Discourse processes in shift handover sessions of medical care units
Responsable du projet Adrian Bangerter
Collaborateur Eric Mayor
Résumé The planned research will investigate discourse processes in shift handover sessions in medical organizations. Shift handover sessions are routine events that punctuate transitions between shifts in care units. They are often organized as meetings where members of the outgoing shift brief members of the incoming shift on new developments that have emerged in the care unit, typically the details of patients' health status. The planned research focuses on handover in nursing teams. Previous research on nursing handover routines has documented the variety of forms of their organization. For example, handover sessions can be conducted orally or by written means, they can involve two nurses at the bedside or a whole care team, and they can be standardized to different degrees. Various artefacts can support the handover process, such as patient files, whiteboards, computerized summarizing software, or personal notes of team members. Research has also identified several different functions of handover. The main, official, function is to guarantee task continuity by transferring patient information from outgoing shift members to incoming members. However, discourse during sessions also serves to integrate information among team members or to interpret and contextualize information from written records. It also serves several group or social functions, including expressing professional values, teaching and socialization of new nurses, social support and marking the transfer of accountability for patients' well-being. Some or all of these functions may be important for patient health, because they increase the reliability of information distribution within the care unit. Administrative pressures increasingly push hospitals in the direction of efficiency, e.g., to cut costs by using the time of employees more rationally. This directly affects care unit operations, and thus, handover procedures are currently changing. There is a tendency to attempt to streamline them by standardizing oral and written communication. However, the impact of these changes on the quality of information transfer during handover is poorly understood to date. Research on handover has been conducted mainly from a nursing science perspective. Moreover, there is an overabundance of singlecontext case studies, with little attempts at synthesizing findings across contexts. What is needed is a theory of how handover procedures are related to the various environmental aspects of care units.
The goal of the planned research is to remedy this situation by contributing to an understanding of the relations between discursive features of handover organization and the task and organizational environment of the care unit. Thus, there are two main research question questions. First, how are shift handover sessions organized in Swiss hospitals? Second, how is the organization of handover related to the organizational and task environment of the care unit? Two studies are planned for a total funding period of 36 months. The goal of Study 1 is to obtain a representative overview of shift handover procedures in care units of Swiss hospitals. Forty care units will be sampled. Head nurses responsible for shift handovers in each unit will be interviewed about various aspects of handover in their units (e.g., number and duration of handover sessions per day, preparation, who is present, who participates, communication type, functions, problems and critical incidents, satisfaction and change). Beyond a description of handover practices, Study 1 will serve to identify relevant dimensions of task environments that differentiate care units according to their handover procedures. Building on these results, Study 2 consists of in-depth observation of communication processes in handover sessions over a consecutive fiveday period in four care units. The care units will be selected from participating organizations in Study 1 to vary according to the relevant environmental dimensions identified. Analysis will first consist of detailed within-case analyses of the discourse processes in the handover sessions (e.g., who contributes information, content of information, phases in handover). Then, cross-case analyses will be performed to compare discourse features as a function of the organizational and task environment.
The planned research has implications for theory. First, it can contribute to a better understanding of the interplay of formal and informal processes in organizational communication routines. Second, it can link studies in neighboring fields such as collaborative work and organizational theory. The applicant and the doctoral student will seek publication of the results in international peer-reviewed journals in these fields. Practical implications for the design or reengineering of shift handover sessions may also result from the study, especially better insights about the potential implications of streamlining particular aspects of the handover routine. A special effort will be made to communicate the study results to participating organizations. A report will also be made available to other interested organizations (e.g., professional associations).
Mots-clés Shift handover, dialogue, nursing teams
Type de projet Recherche fondamentale
Domaine de recherche Psychologie
Source de financement FNS
Etat Terminé
Début de projet 1-12-2007
Fin du projet 30-11-2010
Budget alloué 141'634
Contact Adrian Bangerter