You are on page 1of 20

AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 1

An Integrative Review: Bedside Shift Reporting

Chelsea Woodmore

Bon Secours Memorial College of Nursing

NUR4122 Nursing Research

4/19/17

I pledge.
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 2

Abstract

The purpose of this integrative review is to appraise literature relating to the use of

bedside shift reporting and the effects it has on patient care satisfaction. One of the

most frequent causes of sentinel events in hospitals result from ineffective

communication. A key component of nursing practice is handing off pertinent

patient information. The implementation of bedside shift reporting allows for better

communication between nurses, and also helps ensure that misinformation is not

passed on between care providers. Databases such as EBSCO and PubMed were

utilized to find research articles. The search yielded 47 articles form the Nursing

Reference Center and 22 articles from PubMed. The results of these five articles

showed that implementing bedside shift report lead to an increase in patient

satisfaction. Due to the researchers limited experience and first attempt at writing

an integrative review, there are some limitations to this review. Additional research

is needed ensure that bedside shift reporting continues to be implemented in the

hospitals.
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 3

An Integrative Review: Bedside Shift Reporting

The purpose of this integrative review is to search the literature pertaining to

the use of bedside shift reporting and the effects it has on patient care satisfaction. A

key component of nursing practice is to ensure the communication of information

facilitating the transition of care from one provider to another (Cairns, Dudjak,

Hoffmann, & Lorenz, 2013). The most frequently cited root cause of sentinel events

evaluated by the Joint Commission (TJC) is communication failure during handoffs

(Cairns et al., 2013). Shift report routinely takes place behind the nurses station or

outside the patients room, opening the door for misinformation. Also, this type of

reporting rarely gives the patient or family a place to exchange information that may

be important to the oncoming shift (Radtke, 2015). This area interests the

researcher due to the decrease in patient care satisfaction that impacts many

aspects of the organization, including the health care providers. Therefore, the

proposed PICO question by this researcher is as follows: Among staff nurses on a

medical-surgical unit, does implementing bedside shift report lead to greater patient

satisfaction with care when compared to traditional shift change report at the

nurses station?

Design/Search Methods

The research design is an integrative review, which was conducted for a class

assignment for an undergraduate nursing program. The search for research was

conducted utilizing the computer-based search engines EBSCO and PubMed. The

search terms included, bedside shift report, patient satisfaction, traditional shift
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 4

report, and patient care. The search yielded 47 articles from the Nursing Reference

Center and 22 articles from PubMed, indicating an abundance of literature on this

topic. To obtain current articles, the search was limited to quantitative and

qualitative articles written between 2012-2017. The articles had to be peer-

reviewed and in English. The articles also needed to pertain to the researchers PICO

question, Among staff nurses on a medical-surgical unit, does implementing

bedside shift report lead to greater patient satisfaction with care when compared to

traditional shift change report at the nurses station? The articles were then

selected based on the following inclusion criteria: med-surg units, bedside shift

reporting, and patient satisfaction about care. The research articles were screened

based on inclusion criteria and PICO question significance. Articles that did not meet

criteria were excluded from the review. The screening produced 5 bedside shift

report implementation articles, including 4 quantitative articles and 1 literature

review.

Findings/Results

The findings and results of the five reviewed studies indicated an increase in

patient care satisfaction of the implementation of bedside shift reporting as

evidenced by clinical measure outcomes (Cairns, Dudjak, Hoffman, & Lorenz, 2013;

Gregory, Tan, Tilrico, Edwardson, & Gamm, 2014; Luthy et al., 2017; Radtke, 2013; &

Sand-Jecklin & Sherman, 2014). A summary of the compiled research articles is

presented in Appendix 1. The researcher framed the review according to the

following categories: better communication between patient and nurse and

increased perception of patient involvement.


AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 5

Better communication between patient and nurses

Three studies concluded that patient satisfaction increased because of more

effective communication, after the implementation of bedside shift reporting (Cairns

et al., 2013

; Radtke, 2013; & Sand-Jecklin & Sherman, 2014). In the quantitative study

conducted by Cairns et al. (2013), outcomes confirmed positive relationships

between bedside shift reporting and patient satisfaction. Utilizing a 5-point Likert

scale (1 = strongly agree to 5 = strongly disagree), data was collected from patients

at an academic hospital. Using the W. Edwards Demings plan-do-study-act (PDSA)

model as the framework, the surveys were administered pre and post

implementation of bedside reporting. No mention was made of the sample size, but

it was concluded that patients felt as the nurses kept them better informed of their

care.

Sand-Jecklin and Sherman (2014) conducted a quasi-experimental pre- and

post implementation design to measure quantitative outcomes of a practice change

of bedside reporting. The authors surveyed 233 patients before bedside

implementation, 157 patients three-month post implementation, and 154 patients

13-month post implementation of bedside reporting. Using the Patient Views on

Nursing Care survey tool, the authors engaged patients views on communication

including, if important information was reported from shift to shift and if patients

were included in shift report discussion. All data was analyzed using ANOVA
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 6

comparisons, and the authors found that patients perceived better nurse

communication and felt that they were continually informed of their care.

Similarly, Radtke (2013), created a pilot program that aimed at implementing

a bedside shift report process on a medical-surgical unit in a tertiary hospital. Over

1100 patients were surveyed during the course of one year. As their framework,

Radtke used Peplaus interpersonal relations theory that is based on the idea that

the nurse-patient relationship is therapeutic and that it is crucial for nurses to

assess, plan, and put context behind the care delivered to their patients (Radtke,

2013). The author also used Lewins Theory of Planned Change to drive the pilot

study for bedside implementation. Patients were surveyed before the change to

bedside shift reporting, after the six-month implementation of bedside reporting,

and again three-months after. After completion of the study, the author found that

patient satisfaction in nursing communication rose to 87.5%m, an increase from the

75% in the previous six months. The author concluded that using bedside shift

reporting could improve handover communication that would essentially improve

patient safety and overall enhancing patient satisfaction.

Increased perception of patient involvement

Three articles found that with the implementation of bedside reporting,

patients felt that they were more involved in their own care (Gregory et al., 2014;

Luthy et al., 2017 and Sand-Jecklin & Sherman, 2014). In the two quasi-experimental

controlled studies, patients were more involved with the day-to-day decision of

their care and that more family involvement also occurred with bedside shift

reporting (Luthy et al., 2017 & Sand-Jecklin & Sherman, 2014). Sand-Jecklin used a
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 7

sample size of 157 patients and surveyed them a three-month implementation of

bedside reporting, and another sample of 154 patients after a 13-month

implementation of bedside reporting. Data was analyzed using ANOVA comparisons

and the authors found that patients were encouraged more by the nurses to be

involved in their own care and were offered good explanations about their care.

Utilizing the Picker questionnaire, Luthy et al. (2017) measured patient

satisfaction of bedside reporting compared to traditional reporting in a 6 ward

medical unit. 90 patients from each ward were asked such questions as whether

they felt sufficiently involved in treatment and if they felt family was given the

opportunity to be involved in care. The authors found that patients in the bedside

report group felt more involved in their care compared to the group that kept the

traditional nurse reporting style.

The literature review conducted by Gregory et al. (2014), created a systemic

review of bedside shift reporting as it relates to patient safety and satisfaction. Using

a computer-assisted search, the authors yielded 310 potential articles, eventually

narrowing down the number to 33. These articles had to have met the inclusion

criteria and the summary of their findings yielded six major themes. Two themes,

team-based variables and individual benefits, discussed positive outcomes of

bedside reporting. According to Gregory et al. (2014), with bedside reporting,

patients felt more comfortable asking nurses about their health, felt more involved

with their care, and felt more empowered with their health care.

Discussions/Implications
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 8

The findings of the integrative review address the effects of bedside shift

reporting versus traditional shift reporting at the nurses station concerning patient

satisfaction of care received. Therefore, the review findings relate to and support

the researchers PICO question. The PICO question specifically asked about the

effects of bedside shift reporting on patient care satisfaction. The four quantitative

studies showed statistical significance in clinical outcome measures specifically with

increased patient satisfaction (Cairns, Dudjak, Hoffmann, & Lorenz, 2013; Luthy et

al., 2017; Radtke, 2013; & Sand-Jecklin & Sherman, 2014).

Bedside shift reporting has proved beneficial for both the patient and the

nurse, but one of the biggest challenges comes with maintaining implementation of

bedside shift reporting (Gregory et al., 2014). Hospitals must find a way to ensure

that nurses continue to utilize bedside reporting, thereby increasing patient

satisfaction and driving up HCAPH scores. One issue that will continually need to be

addressed is the assurance of patient confidentiality when it comes to bedside

reporting, as some studies found that patients and nurses alike were concerned

about relaying private information during bedside reporting (Cairns et al., 2013).

Limitations

There are numerous limitations acknowledged by the researcher that have

influenced this integrative review. The review is a final class assignment being

conducted solely by the researcher. The researcher is a full-time undergraduate

nursing student who commutes two hours every day, with limited time available

due to class schedule and other commitments. This is the researchers first attempt

at writing an integrative review hence there is an inherent lack of knowledge


AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 9

affecting the project. The assignment criteria were limited to 5 nursing journal

articles within the last 5 years.

Conclusion

Finding discussed in this integrative review showed the benefits of

implementing bedside shift reporting in increasing patient satisfaction. Studies

showed that bedside reporting made patients feel more involved in their care and

created better communication between them and their care providers (Cairns et al.,

2013; Gregory et al., 2014; Luthy et al., 2017; Radtke, 2013; & Sand-Jecklin &

Sherman, 2014). Bedside shift reporting also improved nurse perception, as nurses

felt more prepared at taking on the responsibility of their patients and were able to

form a more trusting relationship with their patients (Cairns et al., 2014 & Gregory

et al., 2014). It is important to continue to implement bedside reporting because

better communication between nurses and patients can increase patient safety and

reduce the number of sentinel events.


AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 10

References

Cairns, L. L., Dudjak, L. A., Hoffmann, R. L., & Lorenz, H. L. (2013). Utilizing bedside

shift report to improve the effectiveness of shift handoff. Journal Of Nursing

Administration, 43(3), 160-165. doi:10.1097/NNA.0b013e318283dc02

Gregory, S., Tan, D., Tilrico, M., Edwardson, N., & Gamm, L. (2014). Bedside shift

reports. Journal of Nursing Administration, 44(10), 541-545.

doi:10.1097/NNA.0000000000000115

Luthy, C., Francis Gerstel, P., Pugliesi, A., Piguet, V., Allaz, A., & Cerraschi, C. (2017).

Bedside or not bedside: Evaluation of patient satisfaction in intensive

medical rehabilitation wards. Plos ONE, 12(2), 1-11.

doi:10.1371/journal.pone.0170474

Radtke, K. (2013). Improving patient satisfaction with nursing communication using

bedside shift report. Clinical Nurse Specialist: The Journal For Advanced

Nursing Practice, 27(1), 19-25. doi:10.1097/NUR.0b013e3182777011

Sand-Jecklin, K. & Sherman, J. (2014). A quantitative assessment of patient and

nurse outcomes of bedside nursing report implementation. Journal Of Clinical

Nursing, 23(19/20), 2854-2863. doi:10.1111/jocn.12575


AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 1

Appendix 1: Qualitative and Quantitative Table of Evidence

First Author Luthy, Christophe (2017) / Attending physician at Geneva Hospital


(Year)/Qualifications
Background/Problem Bedside rounds is aimed at gathering and synthesizing information about patients,
Statement to transmit interdisciplinary information, and create a shared project of care and
decision making with the patient
Nurses were concerned that bedside shift reports could make the patients
uncomfortable, which led them to conduct shift reports outside the patients room
A study was performed to measure patient satisfaction between the two different
communication approaches

Conceptual/theoretical The researchers did not state a theoretical framework


Framework

Design/ A quasi-experimental controlled study


Method/Philosophical Patient satisfaction was measured using the Picker questionnaire (PiQ)
Underpinnings All patient data was anonymous and all patients signed a consent form

Sample/ Setting/Ethical 3 wards were used in the hospital, with 90 patients from each ward were included in
Considerations the study and completed the PiQ
Because this study was not considered a human subjects research, but instead an
institutional quality improvement study, it was exempt from the Institutional Review
Board of the Geneva University Hospitals
Major Variables Studied Independent variable: one group of four units were assigned to conduct bedside
(and their definition), if rounds, while the other group of four units were assigned to round as usual, whether
appropriate that be bedside or outside the patients room

Measurement Tool/Data
Collection Method Patient satisfaction was measured using the Picker questionnaire
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 12

Data Analysis Chi-square tests were used to analyze the differences in individual items of
satisfaction
One-way ANOVA tests were utilized to analyze the 9 satisfaction dimensions
between groups

Findings/Discussion
Significant improvement in patient satisfaction was seen in the group that conducted
bedside reporting, including increased satisfaction in involvement of family and
friends, discharge planning, and coordination of care
There was also increased patient satisfaction regarding patients being able to
identify the attending physician and nurse, receiving more information about their
health, and the opportunity to discuss treatment tailored to the patients needs.

Appraisal/Worth to
practice Bedside shift reporting is an essential part of inpatient care and contributes to
increased patient satisfaction, with better family involvement, care coordination, and
transition of care.
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 13

First Author Sand-Jecklin


(Year)/Qualifications (2014) / Associate professor of nursing at West Virginia University
Background/Problem The focus of research on bedside shift reporting is related to implementing it or
Statement explaining how other organizations could implement the change.
The second focus is improving the process of bedside reporting, which is often
through observation and identifying common themes, or by describing how others
may improve their own reporting process
Problem Statement: there is still a gap in the literature in terms of documenting
quantitative patient and nurse outcomes

Conceptual/theoretical Researchers did not state a specific theoretical framework


Framework The researchers looked at The Joint Commissions report that claimed that
miscommunication was one of the leading causes of sentinel events occurring in the
hospital
Design/ Quasi-experimental pre- and post implementation design
Method/Philosophical
Underpinnings

Sample/ Setting/Ethical The sample size for the patient survey was 233 at baseline data collection, 157 at
Considerations three-month post implementation, and 154 patient at 13-month implementation
The sample size at baseline for the nurse perception survey was 148, at three-
month post implementation it was 98, and at 13-month post implementation it was
54
The researchers stated their research was approved by an internal review board
Major Variables Studied Patient satisfaction of bedside reporting
(and their definition), if Nurse perception of bedside reporting
appropriate Three-month post implementation of bedside reporting
13-month post implementation of bedside reporting
Measurement Tool/Data The Patient Views on Nursing Care patient survey tool was used to engage
Collection Method patients views on different aspects of patient satisfaction
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 14

17 items were surveyed and each item had a five-point Likert-type response option,
with five indicating excellent care and one indicating poor care
Nurse perception of bedside report was collected using the Nursing Assessment
Shift Report; survey

Data Analysis Data was analyzed using ANOVA comparisons


Descriptive analysis with thematic coding was completed for the patient narrative
comments and narrative of the nurse survey

Findings/Discussion Patients perceived better nurse-to-nurse communication, more patient involvement


in care, more involvement in shift report, and staff making sure the patient knew
whom his/her nurse was.
Nurses perceived increased nurse accountability, increased patient involvement in
care, and increased prevention of patient safety problems as a result of
implementation of bedside reporting

Appraisal/Worth to Bedside shift reporting may improve patient satisfaction, perception of care,
practice involvement in care and could also impact the frequency of medication errors and
patient falls at shift change.
More quantitative research is needed to measure the efficiency of bedside reporting
in the nurses perception
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 15

First Author Gregory, Sean


(Year)/Qualifications 2014 / PhD, assistant professor at Texas A&M University Health Sciences Center
Background/Problem 2 major foci of modern medical care are patient centered care and improved quality
Statement and safety in patient care.
Central to both concerns is improved communication among care professionals and
between this team and the patient
Problem Statement: Evidence supports that breakdowns in communication and
occurrences of medical errors occur during patient handoff

Conceptual/theoretical The researcher did not state a theoretical framework


Framework

Design/ This article is a systematic literature review of bedside reporting


Method/Philosophical
Underpinnings

Sample/ Setting/Ethical 33 studies met all inclusion criteria including: data specific to nurses and shift
Considerations reports at patients bedside

Major Variables Studied Team-based variables


(and their definition), if Dyadic relationships
appropriate Individual benefits
Confidentiality concerns
Accountability
Cost containment
Measurement Tool/Data Data was collected using a computer-assisted search in the MEDLINE, PubMed,
Collection Method and Ovid databases, with additional search using Google Scholar.
Manual searches of references from relevant articles were performed to identify
studies that were missed by the computer-assisted search
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 16

Data Analysis Studies were used that met specific inclusion criteria: (i) data specific to nurses and
(ii) shift reports at the patients bedside
Studies with (i) non-empirical data, (ii) non-peer reviewed articles, (iii) overlapping
cohort studies, (iv) articles not in the English language, and (v) published abstracts
were excluded

Findings/Discussion Strong evidence supports the benefits of bedside reporting, however issues still
remain about sustaining implementation of bedside reporting.

Appraisal/Worth to Evidence continues to support the benefits of bedside reporting, but one of the
practice biggest concerns is staff continuing to implement the change which may require a
more standardize approach to implementation
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 17

First Author Radtke, K.


(Year)/Qualifications (2013) / MS, RN, APNP, CCRN, ACNS-BC
Background/Problem Active communication and sharing information from patient to nurse are an avenue
Statement to improve patient satisfaction
The exchange of information from nurse to nurse without the presence of the patient
opens the door for misinformation and does not give the patient or family a venue to
exchange information
Problem Statement: Researchers seek to answer is whether initiating bedside shift
report improves patient satisfaction scores when compared with current practices of
centralized reports

Conceptual/theoretical Peplau theory of interpersonal relations


Framework Lewins Planned Change Theory
The need for improvement of patient satisfaction as noted in the HCAHPS scores
Design/ Implementing a pilot program for a 16 bed medical-surgical intermediate care unit
Method/Philosophical
Underpinnings

Sample/ Setting/Ethical A sample size of an average of 280 patient per quarter, with a total of more than
Considerations 1100 patients annually

Major Variables Studied Unfreezing stage: getting rid of the old way of nurse reporting and implementing
(and their definition), if bedside shift reporting
appropriate Moving stage: Once the goal was reviewed, a proposal was developed
Refreezing: the process of bedside reporting was implemented
Measurement Tool/Data Data was collected via survey and interviews
Collection Method

Data Analysis The researchers did not state how they analyzed the data
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 18

Findings/Discussion There was a rise in patient satisfaction in nurse communication after implementation
of bedside reporting.
The unit did not reach its goal of 90% HCAPHS score, but did show that practice
change did impact this particular area of patient satisfaction

Appraisal/Worth to This article showed that it is possible to sufficiently organize the implementation of a
practice new type of reporting process
It highlighted the different complications for implementing new policies and how an
organization can overcome them
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 19

First Author Cairns, L. (2013) / DNP, RN


(Year)/Qualifications
Background/Problem According to the Joint Commission, a root cause of sentinel events is
Statement communication failure during handoffs
While there are numerous benefits to bedside reporting, nurses still have a difficult
time transitioning to this type of reporting, citing concerns about patient
confidentiality and length of time to complete the report

Conceptual/theoretical This particular study was conducted as a result of a unit staff nurse concerns about
Framework the length, accuracy, and disorganization of the current method of automated shift
report
W. Edwards Demings plan-do-study-act (PDSA) model was the framework used for
this study
The PDSA model is a method of performance improvement incorporating tracking,
defining, and evaluating a practice or process change
Design/ Quantitative experiment
Method/Philosophical
Underpinnings

Sample/ Setting/Ethical The researchers did not mention how many nurses and patients were involved in
Considerations this study
The article did not mention if the study was approved from the ethics board
Major Variables Studied The survey was given to the nurses 3 months before implementation of bedside
(and their definition), if shift reporting and 3 months after implementation
appropriate

Measurement Tool/Data 7-question anonymous survey


Collection Method 5-point Likert scale (1 = strongly agree to 5 = strongly disagree)
AN INTEGRATIVE REVIEW: BEDSIDE SHIFT REPORTING 20

Data Analysis The researchers did not mention how the data was analyzed

Findings/Discussion Positive outcomes of the implementation of bedside shift report included reductions
in shift overtime and call light usage and an increase in patient satisfaction

Appraisal/Worth to The reduction in call light usage has significant safety implications for those patients
practice that pose a fall risk
The decrease in overtime can help the organization save money
Increased patient satisfaction helps increase HCAPH scores and therefore increase
business for the organization