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首页> 外文期刊>Applied nursing research: ANR >Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings
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Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings

机译：混合方法评估护士到护士床边临床切换的质量改进和审计工具

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BackgroundNurse bedside handover quality is influenced by complex interactions related to the content, processes used and the work environment. Audit tools are seldom tested in ‘real’ settings. ObjectiveExamine the reliability, validity and usability of a quality improvement tool for audit of nurse bedside handover. DesignNaturalistic, descriptive, mixed-methods. SettingSix inpatient wards at a single large not-for-profit private health service in Victoria, Australia. ParticipantsFive nurse experts and 104 nurses involved in 199 change-of-shift bedside handovers. MethodsA focus group with experts and pilot test were used to examine content and face validity, and usability of the handover audit tool. The tool was examined for inter-rater reliability and usability using observation audits of handovers across six wards. Data were collected in 2013–2014. ResultsTwo independent observers for 72 audits demonstrated acceptable inter-observer agreement for 27 (77%) items. Reliability was weak for items examining the handover environment. Seventeen items were not observed reflecting gaps in practices. Across 199 observation audits, gaps in nurse bedside handover practice most often related to process and environment, rather than content items. Usability was impacted by high observer burden, familiarity and non-specific illustrative behaviours. ConclusionThe reliability and validity of most items to audit handover content was acceptable. Gaps in practices for process and environment items were identified. Context specific exemplars and reducing the items used at each handover audit can enhance usability. Further research is needed to develop context specific exemplars and undertake additional reliability testing using a wide range of handover settings. What is already known about this topic?The quality of nurse bedside handover is influenced by complex interactions related to the content, processes used and the work environment.?Standardised handover tools to guide training, coaching and audit provide a consistent framework of behaviours, content and processes in line with expectations of quality practice.?Reliable and valid handover quality improvement tools are necessary to provide quality data to improve patient safety and quality of care, however these are seldom examined in the context of daily practice. Contribution of the paper?High content and face validity of the handover audit tool provides guidance to standardise practices to improve the quality of nurse bedside handover related to content, process and environment across different clinical contexts.?This research demonstrated nurse handover practices related to content were most frequently addressed, but gaps related to handover process and environmental safety emerged.?Tool reliability was acceptable for frequently observed content items, however practice improvement is required before further reliability analysis can evaluate process and environment items.
机译：背景Nurse床头旁切换质量受到与内容，使用的流程和工作环境相关的复杂互动的影响。审计工具很少测试在“真实”设置中。 ObionEt评价质量改进工具的可靠性，有效性和可用性审计护士床边切换。 DesignNatural，描述性，混合方法。 SettersionIX住院病房在澳大利亚维多利亚的单一大型非营利性私人健康服务。参与者护士专家和104名护士参与了199例换身床边切换。 Methodsa与专家和试验试验的焦点组用于检查内容和面部有效性，以及切换审计工具的可用性。使用六个病房的切割审计检查该工具用于帧间可靠性和可用性。数据在2013-2014收集。结果有关72项审计的独立观察员，表明了27（77％）项目的观察员间协议可接受。对于检查切换环境的项目，可靠性薄弱。未观察到十七件物品反映了实践中的差距。在199个观察审核中，护士床边切换实践中的差距通常与过程和环境相关，而不是内容物品。可用性受到高观察员负担，熟悉性和非特异性说明行为的影响。结论大多数物品的可靠性和有效性可接受。确定了流程和环境项目实践中的差距。背景技术具体示例和减少每个切换审核时使用的项目可以增强可用性。需要进一步研究来开发上下文具体示例，并使用各种切换设置进行额外的可靠性测试。关于这个主题已经知道的？护士床边切换的质量受到与内容的复杂互动的影响，使用的流程和工作环境。标准化的切换工具指导培训，教练和审计提供一致的行为框架，内容和根据质量实践的期望的过程.?可接定和有效的切换质量改进工具是提供质量数据，以提高患者安全性和护理质量，但是在日常练习的背景下很少考察这些。撰写文件的贡献？切换审计工具的高含量和面部有效性为规范措施提供了指导，以规范改善与不同临床环境中的内容，过程和环境相关的护士床边切换的练习。这个研究表明了与内容相关的护士切换实践最常解决，但与移交过程和环境安全有关的差距。获取经常观察到的内容物品可以接受，但在进一步的可靠性分析可以评估过程和环境项目之前需要进行实践改进。

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