Shift-to-Shift Nursing Handovers at a Multi-cultural and Multi-lingual Tertiary Hospital in Singapore: An Observational Study

Ineffective communication, during handover, is a major factor in subsequent incidents and patient harm. There is a dearth of evidence on the quality of handovers in a multi-cultural, multi-lingual and cohort care setting, such as in Singapore. This is the first Singaporean study aimed to observe, analyse and evaluate clinical handover by nurses. Fifty shift-to-shift handovers were observed and video-recorded. Content and discourse analyses were used and focused on informational, structural and interactional dimensions of handover. Findings revealed that patient safety information was sometimes missed out. The transfer of responsibility and accountability for ongoing patient care was not explicit and poor information framework and flow during the handover process were observed. Some nurses preferred to perform physical assessments prior to handover instead of during or afterwards. Patients’ background and medical history were either not mentioned at handover commencement or excluded. Some nurses appeared apprehensive to bedside handover and had poor patient engagement. Few nurses effectively involved patients or reinforced patient education. Results highlight that nurses need support and training to master some aspects of handover, focused on reducing clinical errors.