Addressed Gap

The proposal will address the communication gap, which is expanding between nurses while making and exchanging handoff reports. There is a misunderstanding between nurses brought about by the way they are preparing handoffs leading to poor healthcare to patients. The proposal will provide a framework for an educational program, which can help to improve nursing students’ skills in preparing handoffs.

Organizational Trends

Health care organizations are making improvements in their management and organization structure to improve their delivery of healthcare services. One of the changes, which are developing, is the introduction of the healthcare information technology (HIT) and software. Hospitals and clinics are moving towards a simplified form of management of hospital records using the latest technology instead of the previous process of opening physical files and keeping medical books (Aragon Penoyer et al., 2014). An example of the HIT is the electronic medical record (EMR) for maintaining the patient’s treatment history.  EMR has incorporated handoffs creating a new way of presenting them and therefore different ways of communicating to nurses on shift.

Culture integration in human healthcare resource is another trend changing in organizations. Most countries, states, and provinces are carrying out exchange programs or hiring nurses and physicians from other regions and countries. The program is leading to the expansion of cultural diversity in nursing staffs. The new nurses are bringing in their culture, which other nurses are adopting through training. The trend is creating a team with a diverse culture of leading to a communication gap. There is a trend in health care organizations to simplify complex bureaucracies to improve healthcare services by reducing the time taken to attend to patients. The simplification is also reflecting in handoffs where a nursing a taking a different simplified way of writing them. The changes are leading to a communication barrier between nurses in a shift.

1 Explanation of Causes

            EMR is a new platform, which most nurses do not know how to use such computer related systems. The technology has come up with a more efficient method of recording patient’s data. Nurses are now using electronic handoffs to turn shifts amongst themselves. Due to the complexity of the systems, nurses are forgetting and becoming unable to include all the relevant information about a patient. Failure to have all the required pertinent details on the handoff report is leading to miscommunication. Also, the simplified form of recording information on the EMR is creating a misunderstanding since the shortened forms of writing are not applicable.

Culture integration in hospitals is bringing in different ways of making handoffs depending on the nurse training or hospital. Different countries and healthcare centers have different ways of presenting patient information. Integration, therefore, means that when nurses from different cultures are exchanging shifts, there will be a gap in communication where there might be an excess of less information about a patient. With the simplification and cutting off bureaucracies, nurses are cutting down important information about a patient while presenting handoffs as a way of trying to make it simple and save time. The issue is creating a situation of communication gap where the nurses are having different information about a patient.

Identification of Target Audience

The audiences for the program are nursing students at the senior level. The proposal is identifying the audience to design a program that meets their expectations and those of the nursing program at each level make. Meeting the expectations will make delivery and understanding of the content efficient. The audience will inform the content depending on the knowledge gap about the program. Analysis of the audience will also help to align the course towards their learning needs. Different students have different needs and therefore require different methods of teaching. The analysis of the audience is also essential to know how to handle different characters in a class setting depending on their culture and therefore, avoid communication barriers.

           

Characteristics of Target Audience

The audiences are ms nursing students in their final year. The students are almost ready to serve patients and therefore need guiding programs to make their service and relation with other medical staffs efficient.  There will be accommodation of students from any country across the world and consequently different cultures as long as they understand the English language. Students should be attached, permanently employed or was working previously in a healthcare center with experience of preparing handoffs. Students of any age and gender regardless of marital status are allowed.  The program will be carried out in nursing school lecture halls and simulation laboratories. Also, the program will allow a preceptor student’s ratio of 1: 25 maximum.

Professional Development

            The proposed education program on improving handoff report using SBAR to bridge communication gap will help to strengthen inter-professional communication skills in nursing. Having excellent communication skills related to nursing will make the audience improve their ways of ensuring patients’ safety. Nursing students will also be able to build teamwork once they can communicate effectively to ensure the patient’s safety and proper treatment. The audience will become proficient in analyzing patients and their conditions. The program equips the students with relevant knowledge required to explain the state of a patient. Also, the students will improve their handover skills by preparing a comprehensive report which enables proper transition between shifts.  The program aims at teaching nursing students the necessary information required in a handoff. By the end of the program, they will be able to better hand over patients to physicians or other nurses in ways that ensure proper continuity in treatment.

Proposed Solution

            The course involves a deeper understanding of the handoff report content. Students will be taught on the primary materials of the handoff that ensures a comprehensive report about the patients. The program will emphasize on the Situation, Background, Assessment, and Recommendation (SBAR) model of writing handoff report. Lecturers will use samples and simulations to show how different cases of patients require different contents in handoffs. Also, the program will teach the students on specific handoffs for specific people like one for exchanging shifts and one for an attending doctor in theaters or emergency rooms. The gap to address is communication. Making comprehensive handoffs means that there is sufficient information transfer from one nurse to the other. Good handoffs will ensure that enough information is transferred between medical staffs avoiding cases there is a lack of proper continuity in treatments

2 Intended Outcomes

The intended outcome of the project is a program that contains all the requirements of handoffs that will address the changing structures of healthcare centers. The curriculum will include information that nurses require to give in different situations and to different staffs. An order of giving patient’s analysis is essential in making an informative handoff, which the program will provide. Another outcome of the project is a detailed description of the structure of a handoff prepared through the EMR, SMS, and email. The curriculum will have information to teach students on ways to ensure that all contents of a handoff are included while using the electronic systems. There will be a lesson plan and a description of requirements for students who will enroll in the program to enable them to prepare adequately.

Evidence Summary

Delivery of information in health care centers is a system that involves several staffs with different training levels. Information transfer in those centers requires that those involved have proficiency and competence, which will enable them to give relevant correct and adequate information. Proper communication is fundamental for the safe care of patients. Handoffs provide the foundation for creating effective communication (Tobiano et al., 2018). Nurses can, therefore, improve their communication through improvement of handoff presentation. Proper structures of handoffs minimize medical errors that may occur because of failure to include all relevant information. A structured report provides an orderly and thorough reflection about a patient (Tobiano et al., 2018). Having a well-standardized handoff within medical staffs ensures that medics across the field understands the information. Proper Handoffs enhances inter-professional communication, collaboration, and teamwork, which are essential in ensuring effective delivery of patient’s information (Kitson et al., 2014). With a well comprehensive handoff, nurses can understand each other and therefore, develop a spirit of oneness that increases the level of communication.

Application of mnemonics in handoffs enhances consistency, comprehensiveness, and relevance in information transfer. According to Gore et al. (2015), mnemonics like the SBAR (Situation, Background, Assessment, and Recommendation) and I PASS (Introduction, Patient identification, Situation, and Safety) offers a framework which helps nurses to organize their information and therefore a proper shift change handoff communication. With such a mnemonics, it is easy for nurses to follow the information in order and understand what the other person is communicating without error. Also, the SBAR ensures that the handoffs have all the relevant information needed to have continuity on patient treatment.

Application of different tools in the handoffs brings about a unified form of presentation which although specialty on patient care may change, nurses will still be able to deliver the necessary information. A well-structured tool for preparing handoffs is essential to help nurses prepare before actual verbal and written report delivery (Cornell et al., 2014). They guide on what to observe in patients during the shift to avoid missing some elements when making the report at the end (Kitson et al., 2014). With the SBAR for example, the medic in charge will be looking for the background information while taking care of the patient through questions or going through the previous files. Nurses fail to include such kind of information at the end because of the speed to reduce the transition time.

SBAR also helps to avoid making too much irrelevant information in handoffs at the expense of the right content and making much information on one patient at the expense of others (Stewart, 2017). Nurses serve many patients at any given time, which means that they have information overload both the necessary and the unnecessary one. Transfer of such information on handoff requires a system that will help them sort the most critical content to save on time while making a comprehensive report (Tobiano et al., 2018). Mnemonics such as SBAR makes the medics to remain focused on the specific content which is required and therefore saves enough time to prepare other patient’s comprehensive reports.

Plan of Action

Approval of the proposal

After completion of the proposal, the instructor will be met to discuss the validity of the knowledge gap. The preceptor will guide more on whether and where to adjust the plan to ensure that the program will solve the problem in question and that the resources and time allocated are enough. The stage will give a go ahead with the next step of implementing the proposal.

Review of the knowledge gap

The objective of this stage is to investigate the extent of the knowledge gap identified. The student will go through healthcare reports, documentaries and periodicals to find the extent of the problem identified. Necessary changes will be made depending on the information obtained.

Literature review

The goal of the literature review is to come up with information that will inform the content of the program. The review will involve the study on the relationship between the identified problem and the suggested solution.  Under the stage, the student will review the proposed method of solving the problem and adjust it to suit the current strategies.

Corse Development

The course development stage involves the development of the content which will lead to the suggested outcomes. The first thing is to give the cause a name. Objectives will follow then outcomes and competencies. Topics to be studied and related content will also be identified in the stage. The audience characteristics and the goals will guide in determining the best teaching strategies. The step will also involve identification of instruction and learning materials.

Development of a lesson plan

The stage will involve the development of an actual plan, which will guide the instructor in class. The first thing will be to identify the time that the whole program will cover to be able to plan the topics for each lesson. The next will be to divide the various topics with the number of identified lessons. The plan will identify eight and ten concepts to cover in every topic and align them with the competencies. There will also be an identification of actual activities and course reading materials. The stage will also identify the assessment methods for each topic.

Timeline

Time	Activity
Week 1	Approval of the proposal from the preceptor ·         Going through the knowledge gap ·         Assessment of the suggested solution ·         Evaluation of the plan of action and schedule ·         Obtaining an approval letter
Week 2	Review of the knowledge gap ·         Review of healthcare reports, documentaries, periodicals
Week 3	Literature review ·         Going through journals related to the solution of the identified problem
Week 4	Corse Development ·         Identification of course name ·         Objectives ·         Course outcomes ·         Competencies
Week 5	Corse Development ·         Development of topic and related content ·         Teaching strategies ·         Instruction and learning materials
Week 6	Development of a lesson plan ·         Identification of duration of the program ·         Divide topics with an identified number of lessons ·         Concepts for each topic ·         Learning activities ·         Methods of assessment

 

Resources and Personnel

Personnel

The instructor will be needed to guide on every step of the project to help identify areas with deficiencies or steps made wrong. Other students in the same level will be required to help brainstorm on the knowledge gap and the solution in the review stage. The help of a librarian will also be needed to identify the books, journals, and periodicals that talk more about the answer to the knowledge gap.

Finances

A total of $ 700,000 will be needed to fund the various activities as follows. Access to books and periodicals on some websites and other physical libraries will need $ 150,000, and $ 200,000 for printing of materials to review in every stage. Subscription for the internet will require $50,000 and another $150,000 to cater for travel to the library, meet the instructor and other students who will be involved. Another $ 150,000 will be used to purchase a laptop for carrying out a literature search and developing the content.

Other resources include a laboratory for setting and identifying the necessary simulation for the instructions. A class or hall space will also be needed to carry out discussions and interview with other students in the process of getting their views on the problem and suggested solutions.

Proposed Change Theory

Lewin’s Change Theory

In theory, Lewis argues that behavior change will occur when people change the driving forces. The secrete of making change is identifying and understanding the forces to know why people behave the way they do and therefore be able to bring change (Mitchell, 2013). The position of Lewis informs the plan in identifying the factors, which are leading to a communication gap. The proposal contains the element, handoff report, which is forcing nurses towards poor communication. Lewin comes up with a three-step model that informs the process of bringing change. The first step is unfreezing where the organization is prepared and made to believe that the incoming change is essential (Mitchell, 2013). The stage informs the plan to have the first few topics to prepare and show students the importance of improving handoff reports through SBAR. Evidence will be provided to illustrate how a patient’s safety will grow with the changes.

The next stage involves exposure of the desired change convincingly to make people believe in it (Mitchell, 2013). Lewin in the step informs the plan to properly expose the change to learners with enough content, evidence, and practice to believe in it. Here the plan will have to include enough simulations and practicals that will make the students prove that the change is essential and therefore accept it. Lewin calls the last stage freezing where the organization is made to settle on the new balance brought by an amendment to sustain it (Mitchell, 2013). The phase informs the plan to suggest policies to nursing faculty, and health centers adopt SBAR in handoffs so that the training offered to students is sustained.

Barriers to Implementation

            Six weeks may not be enough to convert the proposal into a comprehensive plan. The course objectives and topics requite thorough research on literature to make sure that it will meet the course expectations. Online journals will be utilized compared to the physical library because they offer a summary to know whether they are informative therefore help to overcome the time barrier. There will also be discouragements form other instructors and students that the project is not useful. The project will be exposed only to those students whose contribution is needed to avoid constraints. Finances also may be limited because of too many travels and library subscriptions. The barrier will be solved by concentrating more on online materials, which limits movements and physical libraries’ subscription.

 

References

Gore, A., Leasure, A. R., Carithers, C., & Miller, B. (2015). Integrating hand-off communication into undergraduate nursing clinical courses. Journal of Nursing Education and Practice, 5(4), 70.

DOI: 10.5430/jnep.v5n4p70

Kitson, A. L., Muntlin Athlin, Å., Elliott, J., & Cant, M. L. (2014). What’s my line? A narrative review and synthesis of the literature on Registered Nurses’ communication behaviours between shifts. Journal of advanced nursing, 70(6), 1228-1242.

doi/abs/10.1111/jan.12321

Tobiano, G., Bucknall, T., Sladdin, I., Whitty, J. A., & Chaboyer, W. (2018). Patient participation in nursing bedside handover: A systematic mixed-methods review. International journal of nursing studies, 77, 243-258 doi.org/10.1016/j.ijnurstu.2017.10.014

Stewart, K. R. (2017). SBAR, Communication, and Patient Safety: An Integrated Literature Review. MEDSURG Nursing, 26(5), 297–305. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3daph%26AN%3d125833257%26site%3deds-live

Aragon Penoyer, D., Cortelyou-Ward, K. H., Noblin, A. M., Bullard, T., Talbert, S., Wilson, J., … Briscoe, J. G. (2014). Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System. Journal of Healthcare Management, 59(2), 130–144. https://doi.org/10.1097/00115514-201403000-00008

Cornell, P., Townsend Gervis, M., Yates, L., & Vardaman, J. M. (2014). Impact of SBAR on Nurse Shift Reports and Staff Rounding. MEDSURG Nursing, 23(5), 334–342. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3daph%26AN%3d98979524%26site%3deds-live

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32–37. https://doi.org/10.7748/nm2013.04.20.1.32.e1013

 

 
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