Running head: INTERGRATIVE LITERATURE REVIEW 1

Integrative Literature Review

Chrystal L. Allard

Bon Secours Memorial College of Nursing

NUR 4322: Nursing Research

Christine Turner PhD, RN

April 3, 2020

“I Pledge”
INTERGRATIVE LITERATURE REVIEW 2

Abstract

Purpose: The purpose of this integrated review is to identify if there is a relationship between

implementation of bedside report and increased patient satisfaction, safety and quality of care.

Background: Bedside reporting is completed at the patient bedside with patient involvement.

This process is to help patients feel included in their care, provide safe transfer of care, improve

patient safety and satisfaction. Method: This is an integrated review where all resources were

collected from online databases such as OVID, EBSCO and are less than 10 years old. The

articles used in this review are qualitative and one quantitative study that were chosen based on

the PICOT question: Does bedside shift reporting improve patient satisfaction and patient safety

compared to shift report done at the nurse’s station? The information used was to determine if

bedside reporting at shift change did in fact increase patient safety and satisfaction. Limitations:

The limitations of this literature review are the inexperience of the researcher, and the limited

number of articles allowed for the review. Results and Findings: The results showed that

bedside shift report did in fact increase patient satisfaction and patient safety and quality of care.

Nurses were also satisfied with bedside shift report as it holds nurses accountable. Implications

and Recommendations: Implications of the literature review is all the research studies reviewed

used small samples. More research is needs to be conducted to verify validity of the study to

show that bedside shift report increases patient satisfaction and patient safety.
INTERGRATIVE LITERATURE REVIEW 3

Integrative Literature Review

The purpose of this integrated review is to identify if there is a relationship between

implementing bedside shift report and increase patient satisfaction, safety and quality of care.

Bedside report involves the off going nurse giving change of shift report to the oncoming nurse

at the patients beside with the patient included in the conversation. According to (Miller, K.,

Hamza, A., Metersky, K., & Gaffeny, D. 2018) 70% of all sentinel events occur as a result of

communication breakdown between healthcare providers. Safe and quality patient care is

ensured through effective communication between healthcare providers (Grisham, J., Hatch, D.,

Willard, M. & Abraham, S.2016). The ability of the off going nurse to communicate essential

and pertinent information about the patients plan of care with the oncoming nurse is a vital

process that involves sharing information regarding upcoming tests, medications, patient’s status

(Grisham, J. et al. 2016). Studies have shown that bedside shift report increases patient

satisfaction and nurse satisfaction as well as safety and accountability (Szeto, W., Wren, S. &

Milbor, M. 2014). “The Joint Commission recommends that handoff be done at the bedside with

patient involvement to include information regarding patient’s condition, plan of care,

medications, upcoming test and anticipated changes for the patient and oncoming nurse to ask

questions” (Taylor, J. 2015). Shift reports that take place at the nurse’s station or conference

room provide no opportunity for the patient or family to be involved in the conversation or

contribute to the discussion (Miller, K. et al. 2018). Patients and family members want to feel

involved in their care and know what is going on every step of the way. When patients cannot be

involved in their care, they feel powerless. Patients reported that bedside handoff gave them the

opportunity to correct any inaccuracies in nurses reports and helped build working relationships

with the nurses (Ford, Y., Heyman, A., & Chapman, Y. 2014). The benefits of bedside hand off
INTERGRATIVE LITERATURE REVIEW 4

also decreases the risk for adverse events such as falls, medication errors, pressure ulcer and falls

and increases patient satisfaction, trust in nurse’s professionalism and competence (Miller, K. et

al. 2018). The PICOT question being asked is: Does bedside shift reporting improve patient

satisfaction and patient safety compared to shift report done at the nurse’s station?

Design and Research Method

In this integrative review, five research articles were used that related to the PICOT

question being asked. The search engines utilized in the search for articles related to the topic

were EBSCO, OVID, and CINHAL. The words used to search for articles were bedside

reporting, shift report, transfer of care, qualitative study, and patient safety and satisfaction.

Fifteen relevant articles located but only five were used in this integrative review as they

provided the appropriate information related to the topic. The articles used for this integrative

review were qualitative and quantitative studies that focused on bedside shift reporting. All the

articles used are less than 10 years old. The dates of the articles range from 2014 to 2018. The

articles are in the English language. The articles selected were chosen due to them being

qualitative studies and are all related to bedside shift reporting and how it increases patient safety

and satisfaction. Those articles not selected were evidenced based projects (EBP) and those

articles whose dates were too old for validity. The articles used are relevant to the PICOT

question: Does bedside shift reporting improve patient satisfaction and patient safety compared

to shift report done at the nurse’s station?

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Findings and Results

The findings and results of the five reviewed studies showed that bedside reporting did in fact

improve patient satisfaction and patient safety and nurse accountability but there are some

barriers to the process (Ford et al. 2014; Grimshaw et al., 2018; Miller et al. 2018; Szeto et al.,

2014; Taylor et al. 2014). A summary of the research articles is in the appendix 1. Below is a

summary of each article’s findings.

In a study conducted by Ford and Heyman (2014) the authors sought to identify patient’s

perception of bedside handoff using a qualitative and quantitative and direct approach. The main

purpose of the study was to measure patient’s perception using a direct quantitative approach.

The theory that bedside handoff increases patient satisfaction as well as safe transfer of patient

care from one provider to another and decreases the instances of communication errors. The

study was conducted on two med surg units at Borgess Medical Center in Michigan. The sample

consisted of 103 patients. Ford and Heyman (2014) conducted surveys that were categorized into

four variables to include patient understanding, participation, safety and satisfaction. The data

was analyzed using Pearson’s Correlation and IBM statistical package for Social Sciences. The

findings showed that 63.1% of the participants always experienced bedside hand off during their

hospital stay. There was a 25.2 % rate of patients only having experienced bedside report most

of the time. Lastly only 5.8% of participants stated they did not experience bedside handoff. The

results from the survey showed a significant and positive correlation between the frequency of

bedside handoff and safety, understanding of care, and satisfaction (Ford et al., 2014).

In a study conducted by Grimshaw and Hatch (2016) the authors sought to identify acute

care nurses’ perceptions of change of shift reporting at the patients’ bedside. The authors

conducted a qualitative phenomenological study. The study took place on seven medical,
INTERGRATIVE LITERATURE REVIEW 6

surgical, and intensive care units at a community hospital in Indiana. The purpose of the study

was to identify the factors and nurse perceptions that may influence the frequency and

consistency of completing bedside hand off. There were open ended and in-depth interviews

conducted with all participants. Seven nurses were interviewed that participated in the study. The

data collected was divided into 5 central themes that showed: bedside reporting takes longer,

provides increase continuity of care, is modified for staff convenience, provides a visual of the

patient and restricts the nurses from saying everything they want to communicate (Grimshaw, et

al. 2016). The findings showed many of the nurses who participated in the study found that

bedside shift change improves patient safety, satisfaction and nursing quality of care.

In study conducted by Miller and Hamza (2018) the authors sought to identify if transfer

of accountability at patient bedside improved safety and quality of patient care and the patients

and family members perceptions of bedside handoff. The authors conducted a qualitative study at

3 different hospitals in Ontario consisting of a sample size of 44 participants that made up four

focus groups that were interviewed in pre implementation and post implementation of bedside

transfer of accountability. The interviews were recorded and transcribed verbatim. The findings

showed that bedside transfer of accountability increased patient safety, created more informed

patients and family members, and better engagement (Miller et al. 2018) The study also showed

challenges to transfer of accountability at bedside lengthened time of report and increased

workload, fear patients lack comprehension, lack of privacy and potential patient confidentiality

breaches (Miller et al. 2018).

In a study conducted by Szeto and Wren (2014) the authors aim was to identify nurse’s

perception of bed side handoff before and after implementation and the barriers to preforming

this type of handoff. This study is a qualitative study that took place at Washington Regional
INTERGRATIVE LITERATURE REVIEW 7

Regional Medical Center on a cardiac unit. The sample size included 182 bed unit. The authors

conducted pre and post surveys and interviews with nurses that were observed conducting

bedside report. The data collected from the study was to determine nurse perceptions and barriers

to bedside handoff. The data was analyzed using the Mann-Whitney U test to determine the

difference between the pre and post observations (Szeto, W. et al. 2014) The findings showed

that 76% percent of nurses preformed bedside handoff after implementing bedside reporting

(Szeto, W. et al. 2014). Of the nurses that were interviewed 75% of them were satisfied with

bedside reporting and felt it was efficient. The rate of nurses involving patients in bedside report

was 76%. The number of nurses who a barrier to bedside reporting was time consuming and not

efficient was 9%. The over all results of the study showed that nurses perceived bedside

reporting satisfactory and efficient. The nurses saw an increase in patient satisfaction from

bedside reporting. The authors also noted there were still some barriers to be addressed to

increase implementation of bedside reporting.

In a study conducted by Taylor, J (2018) the author sought to identify if patient safety and

satisfaction improved with bedside reporting and walking rounds. This is a qualitative study

conducted on a surgical oncology unit with a sample size of 43 patients and 17 nurses. The data

was collected from a survey formed of a convivence sample of patients and nurses four years

after implementation of bedside handoff and walking rounds. The results of the study showed

that there were barriers to bedside reporting and walking rounds such as unit distractions and

patient privacy breaches (Taylor, J. 2018). The study showed that 12 of the 17 nurses interviewed

stated they were satisfied with bedside reporting and walking rounds (Taylor, J. 2018). The study

showed that bedside reporting increased patient safety and satisfaction while promoting quality

patient care and effective communication. While there were barriers to bedside reporting the
INTERGRATIVE LITERATURE REVIEW 8

authors found them to be insignificant to the positive outcomes and with education these barriers

could be avoided.

Recommendations and Implications

There are three main themes the articles share related to bedside handoff that will be

covered in this review these are benefits, challenges, of bedside handoff. The following is a

discussion on the five articles and the implications each of the two themes have related to the

PICOT question.

Benefits of Bedside Handoff

The benefits of bedside handoff were covered in all five studies and included patient

safety, satisfaction, better communication, and continuity of patient care (Ford, et al.,2014;

Grimshaw, et al., 2018; Miller, et al., 2018; Sezto, et al., 2014; Talyor, J. 2015). The most

common tools used to measure how these benefits improved after the implementation of bedside

handoff was the review of surveys and interviews conducted by the five studies (Ford, et

al.,2014; Grimshaw, et al., 2018; Miller, et al., 2018; Sezto, et al., 2014; Talyor, J. 2015). Patients

have a great sense of satisfaction when they are involved in the discussion of their care. Bedside

handoff improves patient’s safety by providing better communication between providers and the

patient. Patients can fill in the gaps and provide information that may be pertinent to their care. It

also allows the oncoming nurse to lay eyes on the patient to better prioritizing their workflow.

Continuity of care is better when the off going nurse introduces the on coming nurse to promote

safe transfer of care.

Challenges to Bedside Handoff

INTERGRATIVE LITERATURE REVIEW 9

The challenges to bedside handoff being lengthened time of report, privacy issues, and

distractions were common in all five studies (Ford, et al.,2014; Grimshaw, et al., 2018; Miller, et

al., 2018; Sezto, et al., 2014; Talyor, J. 2015). Many times, nurses felt that they were in breach of

patient confidentiality if conducting bedside report in front of family members. This could be

avoided by asking patient for permission before starting bedside report. Some nurses felt that

bedside shift report took longer to complete due to patient questions and concerns that needed

further explaining and the need for direct care such as toileting, and refreshments (Ford, et

al.,2014; Grimshaw, et al., 2018; Miller, et al., 2018; Sezto, et al., 2014; Talyor, J. 2015). This

could also be addressed by the oncoming nurse coming in later to answer questions after report.

Distractions which prevented nurses from conducting bedside hand off were related to

telephones calls, call lights, patients have needs that should be addressed, difficult patients. This

barrier could be avoided by rounding on patients before shift change. Education on bedside

reporting could help clear up any barriers to conducting bedside handoff.

Limitations

In this integrative literature review the author faced many limitations. The author is

inexperienced in the process of integrative literature review. Many of the articles found that

related to the PICOT question were not studies but EBP projects and systemic reviews. Only a

small number of articles could be used in this review. Many of the articles that were found to be

relevant to the PICOT question required payment for viewing the full articles. Searches were

limited based on the key words for searching which produced many articles not related to the

topic of the PICOT question.

INTERGRATIVE LITERATURE REVIEW 10

The major limitations of the study were the sample sizes used in many of the studies.

These sample sizes were small, and results could have been different if the sample sizes were

larger. The high frequency of patient discharges and staff change over made it hard for recruiting

volunteers for the bedside handoff studies (Miller, K. et al., 2018). This made it difficult for

researchers to follow up with patients regarding their experience with bedside handoff. The use

of nonrandomized samples from a single institution ran the risk for selection bias among nurses

(Ford, Y. et al., 2014). Not all nurses were willing to participate in bedside handoff related to

patients being on contact precautions or were deemed difficult patients by nursing staff (Taylor,

J. 2015). Many nurses felt they were violating patient privacy laws by discussing patient case in

front of family members or if patients shared a room with another patient, so they did not want to

participate in bedside handoff (Grimshaw, J. et al., 2018). The other limitation found among all

the studies is that there was no consistency in bedside reporting to see the validity the study has

on the positive impact that beside reporting in patient safety and satisfaction.

Conclusion

The findings discussed in this integrative literature review show that bedside hand off can

increase patient safety and satisfaction. The findings from the studies reveal that bedside handoff

has a positive impact on patients and family’s perception of patient safety, involvement in care

planning and communication. There were some barriers to the studies found and they included

lengthened time of report, nurses concern regarding patient privacy, and distractions. Despite the

barriers bedside reporting allows for nurses to give a pertinent information to on coming nurse

with patient involvement to allow for safe transfer of care. There is better communication among

providers. The oncoming nurse can lay eyes on the patient so they may plan their shift
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appropriately based the patient’s status. The literature proves that bedside handoff can improve

patient satisfaction and safety.

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References

Ford,Y., Heyman, A. & Chapman, Y. (2014). Patients preception of bedside handoff : The need

for a culture of always. Journal of Nursing Care Quality, 29(4) 371-378.

Grimshaw, J., Hatch, D., Willard, M. & Abraham, S. (2018). A qualatative study of the change of

shift report at the pateints bedside. The Healthcare Manager, 35(4), 294-304.

Miller,K., Hamza, A., Metersky, K. & Gaffeny, D. (2018). Nursing fransfer of accountability at

the bedside: Partnering with patients to pilot a new initiative in Ontario community

hospitals. Patient Experience Journal, 5(1), 90-96.

Szeto, W., Wren, S. & Milbor, M. (2014). A qualitative study evaluating bedside reporting and

the impact on nurse satisfaction and communication barriers with Washington Regional

Medical Center. Reteived from: http://scholarworks.uark.edu/nursuht

Taylor, J. (2015). Improving patient safety and satisfaction with standardized bedside handoff

and walking rounds. Clinical Journal of Oncolocgy Nursing, 19(4), 414-416.

INTERGRATIVE LITERATURE REVIEW 13

Appendix I

APA Citation Author Grimshaw, J., Hatch, D., Willard, M. & Abraham, S.
Qualifications (2018). A qualatative study of the change of shift
report at the pateints bedside. The Healthcare
Manager, 35(4), 294-304.
John Grimshaw: Goshen Hospital
Daniel Hatch: Critical Care ICU, Indiana Health Care
System, Pierceton
Melissa Willard: Critical Care Unit, Kosciusko Community
Hospital Warsaw
Sam Abraham: Bethel College School of Nursing
Background/Problem Nursing change of shift report at bedside improves patient
Statement and family satisfaction, nursing quality and patient safety.
What are acute care nurses’ perceptions of the change of
shift report at the patient’s bedside?

Conceptual/theoretical Intends to prove that critical care nurses’ perceptions of

Framework bedside reporting are positive one in terms of patient safety
and satisfaction.
Design/Method/Philosophical A Qualitative study. Open ended in-depth interviews were
Underpinnings conducted with 7 acute care nurses from different units to
gather information regarding their perception of bedside
handoff.
Sample/ Setting/Ethical There were 7 participants in this study. The study was
Considerations conducted in an ICU, Med surg, surgical unit. They were
given consent forms before the research was conducted.
Major Variables Studied (and There were 5 themes identified in the study. Bedside
their definition), if appropriate reporting takes longer, promotes continuity of care,
modified bedside report used, provides for visualization of
patient, nurses cannot say everything at bedside.
Measurement Tool/Data In depth interviews were recorded and handwritten note
Collection Method were completed.

Data Analysis Interviews were reviewed and responses place in to the 5

themes.

Findings/Discussion Bedside shift report is an exemplary model for patient

centered care. It provides continuity of care, patient safety
and satisfaction.

Appraisal/Worth to practice Bedside report increases patient safety and satisfaction and
continuity of care, but more research is needed to be done
since the group was very small.
INTERGRATIVE LITERATURE REVIEW 14

PA Citation Author Miller,K., Hamza, A., Metersky, K. & & Gaffeny, D.

Qualifications ( 2018). Nursing fransfer of accountability at the
bedside: Partnering with patients to pilot a new
initiative in Ontario community hospitals. Patient
Experience Journal, 5(1) 90-96
Kristina Miller, MsC, PhD:Western University
Aden Hamza, MN,RN: Western Univeristy
Kateryna, Metersky, RN,MN, Phd: Western University
Dianne Gaffney MSc, RD: Huron Perth Healthcare
Alliance

Background/Problem Statement Does transfer of care at the bedside with patient and
family member involvement result in increased patient
safety and continuity of care. Problem was there was no
policy in Canadian hospitals for change of shift handoff
which resulted in variances in transfer of care and sentinel
events.
Conceptual/theoretical The theory that bedside TOA will increase patient safety
Framework and nurse accountability helps patients and family feel
involved in care planning.
Design/Method/Philosophical The authors philosophical approach is interpretive,
Underpinnings interactive and naturalistic. The study was completed in a
natural setting with nurses and patients in various
hospitals.
Sample/ Setting/Ethical The sample size was 44 participants which included 33
Considerations nurses and 8 patients 3 family members. All participants
were over the age of 18 and were informed of research
being collected provided informed consent.
Major Variables Studied (and Patient and family members and Nurses perception of
their definition), if appropriate bedside report.

Measurement Tool/Data In depth interviews were conducted with participants the

Collection Method findings were recorded verbatim.

Data Analysis In depth interviews were reviewed to look at the positive

and negative perceptions nurses, patients and family
members had of TOA at the bedside.

Findings/Discussion TOA at the bedside increased patient safety, more

consistent use of white boards in the patient’s rooms and
better family involvement. The negative perceptions were
INTERGRATIVE LITERATURE REVIEW 15
Appraisal/Worth to practice
APA Citation Author
Qualifications
Background/Problem Statement Change of shift handoffs are the transition of
Conceptual/theoretical
Framework
Design/Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and
their definition), if appropriate safety and satisfaction of bedside reporting.
Measurement Tool/Data
Collection Method
Data Analysis
that TOA at bedside lengthened report time, increased
workload, lack privacy, confidentiality breach, lack of
patient understanding.
This research study has value in nursing practice but
needs to be researched on a larger group of participants
more for it to be valid.
Ford,Y., Heyman, A. & Chapman, Y. (2014). Patients
preception of bedside handoff : The need for a
culture of always. Journal of Nursing Care
Quality, 29(4) 371-378.
Yvonne Ford, PhD, RN: Western Michigan University
Bronson School of nursing.
Anita Heyman, MSN, NEA-BC, RN: Department of Med-
Surg and Cardiology, Borgess Medical Center.
Yvonne Chapman, MSN, FNP-BC, RN: Department of
Nursing, Kalamazoo Valley Community College
responsibility for patient care from one provider to
another, have been identified as a source of
communication errors for hospitalized patients. Allowing
patients to be involved in bedside handoff increases
patient safety and satisfaction.
The theory that bedside handoff increases patient
satisfaction as well as safe transfer of patient care from
one provider to another and decreases the instances of
communication errors.
The design is qualitative, quantitative and anecdotal. This
is a Phenomenological study understanding patients
experiences with bedside handoff.
Sample consisted of 2 inpatient Med Surg units with
sample size of 60. Patients were older than 18yrs, fluent
in English, no cognitive dysfunction, able to give
informed consent.
The major variables were understanding, participation,
Data collection consisted of surveys and interviews with
patient that participated in the study.
Author used HCAP scores as well as survey results and
INTERGRATIVE LITERATURE REVIEW 16

interviews to analyze the data.

Findings/Discussion The findings showed that while bedside handoff had a

positive impact patients’ perception of safety,
understanding and satisfaction it only had that effect if it
was consistently done.

Appraisal/Worth to practice While the study showed that bedside handoff had a
positive impact on patient safety and satisfaction it needs
to be consistently implemented to show real progress.

APA Citation Author Szeto, W., Wren, S. & Milbor, M. (2014). A qualitative
Qualifications study evaluating bedside reporting and the impact
on nurse satisfaction and communication barriers
with Washington Regional Medical Center.
Retreived from:
http://scholarworks.uark.edu/nursuht
Win Szeto: Elenor Mann School of Nursing, University
of Arkansas Fayetteville
Sarah Wren: Elenor Mann School of Nursing, University
of Arkansas Fayetteville
Molly Milborn: Elenor Mann School of Nursing,
University of Arkansas Fayetteville
Background/Problem Statement Bedside reporting increases patient satisfaction as well as
nurse satisfaction and build working relationship between
patient and nurse.

Conceptual/theoretical The theory that bedside reporting gives patients the

Framework chance to be involved in their plan of care and informs
them of up to date information concerning their health.
Design/Method/Philosophical This is a qualitative study using interviews and survey pre
Underpinnings and post implementation of the study.

Sample/ Setting/Ethical The sample size was a 180-bed unit. Setting was on a
Considerations cardiac unit.

Major Variables Studied (and Variables studied were the nurse’s perception of bedside
their definition), if appropriate handoff and barriers to completing bedside hand off.

Measurement Tool/Data The use of Mann - Whitney U test was conducted on

Collection Method nurse/ barrier survey. In depth surveys and interviews
with nurses before and after implementation of bedside
handoff.
INTERGRATIVE LITERATURE REVIEW 17

Data Analysis Researchers analyzed answers to surveys and interviews.

Used that data and statistical charts.
Findings/Discussion Nurse participation with bedside reporting was better but
there were some barriers nurses met to not attempt to
conduct bedside reporting.

Appraisal/Worth to practice Bedside report can be beneficial to patient safety

and accountability more research needs to be done as well
as nurse education on the benefits of bedside reporting in
regard to patient safety and satisfaction.

APA Citation Author
Qualifications
Taylor, J. (2015). Improving patient safety and satisfaction with
standardized bedside handoff and walking rounds. Clinical
Journal of Oncolocgy Nursing, 19(4), 414-416.
Julia Taylor: RN, BSN, BA . Clinical II nurse at MemoiralSloan
Kettering Cancer Center New York.

Background/Problem Utilizing bedside hand off and walking rounds to decrease

Statement communication errors and increase patient satisfaction and errors
that lead to sentinel events.

Conceptual/theoretical No theoretical framework was stated.

Framework

Design/ A qualitative study was conducted using surveys of a convenience

Method/Philosophical sample from a surgical oncology unit.
Underpinnings

Sample/ Sample used was 43 patients and 17 nurse’s unit on a surgical

Setting/Ethical oncology unit. No ethical considerations listed.
Considerations

Major Variables Variables studied were patient safety after implementation of

Studied (and their bedside hand off and the barriers to bedside handoff and walking
definition), if rounds.
appropriate

Measurement Analysis of surveys taken from patients and nurses.

Tool/Data Collection
Method

Data Analysis Analysis of Surveys and documented incidences of patient falls,

medication errors, enhanced communication, and patient’s
satisfaction with nurse introductions.
INTERGRATIVE LITERATURE REVIEW 18

Findings/Discussion It was found that there were many barriers to nurses performing
bedside handoff but there were also improvements made with a
decrease in patient fall, and medication errors.

Appraisal/Worth to This study shows how bedside handoff and walking rounds can
practice improve patient safety and communication in the nursing practice
but more research should be conducted.