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A Design Perspective on Nurse Handover Education

PROCESS BOOK BY AMANDA WANGEN

SHIFTING CHANGE

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TABLE OF CONTENTS

INTRODUCTION - PG 3

LITERATURE REVIEW - PG 5

RESEARCH & METHODOLOGY - PG 8

DESIGN PROCESS - PG 14

FINAL PRODUCT - PG 16

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INTRODUCTION

For our project we are proposing a handover education unit within one semester long class for second year students. Our group, developed a package divided into three parts, each detailing an aspect of our proposal that we felt successfully conveyed our reasoning behind the proposed handover education unit. The goal of our project is to give nursing students the chance to learn and practice handover communication before being inducted into the workforce. We felt there was not enough emphasis being put on the handover in the education system and that is why we decided to try and implement a unit that would correct this lack thereof. The project lead us to realize that there is no definite clear solution for the problem, but gave us a chance to tackle the problem from a design perspective and to offer a new outlook on initiating change within the nursing education system.

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Objectives

The research question we began our project with was: “How can we develop a solution to the problem-ridden handover procedures which will be both practical and feasible?” This became our main objective. We wanted a final product that would be practical for nurses and would not become easily superseded.

Criteria

The requirements for this project were to propose a solution for safer handovers, to present that solution for the client, and hand-in a written and well documented process book. Throughout the project we had the opportunity to work directly with nurses in co-creation and user testing activities that informed our research. Our role was to aid Vancouver Coastal Health in a critical challenge using research and design problem solving.

“How can we develop a solution to the problem-ridden handover procedures which will be both practical and feasible?”

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LITERATURE REVIEW

Historical Background

In our research we found that there is not much information behind our initial project idea regarding nurse handover education. There is only a few articles that we found that addressed the lack of nurse handover education. Otherwise, there is a lot of information that can be found in regards to the handover itself historically but not very much that touches on educational models. Connections to previous work & other fieldsIn our research, my group found that there was a lot of information on handover problems and potential solutions but none of them really addressed the educational aspect of them. We found that there was little actual implementation of handover education in the current nursing school system. We found only a few well-written research papers that went into detail about the lack of educational models for handovers, but we found no previous work that was similar to our proposed package.

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Connections to previous work & other fields

Our project is closely linked with the educational field, and then linked back to our field as communication designers through the thought we put into our design of the package.We looked at the paper, “A Systematic Review of Educational Resources for Teaching Patient Handover Skills to Residents” in which they reviewed any literature that identified with educational resources on handovers. In their review they narrowed their findings down to only 12 publications that really matched this educational model.

In the paper, we found a lot of information that backed our project’s intention of trying to put together a package that would successfully show that nurse education on handovers is very important.

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Significance of Project

Our project is significant because we could find no other similar approaches to this problem. The significance of our project lays in the fact that we approached this problem in a way that my group found was not being addressed anywhere currently at schools in BC. Why not take our methods of thinking as designers and use them against the current thinking that has already proved not to work as well as they could.

We think our project remains true to it’s intent as something that is feasible and would not be easily superseded by another newer electronic device for example. The project addresses the root of the problem at the communication level something that electronics doesn’t necessarily address. Our project cannot really address the problem of the forms, but with a better understanding of communication tactics, nurses can make the whole handover scenario far easier.

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Our group performed secondary research to solidify the educational direction we were beginning to decide on. In the paper, A Systematic Review of Educational Resources for Teaching Patient Handover Skills to Residents we found that: “In spite of handovers being increasingly a part of physician’s duty, there is limited research on educational models to teach handover skills to residents.” A few sources caught our attention and supplemented our preliminary findings however in the same initial paper we found a study done in the United States demonstrated that, “Between 60%-90% of programs proved no formal training of the handover.” (Masterson) This was alarming data. We wanted to relate this to a study in Canada, but unfortunately such data has not been gathered. Our group decided that If we could start integrating handover skills at the education level, we could potentially offset errors later on in the workforce. To gather more information on the education of Canadian nurses we were able to design a co-creation kit.

RESEARCH & METHODOLOGY

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Co-creation

Our co-creation kits helped us ground our project in the education of Canadian nurses. Through a questionnaire which we opened our kit with we learned a few important facts. In a list of options we provided for the best places to learn handovers the only ones that did not get a negative response were: fellow nurses, workshops at the hospital and nursing school. We also asked three of the participants if they had been taught shift report handoffs at school and they unanimously responded that they had not. We also included a brainstorming activity that asked nurses in regards to handovers they felt were working presently, would work best in the future and also the negative sides of the present and future of handovers.

Our last activity was a notebook that we were planning to ask nurses to write in how they would personally teach handovers but we did not have enough time in the session to get to the activity.

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Post-Co-Creation Kit Research Question

In our co-creation stage we identified that education was in fact a valid direction for our project. Our research question at this stage was:

Is there inadequate teaching of the handoff during university and college programs that translates into poor communication at the hospital level? Will a program specific training of the handover downsize the number of communication related hospital errors?

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User testing

To enter our user testing phase we had to further research the current education format for nurses in British Columbia. We found that: “Much of literature on handover simply present a mnemonic of checklist for handover without describing educational models.” We had kept in touch with nurse Kim Soltsyk who participated in our co-creation kit. Soltsyk is a working nurse and nurse educator who was able to provide us with more information and contacts within the field of nurse education. We learned through an interview that Nicola in our group conducted with Soltsyk that the teaching of the handover was done using traditional education practices, if done at all. In the textbook, Handoffs Implication for Nurses we found this information:

“There is reported variability in quality, lack of structure in how handoffs usually occur, and variances in shift handoffs. Concern has been raised that the transition of care between providers during handoffs will continue to be problematic as research indicates that ‘only 8 percent of medical schools teach how to hand off patients in formal didactic session’, creating a large educational gap in new professionals and persistence of traditional models.”

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From here we were able to have nurses return to our class for a user testing stage. Our group prepared a number activities that we designed to teach communication and effective handover techniques. Our goal was to try abstract techniques that engage a persons problem solving skills. Our activities were successful with the nurses and lead us to the realization that there was a need for these sorts of activities in university practice.

The first was an icebreaker and involved a tangram blind-folded exercise to open dialogue around the complications of communicating. For our second activity we had a case scenario printed out twice with slight modifications between one and the other. We asked the nurse to read one and take notes. Then we read the second. The nurse’s job was to try and catch any differences between the two almost identical reports. We had modeled this exercise after learning from, “A Systematic Review of Educational Resources for Teaching Patient Handover Skills to Residents that, ”simulation has been used effectively in several of the studies and was well received.” (Masterson)

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Our group found that nurses were really strong in each of the two exercises. This meant that our activities were relevant and nurses had developed the skills most likely on the job. We began to think about it as our goal to foster strong handover communication skills in nurses early on while still in school as a preventative measure against learning potential bad handover communication when starting out in the workforce.

If we could change the initial learning environment at nursing school towards handovers we thought it would directly improve handovers in the future. We learned in our research as well thatComparing students’ responses before a course also stimulates discussion and an open learning environment, as well as it supports the instructor with useful insight in guiding the course instruction (Virgil, Varvel).

After our user testing phases we started planning our actitivies for the package. This quote, “Tools for Teaching” summarizes the reasoning behind proposed activities,“Learning is generally enhanced when learners encounter the same principles in a variety of formats.” (Davis)

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As our group chose to go with an education standpoint, our first design process started with the development of the co-creation kits, mostly with just choosing a typeface and colour scheme we felt was professional. However, from there we chose a rather different style from the initial typefaces and colour choices of the co-creation kits.Our group’s design process for the package started with looking at the material that we had gathered from our research, co-creation kits, user testing and the subsequent images we had taken. We realized we did not have as much high quality imagery as we had hoped to use in our our initial planning of the package. We decided however on a package that would be able to be photocopied thus we decided on 8.5x11 paper. We wanted our package to look professional but not to the degree that it would be regarded as uninspiring. Therefore, we decided on a blue colour that was professional but playful. The package uses some imagery, mostly in the side columns as we could not go too big due to quality restraints. As the package is divided into three parts we decided that we would use larger images only on the initial page introducing the parts and that the images would be in black and white. The typography we chose was Trade Gothic, Scala, and Scala Sans, to keep it modern but professional.

DESIGN PROCESS

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Lastly, our cover is a blurred out abstract image, as we did not want the focus to be on any individuals or a specific thing, but rather emphasize the title of our package.

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Our final product consists of a 30 page package that would ideally be given to prospective nursing schools outlining our project and the research we have put into our proposed educational handover unit. Our package is broken down into three main parts.The first is, “Existing Teaching Methods and Research Defending New Model”, the second, “Psychological Reasons for Proposed Teaching Methods”, and the third, “Resources and Activities”. In the first section we outline our general research behind the educational standpoint we took and our findings from the co-creation kits and further user testing. In our second part, we look at our psychological reasoning behind our activities and how we find students can better learn communication skills from them. In our last part, we provide sample activities, which we have tested and provided steps for. We also provide an appendix, in which there will be photocopiable material such as our activities which educators can use.

In our package, there is an About page which I find summarizes our project’s aim well:

This package focuses on exploring the problems and processes involved in developing a solution to improve handover

FINAL PRODUCT

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communication for nurses during shift change. This is a printed report proposing a handover unit that would be implemented into the current nursing education curriculum. The unit proposed is two classes within one semester long class for second year students. This package is divided into three parts, each detailing an aspect of a proposal that conveys reasoning behind the handover education unit. The goal of the package is to give nursing students the chance to learn and practice handover communication before being inducted into the workforce. Producing this package lead to the realization that there is no clear solution for the problem, but offering a new outlook on nursing education system can initiate change for the better.

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ANNOTATED BIBILIOGRAPHY

Davis, Barbara Gross. Tools for teaching. San Francisco: Jossey-Bass Publishers, 1993.

This book looks at strategies and suggestions for classroom activities and to improve education. It goes over teaching

tools that we thought was helpful for our educational model.

Friesen, Mary Ann; Susan V. White; Jaqueline F. Byers. Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Handoffs: Implications for nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); April 2008

This resource was helpful because it showed exactly what is in handoff and what is missing currently. It also looks at

ideas for how to solve the problems. The book is meant for nurses to read as a textbook so it was a good basis for un

derstanding the handover.

M. F. Masterson, R.S. Gill, P. Shrichand, M. Giuliani, A Systematic Review of Educational Resources for Teaching Patient Hando-

ver Skills to Residents. http://www.cair.ca/u/elibrary/5c_Handover%20paper.pdf

A very helpful review of educational resources and models from research that the authors found. Lots of good quotes,

facts and figures. A very thorough paper that helps supports our educational platform.

Virgil, E. Varvel, Jr. Icebreakers. January 2002. Pointers and Clickers. Accessed April 9th 2012. http://www.ion.uillinois.edu/re-

sources/pointersclickers/2002_01/index.asp

This helped us understand the activity of icebreakers and other classroom activites such as brainstorming and discus

sions and some of the psychology behind them.