## 3 Findings
### Barriers Hindering Patient and Family Involvement in Bedside Handover
#### 3.3.1 Organisational Barriers  
_Informing patients of their involvement_: _Most_ patients said they did not know if involvement in the nursing handover was an option. They were unsure of their role in nursing handover or even whether they could ask questions. They often received routine inquiries from nurses about pain or medications as standard transactions where they felt nurses were in charge and patients just provided answers. Patients thought that formal information about their involvement could help them approach their interactions with nurses more thoughtfully. Informing patient involvement would have inclined patients to participate more actively and feel more at ease asking questions. Being informed that their participation in the handover was encouraged would have boosted their confidence in posing inquiries. _No, I didn't have any idea. No, no information at all about that I could or could not be [involve]. I certainly would have liked to participate,... [but] if no one tells you that you're welcome to participate in the handover..._ (Patient 2) _I think if it was clearly explained that that's [patient involvement] the process and especially if they said why. Then I would be motivated and also feel confident...[and] possibly you would feel more inclined to participate._ (Patient 6)  
_Timing of handover_: Bedside handovers were often conducted outside visiting hours, restricting the presence of patients' families during this crucial time. Patients who were seriously ill, heavily medicated, or unconscious and consequently unable to comprehend or recall the ongoing proceedings expressed a desire for their families to be present during the handover. They conveyed that when their families inquired about the progress of their treatment, they were unable to provide accurate information. Recognising that family members could play a pivotal role in offering both physical and emotional support post-discharge, having them present during the handover was seen as advantageous. This way, patients believed, they could better understand the specifics of their follow-up care. _No, no they [family] couldn't, 'cause the [bedside] handover they did was mostly during the day and my partners... would be at work._ (Patient 10)  
... I myself have been in situations where... I was suffering... something more of a significant injury and I was heavily medicated.... and any information had to be communicated to me.... [when]... my wife came in afterwards,...[asked] what did the doctor say? What's happening?...and I just couldn't remember....And so, they worried....I think that communication piece would be pretty important to immediate family that might have to step in and do things and stuff like that._ (Patient 3)  
Another patient also believed that involving a family member in the nursing handover was crucial, especially for older patients or those who were heavily medicated or those from non-English-speaking backgrounds. Without the presence of a family member, neither the patient nor their family could be involved in discussions about the treatment plan. This lack of knowledge about the medical condition could cause unnecessary stress for both patients and their families. ..._If people with second language was English and or more heavily medicated, or... older than me still again and you know, perhaps have some issues with their reception, so to speak. So that would be really, really hard, really difficult for the family, and that would just cause undue stress, [and] unnecessary trauma._ (Patient 17)  
Family members of patients shared similar sentiments, emphasising the importance of their involvement in the nursing bedside handover. They expressed that being part of the handover allowed them to identify and address any issues that needed attention. They wanted to know if the patient's condition was improving or deteriorating. Not being informed about the patient's condition and care could be very stressful for the family members. _It would be good if the patient's family could be involved in the handover.