Laying The Foundation For New Approaches To Practice ✓ Solved

Laying the Foundation for New Approaches to Practice

As frequently noted in the literature, there is often a gap between research evidence and practice. To address this gap, nurses must be skilled in identifying discrepancies between current practice and evidence, determining best practices based on research, and applying these practices through effective change initiatives. Supporting these efforts requires the use of appropriate evidence-based practice (EBP) models and change theories or frameworks that facilitate systematic and sustainable practice improvements. This paper explores the current state of science underpinning bedside handoff practices, analyzes potential causes for outcome disparities, evaluates their impact on practice, reviews recent evidence-based practices, and discusses the application of change models to support implementation.

Analysis of the Science Underlying Bedside Handoff Practices

The science supporting bedside handoffs has been evolving over the last decade, with literature published primarily between 2009 and 2016 emphasizing their potential to decrease communication errors and improve patient satisfaction (Mardis et al., 2016). These studies highlight that bedside shift reports foster patient involvement, promote transparency, and facilitate real-time correction of misinformation. Evidence suggests that when implemented correctly, bedside handoffs can lead to fewer medical errors, enhanced patient safety, and increased satisfaction scores (Wakefield et al., 2012). However, the currency of the science indicates that while significant strides have been made, ongoing research is essential to adapt practices to varying clinical environments and address implementation barriers.

Possible Causes of Discrepant Outcomes

Several factors contribute to the divergence between research expectations and actual outcomes observed when implementing bedside handoffs. Firstly, staff reluctance stems from discomfort with interpersonal communication, especially due to lack of training or unfamiliarity with HIPAA protocols, which raises concerns about privacy breaches (Mardis et al., 2016). Veteran nurses may resist adopting new practices, influenced by entrenched routines or skepticism about efficacy. Organizational factors also play a role; lack of leadership support, insufficient staff buy-in, and high turnover limit consistent application of bedside handoffs (Natafgi et al., 2017). Additionally, negative attitudes and fear of accountability can hinder open communication, thus reducing the potential benefits of this practice.

Impact of the EBP Issue on Practice

The resistance to bedside handoffs adversely affects patient safety, communication efficiency, and overall care quality. When handoffs are not conducted at the bedside, opportunities for patient engagement diminish, leading to decreased patient satisfaction and potential information loss. Moreover, miscommunications during handoffs have been linked to sentinel events and medication errors, which pose serious risks to patient health (Australian Medical Association, 2006). The lack of consistent adoption also undermines institutional efforts to promote a culture of safety and transparency, ultimately hindering progress toward achieving optimal clinical outcomes.

Current Research Evidence on New Practices

Recent literature emphasizes strategies to enhance bedside handoff adoption. For example, integrated training programs focusing on interpersonal communication and HIPAA compliance have shown promise in reducing staff discomfort and increasing compliance rates (McMurray et al., 2010). A systematic review by Mardis et al. (2016) underscores the importance of structured protocols, such as the use of checklists and standardized scripts, to improve consistency. Additionally, technology-assisted solutions like electronic handoff tools and visual aids augment communication clarity (Wakefield et al., 2012). Evidence also suggests that fostering a unit culture that values transparency and continuous improvement encourages sustained practice change (Scheidenhelm & Reitz, 2017).

Evaluation of Evidence Using the GRADE Model

The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) model applies a systematic approach to appraising the quality of evidence. Applying GRADE to the recent studies on bedside handoffs reveals that the evidence supporting their effectiveness is of moderate to high quality, owing to consistent findings across diverse settings and robust methodologies (Guyatt et al., 2011). Randomized controlled trials (RCTs) and well-designed systematic reviews contribute to high confidence in the benefits of bedside handoffs. However, observational studies highlighting implementation barriers are graded as moderate, indicating need for further high-quality research to confirm findings and explore long-term outcomes.

Selected EBP Model and Change Framework

To systematically implement and sustain bedside handoff practices, Lewin's Change Theory and Peplau’s Interpersonal Relations Theory are appropriate frameworks. Lewin’s model involves three phases: unfreezing, moving, and refreezing. In the unfreezing phase, leadership presents evidence supporting bedside handoffs, addresses staff concerns, and builds readiness for change through education and transparent dialogue (Hussain et al., 2016). During the moving phase, frontline staff transition to new routines with the support of super-users who mentor and troubleshoot issues. The refreezing phase stabilizes the change by integrating bedside handoffs into routine practice, reinforced by ongoing feedback and reinforcement strategies.

Peplau’s theory emphasizes nurse-patient relationships, promoting therapeutic communication that enhances patient engagement during handoffs (Nyström, 2007). Its application ensures that nurses foster trust, clarify patient concerns, and involve patients actively in their care processes. Combining Lewin's structured approach with Peplau's relational model facilitates a holistic and sustainable shift toward bedside handoffs, aligning organizational change with patient-centered care principles (Hussain et al., 2016).

Conclusion

Implementing bedside handoffs requires a comprehensive understanding of current evidence, acknowledgment of barriers, and application of appropriate change models. The evidence indicates that, despite the proven benefits, cultural and organizational barriers hinder full adoption. Utilizing Lewin’s change theory and Peplau’s interpersonal relations provides a strategic pathway to foster acceptance, enhance communication, and embed bedside handoffs into routine practice. Continuous education, leadership support, and a culture of transparency are critical to translating evidence into sustained practice improvements that ultimately improve patient safety and satisfaction.

References

• Australian Medical Association. (2006). Safe handover: safe patients. AMA Clinical Handover Guide. Sydney, Australia.
• Guyatt, G., Oxman, A. D., Schünemann, H. J., et al. (2011). GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology, 64(4), 383-394.
• Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2016). Conceptual paper: Kurt Lewin's process model for organizational change: The role of leadership and employee involvement: A critical review. Journal of Innovation & Knowledge, 1(3), 142–147.
• McMurray, A., Chaboyer, W., Wallis, M., & Fetherston, C. (2010). Implementing bedside handover: Strategies for change management. Journal of Clinical Nursing, 19(17-18), 2430-2437.
• Mardis, T., Mardis, M., Davis, J., Justice, E., Riley, H., Donnelly, J., Ragozine-Bush, H., & Riesenberg, L. (2016). Bedside shift-to-shift handoffs: A systematic review of the literature. Journal of Nursing Care Quality, 31(1), 54–60.
• Natafgi, H., Xi Zbu, V., Baloh, J., Vellinga, A., Vaughn, T., & Ward, M. (2017). Organizational factors influencing the implementation of bedside handoffs. Journal of Nursing Management, 25(5), 358–365.
• Nyström, M. (2007). A patient-oriented perspective in existential issues: A theoretical argument for applying Peplau's interpersonal relation model in healthcare science and practice. Scandinavian Journal of Caring Sciences, 21(2), 123–129.
• Scheidenhelm, S., & Reitz, O.E. (2017). Hardwiring bedside shift report. Journal of Nursing Administration, 47(3), 118–123.
• Wakefield, D. S., Ragan, R., Brandt, J., & Tregnago, M. (2012). Making the transition to nursing bedside shift reports. The Joint Commission Journal on Quality and Patient Safety, 38(6), 265–272.