## 4 Discussion  
The impact of this study is significant due to its comprehensive exploration of patients' and families' perceptions regarding their involvement in nursing bedside handovers in both private and public hospitals, enhancing the broader applicability of its findings within the context of the Australian healthcare setting. The use of a descriptive qualitative approach with in-depth and semi-structured interviews offers detailed and nuanced descriptions of participant experiences of their involvement in the nursing bedside handover process. Conducting bedside handover within a patient-and-family-centred care framework has been shown to reduce patient safety incidents and enhance patient satisfaction [5]. The Standard Operating Protocol for Implementing Bedside Handover in Nursing [23] recommends that both patients and families be formally invited to participate in nursing bedside handovers. Before any bedside handovers, nurses should greet and formally invite patients and their families to participate. Nurses are also advised to inquire whether patients and their families have questions or comments and to confirm and clarify information during the handover process. The study findings echo the known challenges of implementing a person-centred care approach [24], which is also conceptualised as patient-and-family-centred care [25]. Patient-centred care emphasises treating each individual with respect and recognising their unique human identity rather than reducing them to a medical condition [26]. Its implementation in healthcare settings involves actively understanding the priorities of patients, their families, carers, and support people to establish trust and mutual respect [27]. From the findings, we can infer that health services within this study were striving to implement a patient-care approach through bedside handovers. In particular, participants, through their multiple hospital admissions, observed structural improvements in nursing handover processes. These improvements were evident in heightened nurse professionalism, better communication, and consistent practices that ensured attentive care during their hospital stays. In this study, patients were satisfied with nursing care and the professional conduct of nurses. Patients stressed that active involvement in their care was vital for their overall wellbeing. In addition, they considered family members' involvement as also being crucial, particularly when the patients were too unwell to understand anything the nurse told them during the bedside handover. Yet, the findings of this study reveal that patient and family active involvement was largely absent during bedside handover. The findings of this qualitative investigation confirm the results from the cross-sectional survey conducted with a broader participant cohort as part of our larger study [15]. Several factors hindered patients' and families' involvement in bedside handover. Both the cross-section surveys [15] and in-depth interviews in the current study revealed that handovers often occurred away from the patient's bedside. When scheduled at the bedside but outside visiting hours, family involvement was limited. Other studies also reported the absence of beside handover [28; 29], despite patients' preference for handover at the bedside to facilitate their participation [30]. There has not been much research on how patients participate during different nursing shift changes. It is important to study this because shift changes can happen at different times in different settings. Understanding patient involvement during these times and providing advance notice of handover timings can help improve patient and family involvement [1]. Maintaining patient privacy and confidentiality is complex and critical during bedside handover, especially in shared rooms and during visiting hours. Participants in our study acknowledged the challenges of maintaining privacy and confidentiality in hospitals, particularly in shared rooms, but were not \"overly concerned\" and preferred handovers next to their bed.