunity to be involved, and of being in the centre of the nursing
care process. By designing and implementing bedside shift reports,
nurses also have an opportunity to increase patient safety and to
provide concrete proof of the advancements achieved by the
nursing profession in recent years. Conclusions: The bedside shift
reports experience has been little studied to date from the
perspective of patients. According to the findings, implementation of
the bedside shift reports should include providing education to
nurses with regard to the preferences and expectations of patients,
as well as the critical issues that they can experience during the
bedside shift reports. Presenting the bedside shift reports method,
asking patient consent, discussing potential critical issues and the
degree of involvement preferred at hospital admission, is strongly
recommended.
Continental Europe; Core Nursing; Europe; Nursing; Peer
Reviewed
Evidence-Based Practice
Critical Appraisal Skills Programme (CASP)
0283-9318
NLM UID: 8804206
20190913
20200831
10.1111/scs.12673
138540679
CINAHL Plus with Full Text

Patients experiences of bedside handover: findings from a meta‐synthesis

Background: Bedside shift reports have been recently recommended to ensure handovers. However, no
evidence summarising studies designed to determine the qualitative approaches capable of better
understanding patient experience have been published to date. Aim: The aim of this study was to acquire
a deeper understanding of the experiences of patients regarding bedside shift reports. Data sources and
review methods: A systematic review of qualitative studies followed by a meta‐synthesis method based

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upon Sandelowski’s and Barroso’s guidelines was performed. Four databases were systematically
explored (PubMed, CINAHL, Scopus and PsycINFO) without any limitation in time and up to the 31
August 2018. A total of 10 studies were included and evaluated in their methodological quality; then, a
thematic synthesis was developed to synthetize the findings. Results: Three major themes reflect
patients’ experience regarding the bedside shift reports: (i) ‘Being involved’; (ii) ‘Being the centre of
nursing care processes’; and (iii) ‘Experiencing critical issues’. Patients are supportive of bedside shift
reports as a right, as an opportunity to be involved, and of being in the centre of the nursing care process.
By designing and implementing bedside shift reports, nurses also have an opportunity to increase patient
safety and to provide concrete proof of the advancements achieved by the nursing profession in recent
years. Conclusions: The bedside shift reports experience has been little studied to date from the
perspective of patients. According to the findings, implementation of the bedside shift reports should
include providing education to nurses with regard to the preferences and expectations of patients, as well
as the critical issues that they can experience during the bedside shift reports. Presenting the bedside
shift reports method, asking patient consent, discussing potential critical issues and the degree of
involvement preferred at hospital admission, is strongly recommended.

Keywords: bedside handover; bedside shift report; literature review; meta‐synthesis; nursing; patient
experience; systematic qualitative review; thematic synthesis

Introduction
Shift handover has been defined as the process of transferring authority and responsibility of a patient
between two or more healthcare professionals [ 1]. It is considered a basic component of healthcare
organisations due to its influence on the quality of care and consequent patient safety and clinical
outcomes [ 2]. Different shift handover methods have been documented to date, and above all, bedside
shift reports (BSRs) have been considered as one of the best due to their capacity to increase patient
safety, their centred care approach [[ 3]], satisfaction for both patients and nurses, and decreased
miscommunication, errors [[ 5]], and costs [[ 6]].

The BSR occurs when the handover shift report between the off‐going nurse and the incoming nurse
takes place at the patient bedside [ 3]; it requires a face‐to‐face interaction between two or more nurses,
involving the patient as an active member of the process [ 8]. Even if currently no BSR gold standard has
been defined, its key components have been identified in the following elements: (i) participants in the
process and their role (e.g., nurses, other staff members, patients’ relatives); (ii) where and when the
BSR occurs (e.g., in the patient’s room, in a dedicated meeting room); (iii) the nature of the information
shared (e.g., patient’s medical history, nursing care plan) and how (e.g., verbally, through a checklist,
mnemonics) [Forde et al. [ 9]. Moreover, according to Chaboyer et al. [10] five steps are required to
guarantee a good BSR practice: the first step is preparatory, and usually includes staff and patient’s
allocation and an update of patient’s information and care documents. In the second step, outgoing
nurse(s) introduce oncoming staff and patients; then, in the third step, information is exchanged through

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different strategies, such as face‐to‐face communication, patients’ care records, staff questions and
clarifications answers to patients. In fact, in order to improve the quality and the accuracy of handover
contents, patients should be invited to comment or to ask questions during the fourth step of the BSR
process; in the fifth and final step, a safety check of patients’ conditions, environment and equipment
should be performed by oncoming nurses [10].

To date, several reviews and primary studies have documented the advantages and implications of the
BSR on the quality of care and patients’ involvement [e.g., Mardis et al. [ 6]; Tobiano et al. [11]; Ford and
Heyman [12]; Whitty et al. [13]]. However, despite the documented positive outcomes of the BSR, clinical
nurses have been reported to not always adopt it as a standard method to transfer clinical data for
different reasons, including the fear of threatening confidentiality [[14]], of speaking in front of patients,
and/or the increased time required to perform shift reports [18]. Furthermore, the available evidence has
been derived from quantitative studies [e.g., Sand‐Jecklin and Sherman [16]; Wakefield et al. [17]]; only a
few qualitative studies have investigated patients’ BSR experiences. Exploring and better understanding
patients’ feelings and thoughts [19] regarding the BSR can help identify the principles that should be
considered in designing and implementing the BSR in an attempt to respectfully consider the preferences
and values of the patients and their relatives. Thus, a meta‐synthesis was designed to identify and
summarise qualitative studies that have explored to date patients’ experience of the BSR.

The review

Aim
The aim of this study was to acquire a deeper understanding of the experiences of patients regarding the
BSR. The main research question was as follows: ‘What is the experience of patients involved in hospital
BSRs?’

Design
A systematic review [20] followed by a meta‐synthesis [21] was adopted to analytically summarise the
findings of qualitative studies available in the field. As reported by Sandelowski and Barroso [21], the
meta‐synthesis represents an interpretative integration of results that emerge from qualitative studies,
allowing a novel interpretation and exploration of a phenomenon through the lens of the participants
directly involved. According to Thomas and Harden [22], the methodology synthesis adopted in this study
was based on thematic synthesis. The methods and findings have been reported according to the
Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines as
well [23].

Search methods
The pre‐planned review was conducted according to the Preferred Reporting Items for Systematic
Reviews and Meta‐Analyses (PRISMA) statement [24], and the Sandelowski and Barroso qualitative
research synthesis process [21]. Inclusion criteria were applied in the selection of (i) primary qualitative

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studies, (ii) studies which explored the perceptions and experiences of adult (>18 years) patients
regarding BSR(s), (iii) studies published in English and (iv) studies with abstracts available. Moreover,
qualitative data from mixed‐method studies were included, if distinguished; in addition, to guarantee that
all relevant studies were included, no limitations in time have been applied on all potential studies
published before 31 August 2018 were considered.

PubMed, CINAHL, Scopus and PsycINFO databases were searched by two authors in August 2018. The
keywords and MeSH terms ‘patient experience’, ‘bedside handover’ and ‘qualitative research’ were
included and combined using Boolean operators. The search terms were also modified and explored in
the databases to ensure that all possible combinations were considered. A manual search was also
performed by two researchers by accessing the reference lists of the selected studies. To determine the
eligibility of all potentially relevant studies, the same researchers independently scanned all titles and
abstracts.

Search outcomes
Database searches yielded 749 studies during the initial phase of the search. After removing duplicates
and screening the titles and abstracts, 52 full‐text studies were assessed and seven met the inclusion
criteria. The reference lists of the selected studies were reviewed, and three additional papers were
found; therefore, a total of 10 studies were included. The review process including study identification,
inclusion and exclusion, according to the PRISMA guidelines [24], is reported in Fig. .

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Flow chart of the search strategy and results.

Quality appraisal
To evaluate the methodological quality of the included studies [22], all members of the research team
used the Critical Appraisal Skills Programme (CASP) [25] in the initial stage and then agreed upon the
findings. In the case of studies performed by members of the research team, the evaluation was
performed by other researchers.

The 10 appraisal items of the CASP allow researchers to detect the logical and rational flow of the
research process, how ethical issues are addressed, and the value of the research contributions. At the
end of the evaluation process, the score is one of three options, 1 (Yes), 0.5 (Unclear) and 0 (No) [26],
resulting in a maximum score of 10, with higher scores suggesting a higher study quality. The evaluation
of study quality was judged as high, medium or low according to the scores obtained by each study [25].

Data abstraction and synthesis
A researcher extracted the data and populated a grid reporting the study design, the participants’
characteristics, the data collection methods and the analytical strategy used; the main findings of each
study were also extracted (Table ). The extraction process was then checked independently by a second
researcher and disagreements were discussed.

Description of included studies

Author,
year,
country

Study aim(s) Participants
and setting

Study designData
collection
method

Key findings

Bruton
et al.
(2016) 37
UK

To understand the
purpose, impact and
experience of nurse‐to‐
nurse handover from
both patient and staff
perspectives and the
perceived differences
between nurse handover
and medical ward rounds

Eight patients
(gender and
age not
reported)
1 medical and
1 surgical ward

Qualitative
study

Observation,
semi‐
structured
interviews

Patients felt reassured when staff
clearly knew about them, while
they felt insecure if the nurse did
not appear to know about their
care or treatments
Patients’ views and experience of
involvement in handover varied:
some felt involved in the
handover, some would to be more
involved, others wanted to hear
the handover on their condition
but not be involved, and some
thought involvement could be a
distraction for the nurses

Lupieri
et al.

To describe the
experiences of

14 patients
(female = 28%;

Qualitative
descriptive

Semi‐
structured

Four themes emerged:
(1) discovering a new nursing

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(2015) 31
Italy

postoperative cardio‐
thoracic surgical patients
experiencing nursing
bedside handover

range
age = 49–
86 years)
1 cardio‐
thoracic
intensive care
unit

study interviews identity
(2) being apparently engaged in a
bedside handover
(3) experiencing the paradox of
confidentiality
(4) having the situation under
control

Lu et al.
(2014) 35
Australia

To explore patients’
perceptions of bedside
handover

30 patients
(female = 73%;
age not
reported);
acute medical,
acute surgical,
and maternity
wards

Qualitative
descriptive
study

In‐depth
semi‐
structured
interviews

Four themes emerged:
(1) a more effective and
personalised approach
(2) being empowered and
contributing to error minimisation
(3) privacy, confidentiality and
sensitive topics
(4) training need and avoidance
of using technical jargon

Bradley &
Mott
(2013) 36
Australia

To study empirically the
process and outcomes of
nursing bedside
handover implementation

Nine inpatients
(gender and
age not
reported)
3 acute rural
hospital wards

Mixed‐
method:
quantitative
(quasi‐
experimental),
qualitative
(ethnography)

Ethnographic
interview,
observations
journaling

Patients preferred the bedside
handover method to the
traditional closed‐door office
handover approach: they know
who is looking after them and
they are involved in discussion
related to their care
Patients felt empowerment linked
with being active in their care

Jeffs
et al.
(2013) 30
Canada

To explore patients’
experiences and
perceptions associated
with implementation of
bedside nursing
handover

45 patients
(female = 66%;
age not
reported)
surgery 29%;
obstetrics and
gynaecology,
27%;
nephrology
27%; general
respirology,
18%

Qualitative
study

Interviews Three themes emerged:
(1) creating a space for personal
connection
(2) ‘bumping up to speed’
(3) varying preferences

Kerr et al.
(2013) 38
Australia

To explore the
perspectives of patients
regarding bedside

30 patients
(female = 60%;
age not

Qualitative
descriptive
study

Semi‐
structured
interviews

Two themes emerged:
(1) patients perceive that
participating in bedside handover

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handover by nurses in
the emergency
department

reported)
1 tertiary urban
emergency
department

enhances individual care: it
provides the opportunity for
patients to clarify discrepancies
and to contribute further
information during the handover
process, and is valued by
patients; patients are reassured
about the competence of nurses
and continuum of care after
hearing handover conversations
(2) maintaining privacy and
confidentiality during bedside
handover is important for
patients: preference was
expressed for handover to be
conducted in the emergency
department cubicle area to
protect privacy of patient
information and for discretion to
be used with sensitive or new
information

Staggers
et al.
(2013) 34
USA

(1) To determine inpatient
oncology patients’
perceptions about
participation in shift
change handoffs
(2) To elicit patients’
information priorities and
identify tools to support
future patient‐provider
handoffs

20 patients
(female = 50%;
range age 28–
85 years;
mean
58.4 years)
1 general
surgery ward
of a large
oncological
centre

Exploratory
descriptive
study

Naturalistic
observations,
interviews,
fields note,
artefact (tool)
capture

Three themes and 15 categories
emerged:
(1) depend upon how sick I am
(level of participation by patients,
frequency of patients’
participation, location of nurses’
handoff, negotiation with patients
after handoff, patients’ barriers to
participating)
(2) I want to know everything
(information needs of patients,
preferences of patients, patient’s
discharge information needs,
patient tools, shared electronic
health record information)
(3) my life is in their hands (take
care of me, being a good patient,
perceptions of the nurses’ role,
perceptions of care)

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McMurray
et al.
(2010) 32
Australia

To interpret patients’
perceptions of shift‐to‐
shift bedside handover in
nursing

10 patients
(female = 60%;
range age 52–
74; median
age 68 years)
2 medical units

Descriptive
case study

Semi‐
structured
interviews

Four themes emerged:
(1) acknowledging patients as
partners
(2) amending inaccuracies
(3) passive engagement
(4) handover as interaction

Greaves
(1999) 29
UK

To explore how patients,
perceive the practice of
nursing bedside
handover

Four patients
(gender and
age not
reported)
hospital setting

Qualitative
study

Semi‐
structured
interviews

Four themes emerged:
(1) patients desire to be involved
and access information
(2) importance of confidentiality
(3) need for continuity of
information passed from nurse to
nurse
(4) neglect the patient presence
during handover

Cahill
(1998) 33
UK

(1) To capture, describe
and provide an analysis
of patients’ perceptions of
the bedside handover
(2) To illuminate which
elements patients,
express either
satisfaction or
dissatisfaction with

10 patients
(gender and
age not
reported)
surgical care
setting

Grounded
theory

In‐depth
interviews

Three categories emerged:
(1) maintaining professional
dominance where patients
identified a division between
themselves and nurses
(2) establishing professional
sharing; for patient’s bedside
handover represented a forum for
debriefing and nurse‐to‐nurse
interaction
(3) managing patient safety

1 Only qualitative data were extracted.

The findings of each study were analysed, and a thematic matrix was built by extracting, coding and
analysing the data as themes or categories, and developing new potential themes [21]. This was
performed through the three stages requested by the thematic synthesis approach as suggested by
Thomas and Harden [22]: (i) the free line‐by‐line coding studies’ findings; (ii) the organisation of codes
into associated areas to settle ‘descriptive’ themes; and (iii) the development of the ‘analytical’ themes.
The new themes were derived inductively [27], and the process was performed manually by involving all
members of the research team; each step was then discussed by researchers to reach an inter‐coder
agreement. For each theme, when needed, sub‐themes were also developed following the same
process.

To detect possible inconsistencies, theme and sub‐themes were analysed repeatedly and summarised
[28]. Then, emerged themes and sub‐themes were evaluated in their occurrence by calculating the intra‐

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study intensity and the inter‐study frequency effect size to avoid under or overweighed themes and/or
sub‐themes [21].

Results

Studies included
Ten studies published between 1998 and 2016 were included (Table ), one of which a mixed‐method
study. Four studies were performed in Australia, three in the UK, and the remaining in Canada, Italy and
the United States. The designs (e.g., qualitative study, qualitative descriptive study, grounded theory,
ethnography) and settings varied across studies, while data collection methods were similar and based
mainly upon observation and semi‐structured/in‐depth interviews. Patients involved in studies ranged
from four [29] to 45 [30] and the total sample participants included in all studies were 180.

Quality evaluation of the selected studies
The CASP evaluation revealed that the majority of studies were of high quality (Table ). All of them
described research aims that were appropriate with the research methodology used; the recruited
strategies and data collection methodologies were also clearly reported. A few studies reported the
researchers’ role during data collection [[30]], and two described ethical issues too briefly [[33]]. Clear
statements of findings were presented in all studies.

Quality assessment of included studies using the Critical Appraisal Screening Programme

Bruton
et al. 37

Lupieri
et al.
31

Lu
et al.
35

Bradley
& Mott
36

Jeffs
et al.
30

Kerr
et al.
38

Staggers
et al. 34

McMurray
et al. 32

Greaves
29

Cahill 33

Item 1. Was there a clear
statement of the aims of the
research?

Y Y Y Y Y Y Y Y Y Y

Item 2. Is a qualitative
methodology appropriate?

Y Y Y Y Y Y Y Y Y Y

Item 3. Was the research
design appropriate to address
the aims of the research?

Y Y Y Y Y Y Y Y Y Y

Item 4. Was the recruitment
strategy appropriate to the aims
of the research?

Y Y Y Y Y Y Y Y Y Y

Item 5. Was the data collected
in a way that addressed the
research issue?

U Y Y Y Y Y Y Y Y Y

Item 6. Has the relationship
between researcher and

N Y U N Y N N U N N

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participants been adequately
considered?
Item 7. Have ethical issues
been taken into consideration?

Y Y Y Y Y Y U Y Y U

Item 8. Was the data analysis
sufficiently rigorous?

U Y Y Y Y Y Y Y U Y

Item 9. Is there a clear
statement of findings?

Y Y Y Y Y Y Y Y Y Y

Item 10. Was this research
valuable?

Y Y Y Y Y Y Y Y Y Y

Overall score 8 10 9.5 9 10 9 8.5 9.5 8.5 8.5
Overall Level of Quality Moderate

to High
High High High High High Moderate

to High
High Moderate

to High
Moderate
to High

2 Y = Yes ( 1); N = No (0); U = Unclear (0.5).

Synthesis of findings
Three major themes emerged from the selected studies as reflecting the experience of patients involved
in hospital BSRs: (i) ‘Being involved’, (ii) ‘Being the centre of nursing care processes’ and (iii)
‘Experiencing critical issues’. The themes were divided into several sub‐themes of meaningful units
(Table ).

Intra‐study intensity and inter‐study frequency effect sizes of sub‐themes/themes

Themes 1. Being
involved

2. Being the
centre of
nursing care
processes

3. Experiencing
critical issues

Intra‐study
intensity
effect size, %
(n/N)

Sub‐themes 1.1 Being
involved
is a right

1.3 Being
involved is a
controversial
experience

1.4 Being
involved at
different degrees
of intensity

2.1
Experiencing
a sense of
safety

2.2 …

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