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Keywords:

  • Acute Care < Nursing;
  • Communication;
  • Health Services Research < Research;
  • Informatics;
  • Information Technology < Information Technology;
  • Nursing Classification < Nursing;
  • Nursing;
  • Patient Safety < Workforce Issues;
  • Quantitative Methods < Research;
  • Risk Management < Health Service Management

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

Aim

The aim of this study was to explore the potential for one set of patient information for nursing handover and documentation.

Background

Communication of patient information requires two processes in nursing: a verbal summary of the patients' care and another report within the nursing notes, creating duplication.

Introduction

Advances in speech recognition technology have provided an opportunity to consider the practicality of one set of information at the nursing end-of-shift.

Methods

We used content analysis to compare transcripts from 162 digitally recorded handovers and written nursing notes for similar patients within general medical-surgical wards from two metropolitan hospitals in Sydney Australia.

Findings

Using the Nursing Handover Minimum Dataset analysis framework similar content [n = 2109 (handover) n = 1902 (nursing notes)] was found within the handovers and notes at the end-of-shift (7:00 am and 2:00 pm). Analysis of the overarching categories demonstrated the emphasis within the differing data sources as: patient identification (31%), care planning or interventions (25%), clinical history (13%), and clinical status (13%) for handover, vs. care planning (47%), clinical status (24%), and outcomes or goals of care (12%) for nursing notes.

Discussion

This study has demonstrated that similar patient information is presented at handover and within documentation. Major categories are consistent with international nursing minimum datasets in use.

Conclusion

We can use one set of patient information (within some limitations) for two purposes with system design, practice change and education. Experiments are currently being conducted trialling speech recognition within laboratory and clinical settings.

Implications for Nursing and Health Policy

One set of patient information, verbally generated at handover delivering electronic documentation within one process, will transform international nursing policy for nursing handover and documentation.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

The accurate transfer of patient information at shift changeover is fundamental to supporting continuity of care and delivering quality nursing care (Poletick & Holly 2010). Difficulties with communication have been proposed as a key factor in adverse events with 65% of all US sentinel events including communication error as a contributing factor (Haig et al. 2006). Similar results have been found in Australian health services with 22% of clinical management nursing incidents being related to poor communication at handover or within documentation (Tran & Johnson 2010). Most countries have two forms of communication of clinical information relating to nursing care: verbal handover at the end-of-shift changeover (often referred to as ‘handover’ or ‘handoff’ or ‘report’) (including or not including the patient) and nursing notes within the patient health care record (PHCR).

The rapid deployment of the electronic medical record (eMR) within Europe and North America has resulted in a move towards the use of eMR as the focus or replacement for handover (Engesmo & Tjora 2006; Hertzum & Simonsen 2008; Wallis 2013). However replacing handover with asynchronous communication (such as reviewing the patient's eMR at a later time) may not be supportive of the complex social interaction occurring at handover (Engesmo & Tjora 2006). Although there is an ongoing debate, Australian and many international health services require nursing handover to be conducted at the bedside where critical patient information is transferred from the outgoing team (nurse) to the oncoming team (nurse) within a social interaction which includes the patient (Australian Commission on Safety and Quality in Health Care 2011; Cairns et al. 2013).

Rather than proposing that either form of information transfer (verbal handover or written notes) is preferred, we examine the potential for one set of clinical information, derived from handover, being used to form the nursing notes within the PHCR. This study informs experiments using speech recognition and information extraction where handover will be captured, restructured using an existing template, and re-presented within an eMR for ‘signing off’ by nursing staff. We seek to provide an opportunity for nurses to reduce duplication using one set of information.

Background

Nurses traditionally provide a verbal summary of the patients' care at handover (Poletick & Holly 2010) and also write a report within the nursing notes of the PHCR (Karkkainen & Eriksson 2005). However, there are now three presentations of the patient's care: clinical handover (verbal), the handover summary sheet (Poletick & Holly 2010) and nursing notes (written). Nurses perceive multiple sources of patient information as unnecessary (Johnson & Cowin 2013). The term ‘written’ refers to handwritten or typewritten or electronic material and represents a documented form of information throughout this study.

Fundamental to any discussion of one set of patient information is an acknowledgement of the substantial international work undertaken on nursing minimum datasets (NMDS; Mac Neela et al. 2006); Australia (Gliddon 1998), Ireland (Butler et al. 2006), Netherlands (Goossen et al. 2001) and the North American Nursing Diagnosis Association Classification, Nursing Interventions Classification and the Nursing Outcomes Classification (Delaney et al. 2000) and the International Classification for Nursing Practice (ICNP; International Council of Nurses 2012). Natural language rather than standardized nursing language is used within acute settings within Australia, although community nursing does use standardized language. The Nursing Handover Minimum Dataset (NH-MDS; Johnson et al. 2012a) and overarching structure [identification of the patient, clinical history/presentation (patient problem), clinical status (vital signs, general patient condition), care planning (interventions), outcomes/goals of care, referred to as ICCCO] (Johnson et al. 2012b) were developed within Australia (Royal Hobart Hospital 2008). This NH-MDS has been validated in medical-surgical patients, and will be the framework for the analysis in this study.

Speech recognition technology is being embraced worldwide with word accuracies of 94–99% with minimal training (Al-Aynati & Chorneyko 2003; Zick & Olsen 2001). The effects of background noise, interruptions and accents do influence accuracy; however, Dragon Medical™ now provides accented voice profiles, for Australian English, Indian English and South East Asian English. Patient reporting times have been reduced by 82% (Koivikko et al. 2008), partially related to the use of templates. The NH-MDS and ICCCO will shape the template for future speech recognition processes.

Verbal nursing handover continues to be the preferred form of communication of patient information among nurses (Pearson 2003). Shortcomings with handover continue (Sexton et al. 2004) although improvements through the use of structured content (Ahmed et al. 2012; Staggers & Blaz 2013), returning to the bedside (Chaboyer et al. 2010), the use of minimum datasets and electronic tools (Matic et al. 2011) are emerging.

Nurses' use of nursing notes also raises many issues. Nurses often do not access the notes prior to attending the patient, while receiving verbal nursing handover is mandatory before delivering care to a patient (Johnson & Cowin 2013). Moreover, nursing notes within the PHCR should present an accurate record of the patient's nursing care (Cheevakasemsook et al. 2006) ‘furnishing legal evidence of the process and outcomes of care’ (p. 367). Nurses continue to document observations and ‘task-orientated, physical aspects of the nurse's work’ (Hyde et al. 2005; p. 74) often related to medical or biological models (Irving et al. 2006) with little evidence of individualized patient care (Karkkainen et al. 2005).

The relationship between the information presented at handover and within documentation has been examined. In a British study of 60 cases, handovers and medical and nursing documentation (care plans, observation and medication charts) from four medical-surgical wards were compared using content analysis and a coding framework (Lamond 2000). Lamond reported that more information was contained in the notes and charts than in the handover, except for the patient's condition and psychological state. Similar findings were reported by Sexton et al. (2004) in an Australian study of 23 handovers from one medical ward, with 93.5% of the information from handover being available within the PHCR or other documentation (Sexton et al. 2004), although no content analysis of notes was presented.

Further contemporary Australian work by Jefferies et al. using two data sources – 67 examples of nursing documentation (10 hospitals) and 195 handovers (9 specialties) – found that handover and nursing notes did deliver similar information, although the focus of content relating to admission, clinical history and care planning was more frequent in handover. It was argued that the handover emphasized clinical history, observation and care, and the response to care, which was more informing (Jefferies et al. 2012). Nursing notes were ‘constrained’ to reporting tasks (Jefferies et al. 2012; p. 165). Finally, these authors noted that the challenge was to ensure written and oral communication of critical patient information required for continuity of care was consistent. Although this study was informative, no matching of patients or time points of data extraction had occurred.

Several studies have considered the relationship between nursing handover and documentation, concluding that there are some differences in the content of both forms of information. Lamond (2000) used additional information from all forms of documentation and Jefferies et al. (2012) used data from two differing sources. We used content from nursing handover and nursing documentation to examine the potential for one set of clinical information at the end-of-shift handover.

Aim

This study compared the content of verbal handover and written nursing note, for patients at similar time points, and examined whether information derived from handover could shape the nursing notes within the PHCR.

Method

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

Design

This descriptive study used content analysis to examine and compare the transcripts of handovers and nursing notes relating to the change of shift at 7:00 am and 2:00 pm. Matching sets of end-of-shift patient information (handover and nursing notes), collected from March to May 2012, formed the data for analysis.

Sample

A total of 179 medical-surgical patient cases from two metropolitan hospitals in Sydney Australia (4 wards in hospital 1, 5 wards in hospital 2) were initially included. Seventeen cases had only one set of information available; 4 patients with nursing notes and 13 patients with only handover data, resulting in 162 cases being included in the analysis. Verbal nursing handovers (n = 162) and related written nursing notes from 74 (46%) medical and 88 (54%) surgical patients (aged care and gastroenterology, cardiothoracic, gynaecology, haematology, medical assessment unit, nose and throat, orthopaedics and trauma, surgical colorectal and urology, surgical orthopaedics, respiratory and stroke unit, and vascular surgery) were examined. Style of handover varied with four wards delivering handover at nursing stations (hospital 1) and five wards delivering handover at the patient's bedside (hospital 2).

Data collection

Nursing handovers were digitally recorded at either 7:00 am (n = 50, 31%) or 2:00 pm (n = 112, 69%). Nurses' recorded their own handovers using digital recorders with minimal training. These recordings were transcribed verbatim and de-identified (removing patient and health staff information). Nursing notes for the same patients were extracted from the PHCR by capturing an image using an iPhone, which was later transcribed. Nursing notes mainly had one entry per shift (n = 136, 84%), with 16% (n = 26) having more than one entry and 3.7% (n = 6) with more than one nurse reporting. Nursing notes were written within 1 h of delivering verbal handover for 23.5% (38/162) of the notes. A further 52.5% (85/162) of the notes were written between 1 and 7 h before handover (20 cases ≥3 h). Another 24% (39/162) of the notes were written (>1 to 1.5 h) after the handover.

Data analysis

Transcripts were analysed using content analysis or ‘a systematic means of measuring the frequency, order, or intensity of the occurrence of words, phrases, or sentences’ (Burns & Groves 2009; p. 528). Directed content analysis using an existing framework was used (Hsieh & Shannon 2005). Initial codes and categories were developed using the previously described framework [ICCCO (categories), NH-MDS (codes)] (see Johnson et al. 2012a,b). The process involved developing the coding manual (categories, codes and examples), implementing the coding process and analysing and describing the results (Hsieh & Shannon 2005). Analysis was conducted with NVivo 9™ (http://www.qsrinternational.com/products_nvivo.aspx), which provides the frequency of words/phrases coded within the categories or codes.

Ethical approval was obtained from the research and ethics committees in the local health services and university. Information about the study, participant's consent and evidence of ethical approval was sent to managers and educators of the participating wards. Written consent was obtained from all nurses whose handovers and documentation were the subjects of the study.

Validity and reliability/rigour

Inter-rater agreement of 88% was demonstrated by two raters (experienced registered nurses) coding selected text independently using the developed coding manual (Lombard et al. 2002).

Computerized analysis tools ensured authentic data representation and enumerated content. Data saturation was achieved.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

Content of verbal nursing handover

ICCCO categories

Data from the overarching categories provides the focus of the information.

The most frequent categories were: identification of the patient (31.4%; 383/1219), care plan (25.2%, 307) and clinical history and presentation (12.7%, 155) followed by clinical status (12.5%, 152), and outcomes/goals of care (3.7%, 45). All the nursing handovers began by specifying the patient name. Eleven per cent of the transcriptions could not be coded within the ICCCO model and related to nurse to nurse or other person interaction.

NH-MDS codes

For nursing handover data there were 2109 references to the NH-MDS.

Within the identification of the patient category patient name (7.5%), bed number (5.7%) and to a lesser extent the patients age or social status (3.5%), were frequently spoken (see Table 1). Clinical history and presentation included predominantly reason for admission, clinical history and procedures undertaken. Current clinical status was the most frequent NH-MDS code within clinical status (4.5%) followed by current observations (2.8%). Within the care plan category activities of daily living (ADLs) were frequently reported (8.1%), with medications (6.6%), and input and output (6.3%), medical and other team reviews and instructions (5.7%), and pending tasks and procedures (5.3%; see Table 1). Less frequently mentioned were pathways and plan instructions, supporting devices, wounds and dressings, and nursing care and tasks attended (Table 1). Outcomes/goals of care were infrequently mentioned (2.1%). Resuscitation status was rarely reported (0.7%). Discharge and transfer information was infrequently reported (3.9%). Nurse interactions were relatively frequent (6.4%). Patient wishes, requests, compliance and involvement (2.6%) were limited. Less frequent were reports about the family and visitors (see Table 1).

Table 1. Frequency of categories using the ICCCO and NH-MDS codes related to the ICCCO in 162 nursing handover (NH) and nursing notes (NN) transcripts
ICCCONHReferences*NNReferences*
NH-MDS codesNH-MDSNN-MDS codesNN-MDS
No (%)No (%)
n= 2109n= 1902
  1. *Items that could not be coded within the model formed the ‘other coding’ category. ADLs, activities of daily living; ICCCO, identification of the patient, clinical history/presentation (patient problem), clinical status (vital signs, general patient condition), care planning (interventions), outcomes/goals of care; NH-MDS, Nursing Handover Minimum Dataset.

Identification of the patientAdmitting doctor or team43 (2.0)Admitting doctor or team
Bed number120 (5.7)Bed number
Clinical risks, alerts and manual handling7 (0.3)Clinical risks, alerts and manual handling41 (2.2)
Patient name158 (7.5)Patient name2 (0.1)
Social status, age and other information74 (3.5)Social status, age and other information1 (0.1)
Clinical history and presentationClinical history102 (4.8)Clinical history
Procedures undertaken or attended74 (3.5)Procedures undertaken or attended26 (1.4)
Reason for admission137 (6.5)Reason for admission7 (0.4)
Clinical statusAbnormal results19 (0.9)Abnormal results21 (1.1)
Current clinical status94 (4.5)Current clinical status192 (10.1)
Current observations59 (2.8)Current observations116 (6.1)
Patient mental status22 (1.0)Patient mental status39 (2.1)
Results25 (1.2)Results5 (0.3)
Signs, symptoms and assessment51 (2.4)Signs, symptoms and assessment86 (4.5)
Care planADLs170 (8.1)ADLs307 (16.1)
Input and output133 (6.3)Input and output209 (11.0)
Medical, other team reviews and instructions121 (5.7)Medical, other team reviews and instructions44 (2.3)
Medications139 (6.6)Medications127 (6.7)
Nursing care and tasks attended29 (1.4)Nursing care and tasks attended130 (6.8)
Pathway and plan instructions40 (1.9)Pathway and plan instructions44 (2.3)
Pending tasks, procedures, tests and reviews111 (5.3)Pending tasks, procedures, tests and reviews77 (4.0)
Supportive devices: oxygen, stockings, slings, others33 (1.6)Supportive devices: oxygen, stockings, slings, others54 (2.8)
Wound and dressings29 (1.4)Wound and dressings34 (1.8)
Outcome and goals of careOutcome of care that the patient received45 (2.1)Outcome of care that the patient received160 (8.4)
Resuscitation status, medical review criteria and end of life14 (0.7)Resuscitation status, medical review criteria and end of life3 (0.2)
Discharge and transfer informationAwaiting transfer or discharge6 (0.3)Awaiting transfer or discharge6 (0.3)
Date, time, place and/or arrangements for transfer29 (1.4)Date, time, place and/or arrangements for transfer12 (0.6)
Enquires and discussion about discharge/transfer19 (0.9)Enquires and discussion about discharge/transfer11 (0.6)
Other coding*Family and visitors10 (0.5)Family and visitors40 (2.1)
Nurse interactions and comments134 (6.4)Nurse interactions and comments
Nurse providing support, reassurance and othersNurse providing support, reassurance and others9 (0.5)
Nurse responsibilities bed and other allocations8 (0.4)Nurse responsibilities bed and other allocations
Patient wishes, requests, compliance, involvement54 (2.6)Patient wishes, requests, compliance, involvement99 (5.2)

There was variation in the content delivered at bedside vs. nurses' station style handovers. Patient interactions with nursing staff, indicative of bedside handover, were coded in the ‘other category’ for the hospital using bedside handover.

Content of the nursing notes

ICCCO categories

Data from the nursing notes were also coded using the ICCCO model and the content and frequency of each category was studied (Table 1). The most frequent categories were care plan (46.5%, 628/1350), clinical status (23.9%, 322), and outcome and goals of care (11.9%, 160) followed by identification of the patient (3.3%, 44), and clinical history and presentation (2.2%, 30). Reported separately, discharge and transfer information was documented infrequently (1.5%, 20) in the notes. Eleven per cent of the nursing notes could not be coded within the ICCCO model and related to patient requests, compliance, and family or visitor issues.

NH-MDS codes

Within the nursing notes there were 1902 references to the NH-MDS.

Coding using the NH-MDS revealed infrequent aspects of identification of the patient, although an emphasis on clinical risks, alerts and manual handling (2.2%) was evident. Clinical history and presentation of NH-MDS codes focused on procedures undertaken (1.4%) and clinical status focused on current clinical status (10.1%), current observations (6.1%), and signs and symptoms (4.5%). Within the care plan category, the NH-MDS codes mainly focused on ADLs (16.1%), input and output (11.0%), nursing care or tasks attended (6.8%), and medications (6.7%; see Table 1). Outcomes/goals of care were infrequently recorded (160/1902; 8.4%). Discharge and transfer information remained infrequent within the notes. Patient wishes, requests, compliance and involvement (5.2%), and family and visitor issues (2.1%) were limited (see Table 1).

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

We have compared the transcripts of verbal nursing handovers and nursing notes for similar patients at the end-of-shift handover. The ICCCO and NH-MDS framework (representing the gold standard of information) was used to direct the comparison. The general categories of clinical history/presentation (presenting problem), care plan (interventions), outcomes/goals of care reflect the key domains from international NMDS (ICNP™, International Council of Nurses 2012; Mac Neela et al. 2006). The ICCCO categories did capture the substantial amount of the text (89%) for the handover and notes, with a further 11% related to diverse issues such as nurse and patient interaction (handover) or patient, family or visitor issues (notes).

Nursing handover contained slightly more coded information than the nursing notes. Common content existed for three major categories: clinical status, care planning (interventions), outcomes and goals of care, although the proportional focus was different within the categories. The content analysis of handover revealed an emphasis on patient identification, care planning (interventions), clinical history including medical diagnosis, presenting problem (using natural language descriptions; Von Krogh et al. 2012), procedure and clinical status (including observations, signs and symptoms), and is consistent with other international studies (Lamond 2000; Liu et al. 2012). Also the content of nursing notes focused on interventions or tasks within care planning, clinical status such as observations, and to a lesser extent, outcomes or goals of care and were also similar to the Australian, British and Irish studies (Hyde et al. 2005; Irving et al. 2006; Jefferies et al. 2012). A large proportion of the differences in the information conveyed was related to not including the identification of the patient, clinical history or presentation information in the nursing notes, and the inclusion of patient or nurse interaction at handover. Differences in the content delivered at bedside vs. nurses' station style handovers did occur, with patient interactions with nursing staff only occurring at handovers for the hospital using bedside handover.

A closer comparison provided further insights into the origins of the major differences in the ICCCO categories and their likely meaning. First, identifying the patient varies substantially. In the nursing notes, an addressograph label containing the required patient information is placed on each page negating any need to include this information in the nursing notes. The clinical presentation described within the nursing notes was limited or absent in nursing notes. Medical history is likely to have been recorded in the medical notes, not examined in this study. However, at handover, extensive detail on the clinical history and presentation is provided by nurses. Clinical alerts or patient safety issues and signs and symptoms were similar. Consistency was also found in relation to ADLs, with minor omissions in the nursing notes or handover relating to diet, hygiene and mobility. Discharge information was limited in both cases. Resuscitation status was described at handover and rarely appeared in the notes. This information could have been recorded within the medical notes or other areas within the PHCR. Specific patient issues such as requesting a private room or not adhering with care recommended (Hyde et al. 2005, Irish study) often appeared in the nursing notes and was described at handover.

Although only slightly more information was conveyed at handover, it may be that critical information (such as the clinical history and presentation, patient condition, pending tasks, tests, reviews, responses to care) may influence care delivery more, a point raised by Lamond (2000) as information having a ‘forceful feature’ (p. 794) and reported by Jefferies et al. (2012). This may support nurses consistent anchoring to nursing handover, where this information predominates (Pearson 2003).

The NH-MDS coding also highlighted that more detail in clinical status and care planning was required at handover. The implementation of NH-MDS and ICCCO model for handover across 10 Australian hospitals, with formal education and a supportive electronic tool, has substantially increased information transfer relating to clinical status and care planning at handover (Johnson et al. 2013).

The comparison presented in this study is the largest quantitative content analysis of matched handover and nursing notes reported to date (n = 162). Lamond (2000) undertook a similar comparison between handover and notes (n = 60) in Britain. Australian work by Sexton et al. (2004) also examined 23 handovers although there was no content analysis of notes or related charts. Jefferies et al. (2012) also compared handover and nursing notes, although the datasets were from unrelated patients.

There was a difference in the time of delivering handover and writing nursing notes. Only approximately one-quarter of the nursing notes were written within 1 h of the handover with most (52.5%) written more than 1 h before handover. The proposed single process using one set of information will require nurses to delay ‘signing-off’ their eMR notes until after handover. Also it is likely that this single process will accommodate most patient situations as most nursing notes (84%) have only one entry per shift.

Implications for practice and policy

Nursing handover contained similar and arguably more critical information to care delivery, than did the nursing notes. The NH-MDS and ICCCO framework has been found to be a suitable template or structure for one set of patient information with supportive education although further studies in different countries are required.

For the information delivered at nursing handover to be able to be recorded and used as the basis of the nursing notes, system design and practice issues would need to be resolved. First, patient identification information not appropriate for the eMR would be excluded from notes. Nurses could delay recording until this information has been delivered. Second, the inclusion of specific statements relating to medical diagnosis may need to be attributed to appropriate medical staff. Third, the extent of clinical history may need to be varied depending upon whether the patient is a new admission (avoiding replication multiple times in the record). Changes in practice will include the need for handover to precede the final report writing for the day, allowing for the generation of a draft with the eMR. Contemporaneous recording of patient incidents would continue as usual.

Speech recognition provides the medium by which handover could be recorded and a text file transferred to the eMR for final editing. This application of these results is currently being tested by these authors. Nurses will have the opportunity to verbally deliver a comprehensive picture of the patients' condition and care in a manner they prefer and be able to edit the re-structured file of that verbally delivered content within the nursing notes (eMR). This has the potential to reduce duplication of information.

The advent of one process of generating patient information at the end-of-shift handover has the potential to revolutionize nursing handover and documentation practice. Should experiments be fruitful and support patient safety, this change will influence both national and international nursing policy relating to handover and documentation. Policy implications include: Information requirements would be defined for handover and nursing notes and generated from one source; reduced duplication would decrease the time required for documentation; a more comprehensive and structured presentation of care delivery and patient condition could be provided; reduced omission of critical information could occur; textual data analysis for research on patient outcomes related to nursing interventions could be enhanced; and finally, better recognition by patients and other health professionals of the contribution of nursing to patient outcomes could occur.

Limitations

We studied handovers and notes at only two time periods. Evening shift (11:00 pm) handover may require differing information to be considered. This sample represents medical and surgical patients and differing findings may occur in critical care or other units. Using a framework derived from handover to apply to the nursing notes may present a limited representation of the documentation, although the core domains (patient problem, interventions and outcomes/goals) reflect international NMDS (Werley et al. 1991). No differences between the experience of the nurses or other factors were examined.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

The results reported in this study indicate that one set of patient information at the end-of-shift, derived through the preferred communication form of verbal handover, is possible within certain limitations. Technology such as speech recognition can be used to enact this visionary approach to patient information transfer among nurses, with the NH-MDS and ICCCO framework as a template. A written record of handover can be delivered as a draft of the nursing notes, as considerably similar information is present in both handover and the nursing notes. System design, practice change and education are required for the full potential of this notion to be enacted in practice. Further experimentation by these researchers is currently underway applying speech recognition and restructuring of text, and if successful, will challenge international nursing policy relating to handover and documentation practices.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

We wish to thank the nurses from South Western Sydney Local Health District for their participation in this study.

Author contributions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References

Conception of the study (MJ, JB, HS, LH, LD) data collection (PS) data analysis (MJ, PS), interpretation of data (MJ, PS, JB, HS, LH, LD, BK) contributions to the writing and final critical review of the paper (MJ, PS, JB, HS, LH, LD, BK).

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgements
  9. Author contributions
  10. References
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