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BEDSIDE REPORTDeena Clevenger BSN, RN and Sheila Connelly MSN, RN
TOP REASONS FOR BEDSIDE REPORT
Patient safety Patient satisfaction Builds teamwork, ownership, and
accountability Allows mentoring for new nurses
(Baker & McGowan, 2010)
Jean Watson Nursing Theory
• The nurses promote health and higher level functioning only when they form person to person relationships.
o Carative #4 Establishing a helping-trust relationship
• Communication includes verbal, nonverbal, and listening in a manner which connotes empathetic understanding.
•http://currentnursing.com/nursing_theory/Watson.com
o Carative #3 Cultivation of sensitivity to one’s self and to others
Jean Watson Nursing Theory cont.
o Carative #7 Promotion of Interpersonal teaching-learning
• Understanding the person’s perception of the situation assist the nurse to prepare a cognitive plan.
o Carative #8 Provision for a supportive, protective, and /or corrective mental, physical, socio-cultural and spiritual environment• Nurse must provide comfort privacy, and safety for the
patient.
•http://currentnursing.com/nursing_theory/Watson.com
PATIENT SAFETY
According to Baker & McGowan, “Bedside shift report decreases the potential for
near misses through a transfer of responsibility and trust by using standardized communication” (2010, p 357).
Improves “patient safety by incorporated safety checks into report, such as ensuring there is a suction machine at the bedside and noting allergy alerts” (Trossman, 2009, p 7).
PATIENT SATISFACTION
“Reassures patients that the nursing staff works as a team, and patients witness a safe, professional transfer of responsibilities” (Laws & Amato, 2010, p 71).
Patients feel more empowered.
Patients are more involved.
Patient becomes an additional resource in diagnosis and treatment (Caruso, 2007).
3 OF THE JOINT COMMISSION’S NATIONAL PATIENT SAFETY GOALS ARE UPHELD
1. “Improve the accuracy of patient identification.”
-Checking armbands during report and asking for two patient identifiers.
2. “Improve the effectiveness of communication among caregivers: managing hand-off communications.”
3. “Encourage patients’ active involvement in their own care as a patient safety strategy.”
(Joint Commission Perspectives, 2008)
BENEFITS FOR THE NURSING STAFF
Oncoming nurse can visualize patients immediately and prioritize care for the shift.
Prepares RN to answer MD questions.
Accountability between shifts is promoted.
Improves the relationships of staff between shifts and builds a “teamwork” environment.
( Anderson & Mangino, 2006)
CHALLENGES
Letting go and allowing
change
Cynicism and pessimism
Lack of a shared vision
Confidentiality and privacy
Fear that report will
take longer
TIPS FOR SUCCESS
“Be sensitive to privacy and information shared in front of patient. Discuss sensitive information away from patients bedside.”
Educate the incoming nurses about how to give report.
Exclude opinions and stories, report is a time for facts.
Avoid putting a nurse on the spot in front of patient and/or family.
(Baker & McGowan, 2010, p 358)
Bedside
report
Informative
Shorter
Involves the Patient
More individualize
d
CHARGE NURSE ON THE PREVIOUS SHIFT
• Palliative care patients
• DNR’s• Isolation patients:
MRSA, VRE, pseudomonas, etc
• Possible discharges
• Close observation• One to one patients• 24 hour urine• Wound vac’s• Anything else that
constitutes extra time for care
oProvides for the on coming shift a one page report sheet showing:
PICO QUESTION
Does the use of a standardized bedside report versus taped report help increase patient satisfaction and decrease nursing overtime usage at the Veterans Healthcare Systems of the Ozarks (VHSO)?
Approval from management as well as U of A professors to begin pilot study. Discussion at both Evidenced Based Practice Committee and Shared Governance Committee
April 1st, 2012 Bedside Report began at VHSO!
DESIGN
Before-after experimental design used.
Independent variable is the method of communication
(taped report versus verbal at bedside)
2 Dependent Variables 1. Patient Satisfaction 2. RN Overtime Usage
DESIGN
Patient Satisfaction Measured by Survey
of Healthcare Experiences of Patients (SHEP) data.
Data gathered pre and post initiation of bedside report.
RN Overtime Usage Overtime use
included the time during change of shift overlap. May include up to 1-2 hours over. Does not include the extra 4- 8 hour shifts that nurses agree to work.
DESIGN
Two acute care nursing units were included in the study (2A and 2B). Both units were performing taped report prior to the study. Starting April 1st, both units transitioned to bedside report.
A standardized communication tool was developed and distributed prior to the initiation of bedside report.
Education was given to all RN/LPN staff members prior to initiation of study via staff meetings and poster presentations.
OUTCOME MEASUREMENT COLLECTION
Sample population Veteran patients hospitalized at VHSO (inpatient setting), Fayetteville, AR.
Inclusion criteria Veterans who respond to the SHEP survey post
discharge.
DATA COLLECTION PLAN
SHEP surveys are mailed to patients post discharge.
Questionnaire includes a total of 53 questions.
It takes an estimated 15 minutes to complete the survey.
We selected 6 total questions directly related to nursing care to include in this study.
In addition to SHEP survey results, we will discuss RN overtime usage results…..
DAY SHIFT RN OVERTIME USAGE
January February March0
5
10
15
20
25
2A2B
HOURS
EVENING SHIFT RN OVERTIME USAGE
January February March0
1
2
3
4
5
6
2A2B
HOURS
NIGHT SHIFT RN OVERTIME USAGE
January February March0
0.5
1
1.5
2
2.5
3
3.5
4
2A2B
HOURS
SHEP DATADURING YOUR HOSPITAL STAY, HOW OFTEN DID
NURSES TREAT YOU WITH COURTESY AND RESPECT?
Always Usually Sometimes Never 0
10
20
30
40
50
60
70
80
90
100
NWeighted %
SHEP DATADURING THIS HOSPITAL STAY, HOW OFTEN DID
NURSES LISTEN CAREFULLY TO YOU?
Always Usually Sometimes Never 0
10
20
30
40
50
60
70
NWeighted %
SHEP DATADURING THIS HOSPITAL STAY, HOW OFTEN DID NURSES EXPLAIN THINGS IN A WAY YOU COULD UNDERSTAND?
Always Usually Sometimes Never 0
10
20
30
40
50
60
70
80
NWeighted %
SHEP DATADURING THIS HOSPITAL STAY, HOW OFTEN WAS PERSONAL
INFORMATION ABOUT YOU TREATED IN A CONFIDENTIAL MANNER?
Always Usually Sometimes Never 0
10
20
30
40
50
60
70
80
90
NWeighted %
SHEP DATA DURING THIS HOSPITAL STAY, HOW OFTEN DID NURSES SHOW RESPECT FOR WHAT YOU HAD
TO SAY?
Always Usually Sometimes Never 0
10
20
30
40
50
60
70
80
NWeighted %
SHEP DATADURING THIS HOSPITAL STAY, HOW OFTEN DID YOU FEEL NURSES REALLY CARED ABOUT YOU
AS A PERSON?
Always Usually Sometimes Never 0
10
20
30
40
50
60
70
80
N Weighted %
CONCLUSION
RN Overtime Usage will continue to be collected over the next 3 months
SHEP data will be reviewed and collected on the next SHEP report, which will include 3 months of data.
Input from the nursing staff on 2A/2B wards will be unofficially collected at staff meetings regarding their satisfaction with the process.
REFERENCES Anderson, C., & Mangino, R. (2006). Nurse shift report: Who says you
can't talk in front of the patient? Nursing Administration Quarterly, 30(2), 112-122.
Baker, S. J., & McGowan, N. (2010). Bedside shift report improves patient safety and nurse accountability. Evidence-Based Practice, 36(4), 355-358).
Caruso, E. M. (2007). The Evolution of Nurse-to-Nurse Bedside Report on a Medical-Surgical Cardiology Unit. MEDSURG Nursing, 16(1), 17-22.
Laws, D., & Amato, S. (2010). Incorporating bedside reporting into change-of-shift report. Rehabilitation Nursing, 36(2), 70-74.
The Joint Commission. (2008). Joint Commission 2009 National Patient Safety Goals. Joint Commission Perspectives, 28(7), 12-14
Tressman, S. (2009). Shifting to the bedside for report. The American Nurse, 41(2), 7.
http://currentnursing.com/nursing_theory/Watson.com
