Effects of clinical handover empowerment program on clinical handover performance and self-efficacy in clinical handover among nursing students in Hong Kong

Abstract

Clinical handover is a crucial routine for the intra- and interprofessional transfer of a range of patient information, and effective handover has been identified as a key factor in maintaining patient safety and continuity of care. The majority of nursing students had not received formal clinical handover education and they learned this essential skill through observation in the clinical settings passively, although a negative relationship between miscommunication and poor patient outcomes has been demonstrated by the body of evidence. There are no generally acknowledged educational frameworks or strategies, indeed, for teaching clinical handover practice to nursing students. In view of little attention has been paid to the educational needs in clinical handover of our future nursing workforce, a sequential explanatory mixed-methods study, including a non-equivalent, waitlist control group, pretest-posttest, quasi-experimental study, and a descriptive qualitative study, was conducted, with the overall aim of examining the effect of the newly developed theory-driven clinical handover empowerment program (CHEP) in enhancing clinical handover performance and self-efficacy in clinical handover among nursing students in Hong Kong. The quasi-experimental study determined the effects of the CHEP on nursing students, while the descriptive qualitative study collected comprehensive descriptions regarding the learning experiences and perceived effects of the CHEP among the students. For the quasi-experimental study, a sample of nursing students (n =139) who are studying Higher Diploma in Nursing Program were recruited from three local nursing schools (School of General Nursing) operated under the Hospital Authority in Hong Kong. The nursing students (n = 71) from the School of General Nursing, Queen Elizabeth Hospital, were assigned to the intervention group, while the nursing students (n = 68) from the School of General Nursing at Caritas Medical Centre and the School of General Nursing at Tuen Mun Hospital, were assigned to the control group. The intervention group attended the CHEP, which consisted of six two-hour modules, over the course of six weeks. The teaching and learning activities of the program included a theoretical lecture, demonstrations, role-plays, simulations, and a simulation scenario writing exercise. The control group received a tailored fact sheet about clinical handover. Clinical handover performance and self-efficacy in clinical handover of the study groups were measured at baseline and one week after the CHEP, while the intervention group participants’ satisfaction with the learning experience and their perceived importance of the experience were collected one week after the CHEP. As for the descriptive qualitative study, a purposive sample of intervention group participants (n = 30) was recruited for focus group interviews. By using the generalized estimating equation model, the intervention group demonstrated significantly greater improvements in overall clinical handover performance (p < 0.001) and self-efficacy in clinical handover (p < 0.001) than the control group with Cohen’s d of 1.80 and 1.88, respectively, indicating large effect sizes. Moreover, the intervention group participants were satisfied with their learning experience with a total mean satisfaction score of 90.81 (SD = 9.00) out of 110, and they pursued a well-rounded learning experience with the total mean score of perceived importance of the learning experience being 93.67 (SD = 8.38) out of 110. The limited difference in the rating for satisfaction and perceived importance for the learning experience revealed that the CHEP was able to fulfill the expectations of the participants for their clinical handover learning experience. In the qualitative interviews, most of the nursing students expressed their satisfaction towards the learning experience of CHEP. Five main themes: a) perceived barriers to learning in clinical handover, b) perceived effects of the CHEP, c) clinical nursing acceptance of Identification, Situation, Background, Assessment, and Recommendation (ISBAR) shapes learning success, d) perceived strengths of the CHEP, and e) perceived weaknesses of the CHEP were coded for interpreting the quantitative findings in order to gain a comprehensive understanding of the effects of the CHEP from different perspectives. The obtained qualitative findings were in line with the quantitative findings, and this method triangulation enhanced the validity and reliability of the research findings. The main findings of the significant differences in clinical handover performance and self-efficacy in clinical handover between nursing students who received the CHEP and the tailored fact sheet were discussed in relationship to previous research evidence. Additionally, the implications of the findings highlight the mutual relationship between clinical handover performance and self-efficacy in clinical handover with theoretical and conceptual supports. Indeed, a number of threats to this mutual relationship were recognized from the qualitative findings, and therefore corresponding recommendations for tackling the identified threats were discussed in order to maintain the beauty of this relationship. Finally, recommendations for further research were discussed with the aim of advancing the knowledge about the effects of the CHEP and strengthening the internal and external validity of the current study findings. Remark: Personal particulars in appendixes are fictitious