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Handing over patients from the ICU to the general ward: A focused ethnographical study of nurses' communication practice
Author(s) -
Bunkenborg Gitte,
Bitsch Hansen Tina,
HølgeHazelton Bibi
Publication year - 2017
Publication title -
journal of advanced nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.948
H-Index - 155
eISSN - 1365-2648
pISSN - 0309-2402
DOI - 10.1111/jan.13377
Subject(s) - focus group , nursing , psychological intervention , participant observation , qualitative research , perception , negotiation , patient safety , ethnography , psychology , medicine , general hospital , family medicine , health care , social science , neuroscience , sociology , anthropology , economics , economic growth , archaeology , marketing , political science , law , business , history
Aim To explore nursing practice and perception of engaging in communicative interaction when handing over multi‐morbid patients from the ICU to general medical or surgical wards. Background Communication failures impose risks to patient safety. ICU and general ward nurses communicate in writing and verbally when handing over patients from one setting to another. A deeper understanding of nurses' communicative interaction and of nurses' perception of their interaction is crucial to facilitate clinical interventions focusing to improve patient safety. Design An explorative, qualitative design using focused ethnography was applied to the study. Methods Participant observation of 22 clinical situations of handing over patients from the ICU to general wards was conducted in November and December 2015, followed by five focus group interviews, three interviews with general ward nurses and two with ICU nurses in January–February 2016. Observation notes and interview transcripts were analysed using content analysis. Findings The theme “Communicative interaction as a process of sharing and adopting ownership” and the subtheme “Communicative interaction influenced by nurses individual expectations towards patient status and the handing over process” emerged from observation notes. From transcribed focus group interviews, the theme “Balancing and negotiating when passing on, consuming and adapting knowledge” was identified. Conclusion A lack of shared goals regarding handing over patients from a high monitoring unit to general wards causes communicative and collaborative difficulties, loss of information and potential risks to patients. Organizational attention in relation to ICU discharge is crucial to improve collaboration, communication and patient safety.