A qualitative study of shift handover practice and function from a socio-technical perspective

Background. Shift handover plays a pivotal role in the continuity of patient care in 24-hour nursing contexts. The critical nature of this communication system is recognized within the literature and by the nursing profession; however, there are few in-depth studies. The rationale for this study is to gain a better understanding of handover practices and functions and their implications for effectiveness. Method. Handover systems on two very different paediatric wards were selected as case studies. In each case, 20 handovers were observed and audio-taped and 12 individual and two-group interviews with nursing staff about handover were also conducted. Analysis involved categorizing the data and characterizing handover practices and functions using an inductive approach to generate qualitative themes. The ethics committees of the hospital and the university approved the research. All involved were fully informed about the study, with confidentiality maintained throughout. Results. Handover practices are distributed over time, socially among the staff and technologically through a range of artifacts, while the system also accomplishes informational, social and educational functions. Handover effectiveness is characterized by flexibility in managing competing demands and tensions, such as maintaining confidentiality while practising family centred care. There are limitations in how far the findings can be generalized to other nursing contexts, and the possible effects of the researcher's presence are also recognized. Conclusions. Handover is a complex system based on several sound socio-technical principles and the value of this nurse-to-nurse communication should be acknowledged. The multiple functions highlight the knowledge and expertise currently hidden within handover, which could be promoted in terms of nursing professionalism.