The Effect of Bedside Handoffs on Patients’ Perceived Fears

Fear, anxiety, and apprehension can have a profound effect upon patient outcomes, possibly leading to a worsened health condition or delay in recovery. Current literature finds that communication and social support by the nursing staff may foster patients’ understanding of their care and their experiences of feeling safe. The bedside handoff is one way of enhancing communication and providing support within nurse patient interactions. The purpose of this study is to explore the effect of bedside handoffs on patients’ perceived fear, anxiety, and apprehension. A secondary analysis was performed upon a larger quantitative data set from two studies that were designed to identify inpatients’ perceptions of bedside handoffs. Data analysis focused upon the following variables from the original studies: frequency of bedside handoff, the degree to which bedside handoff made patients feel safe, patients’ reports of fear, anxiety, or apprehension, and the degree to which patients reported that bedside handoff relieved fear, anxiety, or apprehension. Descriptive statistics, Pearson’s correlation coefficient, independentsamples t-tests, paired-samples t-tests, and one-way analysis of variance were conducted to summarize the data and identify significant relationships between variables. Preliminary findings illustrate that bedside handoff shows some benefit in reducing patient reported fear, anxiety, and apprehension and a great benefit in helping patients feel safe within the hospital setting, but only when it is implemented consistently. These findings demonstrate the benefits patients receive from being informed, participating in their care, and communicating with the nursing staff throughout the hospital experience. However, current practice indicates that fear may continue to hinder patients from receiving the full benefit of interventions, and nurses may use this knowledge to identify and provide further care for these patients. EFFECT OF BEDSIDE HANDOFFS 3 The Effect of Bedside Handoffs on Patients’ Perceived Fears Background and Significance Fear, anxiety, and apprehension are basic human emotions that are experienced by many. The terms are generally defined as a state of uneasiness, uncertainty, dread, or anticipation related to a real or perceived threat of danger (Venes, 2009). Fear, anxiety, and apprehension are essential for human motivation and survival; however, if prolonged they may drive individuals to engage in defensive and avoidant behaviors, which can affect physiological functioning and healing (Dubayova et al., 2010). The general adaptation syndrome identifies the physiological stages an organism may experience when confronted by a perceived threat. When the threat is first perceived, the organism goes into the alarm response and physiological functioning initially declines; however, over time the body utilizes resources to restore this functioning in the stage of resistance. Without proper adaptation or intervention, an organism may persist in the stage of resistance or progress to the stage of exhaustion. This may lead to depletion of natural resources, malfunctioning of vital organs, and an overall endangerment to life (Selye, 1950). Promoting health outcomes and physiological healing is the primary goal of healthcare environments. The significant health risks associated with unrecognized fear, anxiety, and apprehension, therefore, sparked healthcare researchers to study the cause of these emotions for patients within the hospital setting. Symptom-induced pain or discomfort, presumed diagnosis, anticipated consequences of treatment, coping failures, and reinterpretations of the illness condition were found to be causes of patient reported fear (Dubayova et al., 2010). A lack of caring relationships from healthcare professionals was also found to create anxiety, unnecessary discomfort, dissatisfaction, uncertainty, and functional decline in patients (Mollon, 2014). EFFECT OF BEDSIDE HANDOFFS 4 To begin addressing patient fear, anxiety, and apprehension, the concept of safe care was focused upon in research. Safe care involved a safe environment, safe patient practices, and a therapeutic unit culture where care is delivered (Mollon, 2014). Safe care was found to be effective in addressing actual patient safety; however, patient fear, anxiety, and apprehension required the focus of safe care to be shifted to perceived safety or feeling safe (Mollon). Feeling safe is a concept that was originally defined as an emotional state where no imminent danger or injury is perceived (Russell, 1999). Over time, feeling safe developed into an ideal where patients perceived a sense of security and freedom from harm (Mollon, 2014). Feeling safe can be promoted in the inpatient setting in a multitude of ways. The use of patientcentered care models and the creation of positive healthcare environments through trust, caring, presence, and knowledge within the nurse-patient relationship promoted a sense of safety while hospitalized (Mollon). Social support and increased communication between nurses and patients also improved patients’ sense of feeling safe, as well as overall satisfaction with the health care process (Gill, Dunning, McKinnon, Cook, & Bourke, 2014; Lasiter, 2011). Specifically, patients reported a sense of feeling safe when nurses showed at least two of the following four attributes: initiative, oversight, predictability, and proximity (Lasiter). Additionally, patients stated that they felt the most safe and satisfied with their care when they were able to communicate their needs, demonstrate some level of control over their situation, and participate in their care (Gill et al.). The Joint Commission has recognized the need to encourage patients to be active participants in the healthcare process, stating that patient and family involvement regarding care, treatment, and services is an important component to the culture of safety (Ofori-Atta, Binienda, & Chalupka, 2015). To promote this ideal, the bedside handoff has been proposed as a means of promoting patient inclusion and communication. Bedside handoff involves an interactive EFFECT OF BEDSIDE HANDOFFS 5 discussion occurring at the bedside between the incoming nurse, outgoing nurse, patient, and family about the patient’s status and plan of care at every shift change. The Agency for Healthcare Research and Quality defines bedside handoff as an opportunity to create an environment where patients, families, clinicians, and hospital staff can work together to improve quality and safety of care (Ofori-Atta et al.). Patients have reported a significant increase in their perception of being informed, being an active participant within the healthcare team, and feeling confidence that their concerns were known after bedside handoffs were instituted (Maxson, Derby, Wrobleski, & Foss, 2012). Bedside handoffs also promoted patients’ perceived comprehension and understanding of their care and satisfaction with the health care process (Ford, Heyman, & Chapman, 2014). These attributes have the potential to lead to an increased sense of autonomy, which in turn may allow patients to exercise control over the situation and participate in their care. These benefits exhibit the attributes Gill et al. (2014) found to improve feelings of safety among patients. Bedside handoff provides the opportunity for both the nurse and the patient to clarify missing information, correct inaccuracies, and detect errors or deteriorating patient status (Jeffs et al., 2013). This promotes nursing surveillance, which plays a key role in the culture of safety, as nurses are able to more rapidly detect patient changes and initiate appropriate interventions (Dresser, 2012). Patients have been found to be a crucial component in detecting errors and correcting information during the bedside handoff (Jeffs et al.). This process not only promotes patient participation that has been documented to improve feelings of safety, but nursing surveillance also aids in establishing the nursing attributes of initiative, oversight, and proximity that Lasiter (2011) found to increase patients’ sense of safety. EFFECT OF BEDSIDE HANDOFFS 6 To achieve the benefits that have been documented for bedside handoffs, the frequency of implementation is important to consider. Patients who experienced bedside handoffs consistently during their stay viewed that they were protected from errors, that the nurses planned their care, and that they were able to be involved in healthcare decisions (Ford et al., 2014). This differed significantly from patients who experienced inconsistent bedside handoffs (Ford et al.). Bedside handoffs, therefore, have the potential for profound positive effects upon patient satisfaction, communication, and understanding when implemented consistently and frequently. These findings continue to mount support for the attributes Gill et al. (2014) outlined to assist patients’ sense of safety within the hospital setting. There are many identified benefits for the utilization of frequent bedside handoffs including improved nursing accountability and patient involvement, communication, sense of control, and satisfaction; however, evidence of its use in relation to patients’ perceptions of feeling safe and the effects it may have on patients’ reported fears has yet to be established. Therefore, the purpose of this study is to explore the effects of bedside handoff on patients’ perceived fear, anxiety, and apprehension. Methods Design This study is a secondary analysis of a larger quantitative data set from two studies carried out in 2011 – 2013 and 2014 that were designed to identify inpatients’ perceptions of bedside handoffs (Ford et al., 2014; Ford & Heyman, in press). A descriptive correlational design was utilized to explore the relationship between bedside handoffs and patient fear, anxiety, and apprehension. Descriptive correlational designs are used to explore relationships between variables