Critical care nurses' communication challenges during handovers: A systematic review and qualitative meta-synthesis

Abstract

Aims: To review and synthesize qualitative studies to gain a deeper understanding of critical care nurses' inter-departmental and shift-to-shift handover challenges.

Background: Good-quality nurse-to-nurse handover promotes patient safety, while poor handover has been associated with medical errors. However, systematic reviews of qualitative approaches for better understanding the handover experiences of critical care nurses are lacking.

Evaluation: Systematic review methods incorporating meta-synthesis were used. A comprehensive search of seven databases was conducted. Two independent reviewers performed data extraction and evaluated ten studies using the Critical Appraisal Screening Program. Findings were analysed and synthesized using thematic analysis. The transactional model of communication was used to guide the analysis.

Key issues: A total of 10 qualitative studies were included. Seven major handover themes were identified: (a) expectations of perfection, (b) need for partnership, (c) unilateral communication, (d) obstacles to information acquisition, (e) lack of pertinent patient information, (f) need for a structured handover and (g) interruptions/distractions.

Conclusions: Handovers should be considered an essential part of patient-centred care for ensuring continuity of care.

Implications for nursing management: Poor communication during a handover could increase the nurse's burden or stress and adversely affect patient care. Therefore, training should be provided on explicit handover communication.

Keywords: communication; intensive care units; nurses; patient handoff; systematic review.