What makes a good handover?
Giving an in-depth handover allows you to go home safe in the knowledge that your patients are taken care of but how should you hand over your patients?
Your mentor has asked you give handover. Your heart sinks at the thought of speaking to a room full of people about something you’re still learning. Questions start running through your mind – “Did Bed 12 have any breakfast?” “What tests did the doctor order for Bed 4?” “How many patients are even on the ward?!”
Yes, it’s nerve-wracking and can feel as though you’ve been put on the spot. But handovers are arguably one of the most important parts of nursing, whichever branch you are on – and therefore one of the most important things for you to master.
The NMC code of conduct instructs nurses to work with colleagues to monitor the quality of their work and maintain the safety of those in their care. Handovers give staff the opportunity to discuss the treatment they’re giving, communicate problems and concerns and ensure everyone knows exactly what’s going on. By doing this, the team can prevent jobs from being missed or repeated.
As a student, you can also use this opportunity to ask questions and familiarise yourself with the nursing process.
Sarah Harris, a third year student nurse from Ayr, Scotland, remembers her first experience of handovers. “My concerns when I first started giving handovers were that people would dread it when they found out I was giving it. My initial handovers were all over the place and I’m surprised anyone got any useful information from me at all!”
Of course, if you don’t understand what is going on then no matter how hard you concentrate, the handover will be a waste of time.
“Initially the hardest part of handovers was the abbreviations used,” recalls Sarah. “Once I got used to these it was easier.”
But getting used to abbreviations is easier said than done. The usual studentnursingtimes.net advice still stands (Ask, ask and ask again!) but if that’s not possible, make a note of terms that are new to you and speak to someone afterwards or you can look them up here: Nursepedia.
For help with mental health terms have a look at: Decoding your mental health placement.
What goes in to a handover?
The handover of each patient is generally made up of three sections:
- Past: historical info.The patient’s diagnosis, anything the team needs to know about them and their treatment plan. So you’d include things like whether they are nil-by-mouth or require barrier nursing, if they need help with eating or using the toilet. f they are newly admitted then it is a good idea to cover the circumstances of their admission.
- Present: current presentation. How the patient has been this shift and any changes to their treatment plan. Keep in mind that significant changes might have occurred before your shift that the new team are not aware of; check when they were last in and what they already know. Include physical observations and any results from assessments or investigations.
- Future: what is still to be done. For lots of reasons, there can be jobs that have to be handed over to the next shift. Tasks that need to be completed at a certain time or something the team simply haven’t had time to do yet.
What needs to be happen for this patient to be discharged?
Potentially there is a lot of information that could be handed over. Sarah found that prioritising the most important points and identifying who she was handing over to, helped her to give relevant handovers. “I used to give every single piece of information I had, even if it wasn’t relevant. It doesn’t really matter to night staff if the patient has a package of care at home but I do need to tell them that their vital signs are abnormal and that they are at risk of deterioration overnight.”
So how do you prioritise? Take a step back and think about what the team need to know. If you struggle to decide what is important and what is less so, a good idea is to make notes before you start. Try using a simple table like the one below to help you get what you’re going to say straight in your head beforehand. There’s no reason why you can’t take your notes with you.
|Name/Bed number||Diagnosis||Special notes||Presentation||Tasks|
|John Bloggs, Bed 12||Acute renal failure||MRSA positive, barrier nursed, pressure sore on right leg.|
Slept most of morning.
No change to treatment plan.
Dressings need changing at 17:00.
|Paul Jones, Bed 17||Schizophrenia|
Nursed on 1:1 obs.
Caught smoking in bed area, lighter confiscated.
Compliant with oral medication.
BM’s 5.8 before lunch.
Continue 1:1 observations.
Encourage to attend to hygiene needs.
Beating the nerves
Yes it’s scary. There’s no getting away from that. But, like most things, the best way to get over that fear is to dive straight in.
During handover, it is more important than ever to speak up if you are unsure, it sounds obvious but never make up what you think is happening! If you don’t know what a patient’s blood pressure is, say you don’t or better yet check their chart. Next time you’ll know to check beforehand.
You’re there to learn so it’s reasonable to ask to just handover one or two patients to build up your confidence before you hand over the whole ward. Sarah had positive experiences of working with mentors to learn how to hand over. “Going through the report with me and making sure I understood everything that had been handed over really helped. Practicing handovers with my mentor before hand did as well.”
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— studentnursingtimes (@studentNT) December5, 2011