Perceptions of Patients and Nurses about Bedside Nursing Handover: A Qualitative Systematic Review and Meta-Synthesis

Table 1

Characteristics of the studies included in the meta-synthesis.

Author (year)	Country	Phenomena of interest	Participants characteristics (n)	Data collection/data analysis	Main findings/themes
Johnson and Cowin (2013) [15]	Australia (Sydney)	To explore how nurses experienced the introduction of bedside handover and the use of written handover sheets	(i) Registered nurses and enrolled nurses (similar to licensed practical nurses)	Focus groups/thematic analysis	“(1) Bedside handover strengths and weaknesses (most participants believed that confidentiality issues arising from handovers were minimal and easily managed within their current handover practice although permission is sometimes sought from patients and significant others); (2) patient involvement in handover; (3) good communication is about good communicators; and (4) three sources of patient information (handover, handover sheets, and nursing notes” [15]
			(ii) Sample from medical and surgical wards at three major metropolitan hospitals
			(iii) Sample size: n = 30
			(iv) Age: 21 yrs—50 yrs
			(v) Gender: male (5) and female (25)
Kerr et al. (2013) [34]	Australia	To explore the perspectives of patients about bedside handover by nurses in the emergency department	(i) Patients from the emergency department (ED)	Semistructured interviews/thematic content analysis	“(1) Patients perceive that participating in bedside handover enhances individual care and (2) maintaining privacy and confidentiality during bedside handover is important for patients (preference was expressed for handover to be conducted in the ED cubicle area to protect the privacy of patient information)” [34]
			(ii) Sample size: n = 30
			(iii) Age: ≥18 yrs
			(iv) Gender: male (12) and female (18)
Kerr et al. (2014) [33]	Australia	To explore the perspectives of nurses and midwives towards the introduction of bedside handover	(i) Nurses (registered nurse and enrolled nurse) and midwives	Semistructured interviews/content analysis	“(1) Enhanced individual patient care and documentation, along with improved patient-clinician partnerships and (2) protection of confidentiality and privacy (private and/or sensitive information can be communicated by whispering, pointing at the information in the patient’s chart, or after asking visitors to leave the room)” [33]
			(ii) Nurses sample from medical and surgical wards
			(iii) Sample size: registered nurse n = 17,; enrolled nurse n = 3, and; midwives N = 10
			(iv) Gender: male (5) and female (25)
Jeffs et al. (2014) [32]	Canada (Toronto)	To explore patients’ experiences and perceptions associated with the implementation of bedside nursing handover	(i) Patients from one acute care hospital	Semistructured interviews/a directed content analysis	“(1) Creating a space for personal connection (patients described bedside nursing handover as an engaging, personal, and informative approach to shift handover); (2) bumping up to speed (patients described feeling less anxious about their care, having a sense of security, and experiencing greater satisfaction as a result of their participation in the bedside nursing handover); and (3) varying preferences (patients emphasized the importance of considering their clinical status as well as the preferences of each individual patient before performing bedside nursing handover)” [32]
			(ii) Sample size: n = 45
			(iii) Age: ≥18 yrs
			(iv) Gender: male (15) and female (30)
Grimshaw et al. (2016) [13]	USA	To identify factors and acute care nurses’ perceptions influencing the frequency of change-of-shift reports at the bedside	(i) Nurses from medical unit, surgical unit, and intensive care unit (ICU)	Semistructured interviews/thematic analysis	“Five themes were identified from the collected data, which included the time factor, continuity of care, visualization, and challenges in the communication of discreet information” [13]
			(ii) Sample size: n = 7
			(iii) Age: 19 yrs–59 yrs
			(iv) Gender: male (1) and female (6)
Lupieri et al. (2016) [17]	Italy	To explore the postoperative cardiothoracic surgical patient experience of nurses’ bedside handovers	(i) Patients from a cardiothoracic ICU	Semistructured interviews/Content analysis	“(1) Discovering a new nursing identity (patients getting to know the competence involved in the nursing profession leading to improved patients’ satisfaction); (2) being apparently engaged in a bedside handover (limited patients’ participation, patients prefer to be more involved); (3) experiencing the paradox of confidentiality (lack of privacy is problem but did not represent a concern for patients and patients do not care if another patient know about their medical problems); and (4) having the situation under control (nurses were able to verify the information immediately and feeling sense of safety)” [17]
			(ii) Sample size: n = 14
			(iii) Age: ≥18 yrs
			(iv) Gender: male (10) and female (4)
Khuan and Juni (2017) [35]	Malaysia	To explore Malaysian nurses’ opinions about patient involvement in relation to patient-centered care during bedside handovers	(i) Registered nurses from medical, surgical, and orthopedic wards	Focus groups/content analysis	“(1) Superficial involvement related to a knowledge deficit, inexperience, and a task-oriented mindset; (2) patient-centered care (PCC) as interactive and respectful of patients’ wishes and/or decisions; (3) impracticality of patient involvement in relation to time constraints, length of interaction, and hierarchy of nurse-patient communication; and (4) patient involvement as not representative of PCC due to violations of patient autonomy” [35]
			(ii) Sample size: n = 20
			(iii) Age: 26 yrs–40 yrs
			(iv) Gender: male (6) and female (14)
Roslan and Lim (2017) [18]	Singapore	To explore nurses’ perceptions of bedside clinical handover in an acute-care inpatient unit in Singapore	(i) Registered nurses, enrolled nurses, and nurse clinicians from an acute-care hospital	Focus groups/Semistructured interviews/thematic analysis	“(1) Bedside clinical handover could compromise patient’s confidentiality (potential confidentiality breach, demands for secrecy, and risk of information misinterpretation) and (2) disturbances during the handover (patient and/or their family members and environment are sources of constant interruptions and distractions)” [18]
			(ii) Sample size: n = 20
			(iii) Gender: male (1) and female (19)
Tobiano et al. (2017) [19]	Australia	To explore and understand barriers nurses perceive in undertaking bedside handover	(i) Registered nurses, enrolled nurses from medical wards	Open-ended question/content analysis	“(1) Censoring the message showed that nurses were concerned about patients and third parties hearing sensitive information; (2) disrupting the communication flow, nurses perceived patients, family members, other nurses, and external sources interrupted the flow of handover and increased its duration; and (3) inhibiting characteristics demonstrated that individual patient and nurse views or capabilities hindered bedside handover” [19]
			(ii) Sample size: n = 176
			(iii) Gender: male (18) and female (158)
Dellafiore et al. (2019) [11]	Italy	To explore the perceptions of nurses regarding a recent implementation of bedside nursing handover	(i) Nurses from cardiac surgery	Focus groups/thematic analysis	“The main themes that were identified revolved around improving nursing care, greater professionalism, effective relationships, consequences for the patient, and obstacles to change. Moreover, we found that nurses perceive bedside nursing handover to be effective in promoting patient-centered care. The nurses in our study also felt that any difficulties with the implementation of a bedside nursing handover protocol (e.g., confidentiality) should be addressed through continued nursing education” [11]
			(ii) Sample size: n = 16
			(iii) Age: 26 yrs–48 yrs
Hada et al. (2019) [21]	Australia (Brisbane)	To systematically assess the barriers and facilitators to evidence-based nursing handover in a clinical environment, and to identify potential adopters and attributes of evidence-based nursing handover for translation into practice	(i) Registered nurses, enrolled nurses from medical wards	Focus groups/content analysis	“(1) Content (information transferred); (2) process (steps used to transfer accountability and responsibility for care); and (3) environment (factors impacting safe handover). Participants identified barriers to effective nursing handover including variability of the handover content and process, uncertainty around sharing sensitive information, inconsistency around clarifying gaps through questioning during the handover, superficial patient involvement, time constraints, and environmental challenges. The key facilitators discussed during the focus groups were the use of integrated electronic medical records, support and clear expectations from the nursing leadership, and targeted handover education” [21]
			(ii) Sample size: n = 49
			(iii) Gender: male (8) and female (41)
Jimmerson et al. (2021) [14]	USA	Experiences and opinions regarding bedside shift report	(i) Clinical nurses and their nursing supervisors from acute adult care inpatient units	An in-depth face-to-face interview	“(1) Time constraints nurse’s workflow (more time is spent making the discussion professional because the patient is hearing, patients’ interruptions are time-consuming, and can increase the risk of missing important information); (2) modified approach needed (against full bedside handoff, rehearsal outside patient’s room can help, and patient presence restricts the type of information shared); (3) individualization of process and content to be meaningful (does not fit all size, problem lists and management should be the focus, and waking patient up for the handover is not good); (4) specific critical content that should be discussed inside the patient’s room (plan of care/goals for day and medication infusion); and (5) specific critical content that should be discussed outside the patient’s room (history and review of systems)” [14]
			(ii) Sample size: clinical nurses (n = 22) and nursing supervisors (n = 12)
			(iii) Age: ≥18 yrs