DIscussion Board on Nursing
The article chosen for this discussion board is “Transitioning Nurse Handoff to the Bedside: Engaging Staff and Patients” by White, et al. (2018). The who, what, when, where, and how are addressed in this article. Training of staff, studying patient satisfaction, and staff perception of the intervention are all included. This article provides a strong base for addressing my PICOT question of “Among emergency department patients, does bedside handoff versus handoff outside the room at a computer, at shift change, affect patient satisfaction?” plus how to best implement such a big practice change.
The population in the emergency department (ED) at Community Hospital of the Monterey Peninsula (CHOMP) is very similar to two of the three articles. The CHOMP ED has 40 beds and is a mixed, adult and pediatrics, population. The nurses working in the ED have various levels of education. The average census is 170, although with COVID it has decreased to 120. Bedside handoff occurs between nurses outside the room at a computer in the nurses’ station. The frontline staff is resistant to bedside handoff because they are concerned regarding increased handoff times and having the patients question them (White-Trevino & Dearmon, 2018).
The intervention to be implemented would be bedside handoff using the SBART pneumonic at shift change. In utilizing the SBART pneumonic, consistency is maintained in the report, along with the key patient care handoff items being addressed (White-Trevino & Dearmon, 2018). The staff can easily remember the key points and laminated reminders can be placed on the computers at the patient bedside or badge buddies can be made.
The baseline data collection would be from pre-intervention surveys of staff. The questions that would be included would focus on communication, safety, staff satisfaction, and perceived patient satisfaction. Two open-ended questions that would be asked are “What deters you from performing bedside handoff?” and “What do you think is the best way to train bedside handoff? Video? Posters? Both?”(White-Trevino & Dearmon, 2018)
The outcome that is expected after implementation is improved patient satisfaction, safety, and staff communication. Patient satisfaction will occur immediately by inviting the patient to be an active part in their care. Safety from having improved communication will occur immediately but the full extent may not be realized until nurses have adapted to the process or a sentinel event is avoided by bedside handoff. Once staff has adapted to the change, and bedside handoff is accepted as a standard process and part of the culture, staff satisfaction should increase from the improved patient care and content. This may take some time to achieve and will require the nurses to see sustainability in bedside handoff (Campbell & Dontje, 2019)
Kang, D., Jung, J., Chung, S., Cho, J., & Lee, S. (2014). Factors affecting patient compliance with compressive brace therapy for pectus carinatum. Interactive Cardiovascular and Thoracic Surgery, 19(1), 900-903. http://doi:10.1093/icvts/ivu280.
This article addresses the “WHY” of who may not be compliant in wearing their compression brace as instructed by the clinical staff to avoid the negative effect of non-compliance. It is essential to identify the reason for non-compliance to address the issues and then find solutions to increase compliance.
1. How your population matches the populations in your research articles.
The article I used had a patient population of primary males ranging from 3-20 years of age; the mean age was 12. The sample consisted of 30 out of 86 with symmetric pectus carinatum. The population I work with consists of teenagers from the age of 13 to 18, primarily males. The symmetricity of the pectus carinatum varies.
2. The intervention you would implement
The article I used is a qualitative study in which the aim was to identify factors affecting patient compliance with wearing the brace. The patients were given a questionnaire on the last follow-up appointment to evaluate various things that may have affected their compliance. I would create a questionnaire and distribute it to the patients throughout their treatment to inquire about what is affecting their compliance.
3. Define baseline data collection sources (EMR, datasets, etc.), method, and measures.
I would use the research electronic data capture database know as REDCap to collect data from the patients through an online survey that asks the patients to rate the influence that seven items had on their compliance when wearing the brace. I would use a LIKERT scale that would range from 1-5, with 5 reflecting a significanteffect. The items would include pain, skin problems, confidence, shame, discomfort, initial results, and total the factors together.
4. Expected outcome (Include a specific plan of how you will measure/ evaluate your change in practice: Specifically, Who, What, When, Where, and How.
On the initial fitting of the brace, I would introduce the survey to the patient and families. At that time, I would acquire all consents needed for research. I would ensure that the patient and parents log into the survey without any issues and understand the questions. I would instruct them to fill out the survey before they return to the next visit. There will be reminders sent to their phones the day before their visit, and on arrival, I will verify it was done. Once it is done, if the patient appears to be non-compliant to treatment through physical measurements and the survey information, then it can be addressed before they leave the clinic. This way, the brace is adjusted if the pain is the cause or the plan of wearing time is changed if self-esteem is the reason. The expected outcome would be that the teenagers would become compliant with wearing their brace outside of the clinic for the next four to six weeks through reiterating the importance of consistency and ensuring that they are comfortable when wearing it by evaluating the reasons they did not want to wear the brace in the beginning through the survey.