1. Improving student nurse handoff communication
Jamie Lee, MSN RN CNL, Merle Mast, PhD RN, Margaret Bagnardi, EdD RN CNL CCRN,
Janelle Humbert, MSN RN, Sharlene Richards, PhD
James Madison University
Background
Literature
Study Diagram
Results
Communication is key to providing effective, efficient and safe patient care. However, studies that directly observe student nurses communicating with healthcare clinicians can be challenging to conduct. We describe a pilot study in which clinical simulation is used to provide a means to evaluate student handoff reporting.
Forty four participants enrolled in Transition to Practice were randomly divided into control (n=21) and intervention (n=23) groups. The majority of participants were Caucasian (N = 40, 88.9%), with one Hispanic/Latino (, 1 Asian/Pacific Islander, and 2 identifying as other. Nearly half of the participants in the study had current health care certifications or licensure (N= 21).
A significant difference was observed for “I feel very comfortable when I communicate patient care information to another nurse or my instructor at the end of a shift” (P = .030).
Significant differences were observed for all of the CEX items except setting, which was controlled for in this pilot.
A significant difference was observed for organization/efficiency (P .000), communication skills (P = .000), content (P = .000), clinical judgment (P =.000), humanistic qualities/professionalism (P = .000), and overall sign-out competence (P = .001).
Communication between healthcare providers during patient care transitions directly impacts the quality and safety of care (Randell, Wilson, & Woodward, 2011).
Clear, complete, and accurate communication during care hand-offs can lead to missed care and major harm (Staggers & Blaz, 2013).
Common barriers to reporting include inadequate, too much, or poor quality information, limited opportunities to seek clarification, and interruptions or distractions (Welsh, Flanagan, & Ebright, 2010).
Growing emphasis on improving nurse handoff reporting in clinical practice is leading to standardized approaches and audits of their implementation; but research evidence to support these is lacking (Klee, K., Latta, L., Davis-Kirsch, S., & Pecchia, M., 2012; Reisenberg, L.A., Leitzsch, J., & Cunningham, J.M., 2010).
Simulation has been used effectively to teach professionals and evaluate their handoff reporting in clinical practice (Berkenstadt et al., 2008; Daniel & Wilfong, 2014).  
Research Questions
Is there is a difference in student perceptions of self-efficacy before and after an educational workshop?
Is there a difference in student performance of hand off communication before and after an educational workshop?
Theoretical Framework
 Situated Learning Theory provides a context and culture for learning, allowing knowledge and behaviors to be formed during real-world situations (Lave & Wenger, 1991).
In Self-Efficacy Theory individuals’ beliefs about their ability to successfully perform skills or tasks, is built on the belief that cognitive, self-regulatory, and self-reflective processes are fundamental in human adaptation and learning (Bandura, 1977).
Methods
Self Efficacy Survey Items
Clinical Evaluation Exercise (CEX) Tool
References
Institutional review board approval was obtained prior to the intervention and data gathering. Using a pretest/posttest interventional study design, the researchers evaluated 2 outcomes that included student (1) perceived self-efficacy and (2) ability to demonstrate handoff skills. Data were gathered
from students in both the intervention and control groups prior to the intervention and again at mid-semester when the clinical rotation ended.  
Within course orientation, students in the intervention group attended a 2-hour classroom-based workshop on handoff reporting, whereas students in the control group attended a 2-hour general workshop on key aspects of patient safety and the impact of system failures on safety, without content on handoff reporting.
Berkenstadt, H., Haviv, Y., Tuval, A., Shemesh, Y., Megrill, A., Perry, A., Rubin, O., & Ziv, A.
(2008). Improving handoff communications in critical care: Utilizing simulation-based training
toward process improvement in managing patient risk. Chest: Transparency in Health
Care, 134 (1),  doi /chest  
Daniel, L. & Wilfong, D.N. (2014). Critical Care Nursing Quarterly, 37920,   DOI:
/CNQ  
Klee, K.K, Latta, L., Davis-Kirsch, S., Pecchia, P. (2012). Using continuous process
improvement methodology to standardize nursing handoff communication. Journal of Pediatric
Nursing, 27, doi: /j.pedn
Randell, R., Wilson, S., & Woodward, P. (2011). The importance of the verbal shift
handover report: A multi-site case study. International Journal of Medical Informatics, 80, 803-
812. doi: /j.ijmedinf
Riesenberg, L.A., Leitzsch, J., Cunningham, J.M. (2010). Nursing handoffs: A systematic
review of the literature.American Journal of Nursing, 110(4), doi:
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Staggers, N., & Blaz, J.W. (2013). Research on nursing handoffs for medical and surgical
settings: an integrative review. Journal of Advanced Nursing, 69(2),   doi:
/j x
Welsh, C.A., Flanagan, M.E., & Ebright, P.(2010). Barriers and facilitators to nursing
handoffs: recommendations for redesign. Nursing Outlook, 58(3),
doi: /j.outlook
I feel organized
I feel very comfortable
I have given a verbal handoff report
I have learned a specific method
I am confident in my ability
I feel anxious
I need more experience
I need more information
Two open-ended items:
Describe previous experiences giving handoff reports
Describe the factors influencing their ability to give a handoff report.