How a nurse communicates during bedside handover can be linked to their role in the handover, a new study has revealed.

Communication challenges between nurses and patients during bedside handovers threaten both quality of care and hinder patient involvement. A new study, Tracing interpersonal discursive features in Australian nursing bedside handovers, describes which particular communication behaviours facilitate or hinder patient participation in bedside handover.

Senior Research Fellow Dr Maria Dahm at the Australian National University’s Institute for Communication in Health Care led linguistic analysis of four case studies of naturally occurring bedside handovers recorded at two metropolitan Australian hospitals.

The study showed that outgoing and incoming nurses communicate differently in bedside handovers.

Outgoing nurses showed more negative, disempowering language features which work to discourage patient involvement in handover.

For example, outgoing nurses often did not greet patients, used impersonal pronouns (she) or belittling terms of endearment (lady). They used judgmental labels when talking about patients (she refused shower and wash) and left jargon unexplained. Outgoing nurses also physically excluded patients from the handover by turning their back on them and ignored or interrupted patients and carers when they tried to contribute to handover.

Taken together, such talk can create an unfriendly atmosphere in which the nurse-patient relationship suffers. Patients can feel disempowered and unable to participate in handover.

In contrast, incoming nurses showed more positive, empowering language features that invite patient participation in handover.

For example, incoming nurses introduced themselves and greeted patients by their preferred names. They joked with patients to build social connections. Incoming nurses also actively invited patients’ views and engaged with what patients and carers had to say or wanted to know.

This way of talking can create a positive and friendly atmosphere, fostering the nurse-patient relationship and encouraging patients to participate in handover.

It might seem puzzling at first that how nurses communicate in bedside handover could change so drastically as they move from incoming to outgoing roles over the course of their shift.

Dr Dahm explained this change in terms of the different personal and systemic barriers outgoing and incoming nurses likely face at the shift change when they conduct bedside handover.

“At the end of a long shift, outgoing nurses may be facing personal and systemic barriers while they conduct handovers,’ Dr Dahm said. “On a personal level, they want to end their 8-, 10- or 12-hour shift on time. On a systems level they may feel the need to handover all patients in the time officially allotted for this task. As a result, and maybe not unsurprisingly, they tend to be more oriented towards completing their clinical task rather than encouraging patient participation.”

“On the other hand, incoming nurses are just starting their shift. They are usually under less time pressure and might be more oriented toward building rapport with their patients to facilitate patient-centred care during their upcoming shift,” said Dr Dahm.

Dr Dahm also noted the transient nature of nurse roles in handover and the interplay of nurse communication behaviours.

“Often, the positive language behaviours we have seen from the incoming nurses actually help to counteract some of the more negative behaviours seen among the outgoing nurses, even though nurses take on both these roles and behaviours during their shift. Our findings indicate that it can be hard to strike a balance between systemic and personal pressures and what’s good for the patient. Nurses need to be aware that how they communicate has an impact on whether patients participate in bedside handover.”

Findings can inform reflective practice and communication skills training among practising and trainee nurses.

Read the full study here.