Bedside Reporting vs. Centralized Reporting

Other than integrating audio-tapes in shift reporting, traditional shift reports also included verbal reporting. Such reports were usually performed away from the bedside, mainly at a centralized nursing station. Although these methods had their advantages, their weaknesses greatly compromised patient care as well as safety. The Joint Commission (2006) established the National Patient Care Safety Goals for Hospitals in 2007 (Laws & Amato, 2010). As an outcome, more effective handoff approaches to shift reporting were formulated so that patient safety and improved communication among nurses could be achieved (Laws & Amato, 2010). This is how the approach of bedside reporting was formulated. This essay answers the question relating to whether a change of shift report at the bedside improves patient safety and satisfaction as opposed to centralized reporting at the nursing station.

Change Model Overview

The John Hopkins Nursing Evidence-Based Practice Process provides nurses with the necessary tools to carry out a nursing plan. A nurse is able to review the literature, rate it, relate results to clinical practice and then critique the information retrieved, as well as plan through time and thought.

Practice Question

Step 1: Identify an EBP Question

Does the change of shift report at the bedside improve patient safety and satisfaction as opposed to centralized reporting at the nursing station? The population of interest is patients, in general. The intervention in question is bedside shift reporting, and the comparison interest is centralized shift reporting. The outcome in question relates to whether bedside shift reporting improves patient safety.

Step 2: Scope of Practice Question

Many options have been formulated in order to improve patient safety. Other than integrating technology, managerial practices have also been reviewed as factors that can play a role in enhancing patient safety. According to Laws & Amato (2010), a study conducted in 1991 revealed that 2% of the traditional approaches to change-of-shift reporting incorporated nursing care evaluation while 12% integrated care planning. As it can be noticed, the percentage of the reports expected to deliver the best patient care is rather small. As an outcome, nurses were left with inadequate information, which prohibited them from providing patients with the best care possible. Moreover, the input of patients into their own care plan was also limited. It is, therefore, relevant to review whether patient safety can be improved through bedside shift reporting.

Steps 3, 4, and 5: Team

Among the relevant members of this team, will be a manager, a person who is a patient or one who has been admitted to the hospital at some point. A nurse who has worked using the traditional shift reporting will also be part of the team. A person who visits an admitted patient at the hospital severally will also be included in the team. These members are important because they will allow the team to focus on the issue from the nurse, manager, patient and family/visitor’s perspectives.

Evidence

Steps 6 and 7: Internal and External Search for Evidence

The research identified both qualitative and quantitative data. It also involved descriptive research especially on the articles that mainly focused on the literature review. The research contains information that is verified by credible sources. However, it lacks enough quantitative evidence. Moreover, although information on patient safety is evident, it lacks exclusive information on the same due to the unavailable or not enough evidence on patient safety exclusively. 

Steps 8 and9: Summarize the Evidence

In a research conducted by Wakefield, Regan, Brandt, & Tregnago (2012), a few factors were identified when implementing bedside reporting. The results of the research indicated that patient satisfaction score augmented to 8.7 points. Moreover, when comparing bedside reporting to other approaches to changing shifts, it was identified that rankings shifted from the 20^th to the 90^th percentile. These results were retrieved six months after the implementation of bedside reporting in relation to patient satisfaction scores that are nurse-specific.

In a research conducted by Kassean & Jagoo (2005), it was identified that implementation of change in the nursing care profession took place in three relevant stages. The first stage was called the unfreezing stage, where nurses realized that there was a need for change. The moving change related to planning and implementing the identified change. The refreezing stage related to integrating and monitoring the identified change in nursing practice. The relevance of integrating these stages is based on the fact that the challenges of identifying the need for change, as well as implementing the change, are identified both by Kassean & Jagoo (2005) and Caruso (2007). However, nurses identified some challenges such as communication issues between the nurse and the patient evident in the new bedside reporting, which could not be resolved in the traditional shift change reporting.

For instance, Caruso (2007) notes that nurses had difficulties in communicating with patients during bedside reporting, even though they constantly communicated with them during other scenarios. One of the reasons causing the challenge was that nurses found it difficult to interrupt patients, especially if the patients had monopolized the episode relating to the report. This difficulty, further, was caused by the insufficient communication techniques regarding patients. Bedside reporting, therefore, allows them to develop communication skills that can be integrated in diverse scenarios between a patient and a nurse other than the usual scenarios evident in the patient care practice.

Laws & Amato (2010) notes that another advantage of integrating bedside reporting, instead of centralized nurse station reporting or any other traditional forms of reporting, relates to creating trust and confidence. A nurse cannot always trust that the information given in the report is the actual case of the patient at the time of receiving the report. Although it could have been updated in accordance with the patient’s status at the moment of his or her observation by a nurse, it may not be the patient’s actual status at the time of handing over the report. Handing over the report at the bedside allows the nurse to gauge whether the report reconciles with the prevailing status of the patient since the temperature, blood pressure levels and other factors are prone to change within short periods need to be verified.

One of the issues presented by Laws and Amato (2010) as a barrier/weakness to bedside reporting is confidentiality. Although bedside reporting improves safety, it compromises confidentiality. Patients felt that their health/personal information was being shared among too many health professionals, especially if the patient was in the hospital or under nursing care for a long time. Although this concern is valid, it can be handled accordingly. For example, training nurses on how they can be more confidential plays a significant role in improving patient-nurse confidentiality (Wakefield et al., 2012). Moreover, hospitals can be rearranged or redesigned in order to improve confidentiality in the long-run (Kassean & Jagoo, 2005).

Step 10: Recommendations for Change

The recommendation is to implement bedside reporting despite the implementation challenges that may be encountered. Evidently, bedside reporting is more advantageous in terms of improving patient safety as compared to other traditional approaches, including centralized shift reporting. Strategies to overcome implementation challenges will be put in place.

Translation

Steps 11, 12, and 13: Action Plan

First of all, the plan will put in place by focusing on the expected issues. The second stage will integrate focusing on the unanticipated issues. These stages will be handled through training and having discussions with the relevant stakeholders. One of the issues presented by Laws and Amato (2010) as a barrier/weakness to bedside reporting is confidentiality. While bedside reporting may improve safety, it compromises confidentiality. Patients felt that their health/personal information was being shared among too many health professionals especially if the patient was in the hospital or under nursing care for a long time. Although this concern is valid, it can be handled accordingly. For example, training nurses on how they can be more confidential plays a significant role in improving patient-nurse confidentiality (Wakefield et al., 2012). Moreover, hospitals can be rearranged or redesigned to improve confidentiality in the long-run (Kassean & Jagoo, 2005)

Another challenge of implementing bedside reporting unlike the traditional reporting will include resistance as indicated by Wakefield et al. (2012). These researchers identified that people, including professionals, are not willing to accept change even though it is beneficial to them. This resistance is mainly caused by fear of leaving the known and embracing the unknown. Moreover, professionals are not willing to face the challenges relating to the new approach of changing shifts, hence the resistance. Wakefield et al. (2012), through their research, indicate that one of the ways of overcoming such a challenge is planning and training extensively, as well as implementing the change gradually. 

Steps 14 and 15: Evaluating Outcomes

The outcomes will be evaluated periodically. The process will start by evaluating them twice a week at the initial stages, weekly, monthly and then after three months. Patients and the nurses, as well as the family members to the patients will be asked to fill in questionnaires for evaluation purposes. Feedback can also be retrieved either orally or in written form. Rectifying the mistakes made will occur progressively.

Steps 16, 17, and 18: Implementation

The plan will be implemented in stages. The first level will be to handle the already expected challenges. The other level will engage handling the challenges that may not have been anticipated. Through training and communication, the plan will be implemented progressively. The initial part of the plan will be implemented in the first three months. The other changes will be made during the second three months.

Conclusion

Bedside reporting is more beneficial than centralized reporting or any other traditional of changing nursing shifts because it facilitates communication among nurses and between nurses and their patients. Moreover, this approach creates trust, as well as a patient’s likelihood of following the healthcare professional’s advice and seeking early treatment. Moreover, it allows the nurses to have an exact plan of caring for the patient since the information regarding the patients’ condition will be compared with the actual condition of the patient on the bed. Although confidentiality issues have been presented as challenges to implementing this handover approach, the strengths of bedside reporting out-weigh its weaknesses. Moreover, integrating planning and training extensively, as well as gradual implementation, will minimize the challenges of bedside reporting. Integration of John Hopkins’ Evidence-Based Practice Model allows a nurse to use the tools necessary to carry out the research needed to plan. It allows one to focus on both the greater and smaller factors that determine the failure or success of a nursing intervention plan.