Essay Grade

Running head: LITERATURE REVIEW
1
Literature Review on DNP Project
Julie Ann Childers
Grand Canyon University: DNP 820
June 8, 2019
LITERATURE REVIEW
2
Empirical Literature Review
Introduction
An effective treatment process includes care for the patient in the post-treatment period to
prevent occurrences of new infections or the reestablishment of the original ones. Nurses in the
healthcare system are primary caregivers in health facilities and are consequently responsible for
the care of patients as soon as they are treated or operated on by the doctors or surgeons in whose
hands the patient has been entrusted. During the transition from diagnosis or operation into the
intensive care, there are certain factors, both internal and external, that are involved in
determining the kind of care a patient receives. The review herein entails an analysis of patient
care in five different aspects, including quality and safety in the healthcare system, patient care
safety and quality as well as interruptions and distractions that characterize the healthcare
process. Other elements of consideration by the review regarding patient care include the
handover process in the intensive care unit as well as the coordination and Integration of the
various components of patient care. In each of these aspects, the constituent subthemes also
feature in the discussion as it tries to shed more light on patient care.
Quality and Safety in the Healthcare System
Quality and safety in healthcare systems have been a priority of most institutions,
facilities, and governments, extending even to the global scope where WHO has listed it as one
of its primary objectives. However, achieving the optimal healthcare safety and quality in most
care circles is a complex and gradual process that requires the incorporation of certain concepts
including safety and quality models, corporate governance in hospitals and an understanding of
healthcare sociology in the targeted jurisdictions. Evidence from the synthesized articles proves
that quality and safety in the healthcare system is subject to the strong consideration and
LITERATURE REVIEW
3
realization of the recommendations of the three concepts in tandem with a variation of other
ideas and components of the system.
According to Wiig, et al., 2014, successfully improving the healthcare system is subject
to the cooperation between the various stakeholders involved therein including professionals,
managers, and consumers of the services associated with healthcare. Interestingly, a
collaboration of the entities mentioned herein requires a structured process which is guided to
avoid confusion, allocate roles, and provide a means of evaluating the progress achieved by each
stakeholder in their mandated capacities. Some of the most popular models for improving
healthcare quality that’s been adopted by numerous facilities include Business Process
Reengineering, Lean Thinking and Six Sigma Models which have previously worked in other
sectors of the service industry. The theories of interest in the medical field regarding increasing
healthcare quality and safety are generalized as safety theories and emerge in response for the
need to adopt a system perspective to address the diverse challenges that hinder effective service
delivery in the industry.
The concept of hospital executive boards according to Freeman et al., 2016 though
misunderstood by a significant section of the general populace, is quite influential in
implementing recommendations vital to the improvement of safety and quality levels associated
with healthcare facilities worldwide. The basis of the argument presented by Freeman et al.,
2016 originates from a study conducted in England’s medical boards. In improving the quality
and safety of healthcare within the facilities under their management, executive boards give
thought to the technologies, practices, experiences and the organization quality that’s more
consistent with to spurring growth and capacity in the medical sector (Allen et al., 2016). As a
research whose scope stretches across three continents, community, maternity, mental and
LITERATURE REVIEW
4
hospital healthcare as well as various healthcare professionals, sociology and healthcare safety
explores the multiple aspects of organizational processes that could improve safety in the sector
and provides answers to the dilemma of integrating the numerous understandings of healthcare
safety as one concept.
Safety and Quality of Patient Care
The protection of patients and the quality of care that they are accorded is the
responsibility of the hospital in which they treated, at least according to information based on
various empirical research studies undertaken in that context. Three different articles are
addressing various concepts of patient care in hospitals document studies containing undeniable
evidence that the quality of patient care in a facility depends on its personnel and their levels of
qualification. In the course of the research, one of the most featured questions therein dwelt on
the role of healthcare managers in learning from national safety alerts (Pfeiffer, & Schwappach,
2016).
Research questions
As a responsibility of the facility in which a patient is treated, the safety and quality of
care to which a patient is subjected are set to vary from one facility to the other, and that begs the
question; what factors determine the difference in the level of care offered by hospitals. Also,
one can only wonder what roles the national and federal policies play in uplifting or lowering the
level of patient care in hospitals. In addition to that, a researcher must find out if the condition of
a patient is a determinant in enjoying the level of care and safety that a hospital facility channels
in this or her way.
Sample Populations covered in the research
LITERATURE REVIEW
5
For the research on the quality of patient care, the three research papers reviewed in their
empirical capacity sought to analyze data from various sets of populations and stakeholders
within the health sector. For Roney et al., 2016, the research revolved around clinical faculty
covering 24 patient occurrences. Patients occurrences detailed in the study define incidents, near
miss events and unsafe conditions. Kagan and company’s research, on the other hand, documents
information obtained from 390 medical professionals including physicians and nurses as well as
726 in patients admitted in a hospital ward for not less than three days. Administration of
questionnaires represented the most popular method of collecting data in the case of the second
research article. Finally, the last article contains documentation of data collected from Swiss
healthcare quality risk and quality managers (Roney et al., 2017).
Limitations of the research papers
In the development and documentation of their study, the researchers excluded detail
from their work resulting in a mini-detailed presentation whose figures are subject to minimal
research and analysis. Even though the sample population covered by the study is indicated at the
beginning of the research papers, there is no communication on the results, at least numerically
as the results are descriptive observations of the events associated with the research. The
presentation of the data therein is also dull and monotonous with little pictorial representation of
the information contained therein. Consequently, the audience targeted by the research finds it
annoying as insufficiently informative despite the flashes of brilliance it exhibits.
Summary and conclusion
Acute care settings in the United States are some of the most highly developed centers
following the initial goal of turning them into High-Reliability Organizations. A combination of
cognitive awareness, best practices, and infrastructure as well as pushing for the accountability
LITERATURE REVIEW
6
of all the professionals herein is immensely significant in turning around these centers into
models of quality and safe patient care. Also, general hospitals with a previous record of
excellent safety and quality culture regarding their patients are responsible or higher instances of
patient satisfaction which increases their recovery levels and rates in response to their mental
stability and mental perceptions of safety. Finally, another research paper documented with data
predominantly from Switzerland maintains that national alert systems on patient safety have a
role to play when it comes to patient care. However, the efficacy of these alerts is highly
dependent on the hospital’s managerial infrastructure, which is responsible for transforming the
information from the signals into actions (Kagan, 2018).
Interruptions and Distractions in the Healthcare Process
Sassaki and Perroca, 2017 share their opinion on the breaks and distractions experienced
on the nurses’ workflow and the perceptions of the nurses on those interruptions. Consequently,
their report documents investigation into the phenomenon as they seek an answer to the question
of whether distractions at work interfere with the jobs of a medical professional and the exact
way in which the professionals are affected in their care for patients subject to factors associated
with a disrupted workflow. Other scholars too have compiled data in their research documents
including Taylor and Francis, 2015 who delve on whether distractions in gynecological
operations irritations are or dangerous to the patients (Sassaki, & Perroca, 2017).
Research questions
Regarding coordination between participants involved in patient care, various studies
focus on the aspect of communication of the experts involved, barriers to their conversation and
the fulfillment of a patient’s needs (Yoong, 2015). Some of the pertinent questions that arise with
regards to coordination and Integration of patient care include; how many levels of
LITERATURE REVIEW
7
communication are present in the care process; what are the most common barriers to patientspecialist and specialist-PCP communication and what are the possible solutions to breaking
down barriers in communication during patient care?
Sample populations
The empirical research papers reviewed in the development of this compilation used
different population samples of people to formulate inferences and observations, which led to the
various hypotheses that define the individual research papers. Their research involves specialists
including neurologists, interns, and nurses, where a fraction of the total professionals is
mandated to provide primary care for inpatients and the rest for the primary responsibility of
outpatients. As for the other research papers, one has its data obtained from children hospitals
with its scope limited to the study of discharge communication at a children’s hospital while the
remaining research focused of diabetes patients with military history as well as VHA PCPs and
VHA endocrinologists
Limitations of the paper
The research papers are informative and as specific as can be with research papers due to
its practical nature. However, they are too specific, and the information therein is tied to one
aspect of the study as are their sample populations. One, for instance, obtains data by researching
diabetic people of veterans with their endocrinologists, yet it is supposed to include inferences on
specialist perspectives. One can only wonder the observations made by only one section of
specialists is adequate to speak for all specialized doctors. The same trend is repeated in the
research aimed at improving patient-PCP communication, which focuses on child populations
and the relationships with primary care physicians (Drews et al., 2019).
Summary and conclusion
LITERATURE REVIEW
8
Acute care settings in the United States are some of the most highly developed centers
following the initial goal of turning them into High-Reliability Organizations. A combination of
cognitive awareness, best practices, and infrastructure as well as pushing for the accountability
of all the professionals herein is immensely significant in turning around these centers into
models of quality and safe patient care. Also, general hospitals with a previous record of
excellent safety and quality culture regarding their patients are responsible or higher instances of
patient satisfaction which increases their recovery levels and rates in response to their mental
stability and mental perceptions of safety. Finally, another research paper documented with data
predominantly from Switzerland maintains that national alert systems on patient safety have a
role to play when it comes to patient care. However, the efficacy of these alerts is highly
dependent on the hospital’s managerial infrastructure, which is responsible for transforming the
information from the warnings into actions.
Handover in Intensive Care
As a responsibility of the facility in which a patient is treated, the safety and quality of
care to which a patient is subjected are set to vary from one facility to the other, and that begs the
question; what factors determine the difference in the level of care offered by hospitals. Also,
one can only wonder what roles the national and federal policies play in uplifting or lowering the
level of patient care in hospitals. In addition to that, a researcher must find out if the condition of
a patient is a determinant in enjoying the level of care and safety that a hospital facility channels
in this or her way (Salzwedel et al., 2016).
As a responsibility of the facility in which a patient is treated, the safety and quality of
care to which a patient is subjected are set to vary from one facility to the other, and that begs the
question; what factors determine the difference in the level of care offered by hospitals. Also,
LITERATURE REVIEW
9
one can only wonder what roles the national and federal policies play in uplifting or lowering the
level of patient care in hospitals. In addition to that, a researcher must find out if the condition of
a patient is a determinant in enjoying the level of care and safety that a hospital facility channels
in this or her way.
Sample Populations covered in the research
For the research on the quality of patient care, the three research papers reviewed in their
empirical capacity sought to analyze data from various sets of populations and stakeholders
within the health sector. Patients occurrences detailed in the study define incidents, near miss
events and unsafe conditions. Kagan and company’s research, on the other hand, documents
information obtained from 390 medical professionals including physicians and nurses as well as
726 in patients admitted in a hospital ward for not less than three days. Administration of
questionnaires represented the most popular method of collecting data in the case of the second
research article. Finally, the last article contains documentation of data collected from Swiss
healthcare quality risk and quality managers (Ganz et al., 2015).
Limitations of the research papers
In the development and documentation of their study, the researchers excluded detail
from their work resulting in a mini-detailed presentation whose figures are subject to minimal
research and analysis. Even though the sample population covered by the study is indicated at the
beginning of the research papers, there is no communication on the results, at least numerically
as the results are descriptive observations of the events associated with the research. The
presentation of the data therein is also dull and monotonous with little pictorial representation of
the information contained therein. Consequently, the audience targeted by the research finds it
annoying as insufficiently informative despite the flashes of brilliance it exhibits.
LITERATURE REVIEW
10
Summary and Conclusion
The transition from specialized care to primary care is subject to numerous instructions,
including medication and treatment plans, discharge documentation, as well as the multiple
modes of communication available between the various care teams. Miscommunication
concerning any one of the three sets of instructions is cause for adverse repercussions and could
delay the recovery process or trigger an unrelated complication. In addition to instruction
adherence, understanding o stakeholder perspective plays a vital role in the patient recovery
process. For instance, clarity and agreement of the roles and responsibilities of an
endocrinologist in treating a veteran diabetic reinforces their qualifications at the back of the
patient’s mind resulting in respect and obedience from the patient, two values necessary for the
purposes of enhancing a patient’s discipline (Spooner, et al., 2015).
Care coordination and Integration
Patient care is a process that begins with preventive measures taken for individuals at risk
of disease contraction or condition development and ends with healing after treatment, operation
(where applicable) and completion of the convalescence stage. Therefore, various individuals are
involved in the care process which also requires the attention of different classes of medical
professionals including medical doctors, surgeons, nurses, nutritionists, and even psychologists
and physiotherapists if the need arises. Communication between the levels of care for a patient is
varied according to the research documents reviewed in this review. Also, the research evaluates
the importance of communication with primary care physicians and tests out the means involved
in improving communication with PCPs. Finally, (Vimalananda, et al., 2018) looks at specialty
patient care in an integrated healthcare system and the role of patient, PCP and specialist’s
perspective in patient care (Rattray et al., 2017).
LITERATURE REVIEW
11
Research questions
Regarding coordination between participants involved in patient care, various studies
focus on the aspect of communication of the experts involved, barriers to their communication,
and the fulfillment of a patient’s needs. Some of the pertinent questions that arise with regards to
coordination and Integration of patient care include; how many levels of communication are
present in the care process; what are the most common barriers to patient-specialist and
specialist-PCP communication and what are the possible solutions to breaking down barriers in
communication during patient care?
Sample populations
The empirical research papers reviewed in the development of this compilation used
different population samples of people to formulate inferences and observations, which led to the
various hypotheses that define the individual research papers. For instance, Rattray’s Crossing
the Communication Chasm: Challenges and Opportunities in Transitions of Care from the
Hospital to the Primary Care Clinic limits its scope to stroke patients. Their research involves 21
specialists, including neurologists, interns, and nurses, where nine professionals are mandated to
provide primary care for inpatients and 12 for the primary responsibility of outpatients. As for
the other research papers, one has its data obtained from children hospitals with its scope limited
to the study of discharge communication at a children’s hospital while the remaining research
focused of diabetes patients with military history as well as VHA PCPs and VHA
endocrinologists (Destino et al., 2017.).
Limitations
The research papers are informative and as specific as can be with research papers due to
its practical nature. However, they are too specific, and the information therein is tied to one
LITERATURE REVIEW
12
aspect of the study as are their sample populations. One, for instance, obtains data by researching
diabetic people of veterans with their endocrinologists, yet it is supposed to include inferences on
specialist perspectives. One can only wonder the observations made by only one section of
specialists is adequate to speak for all specialized doctors. The same trend is repeated in the
research aimed at improving patient-PCP communication, which focuses on child populations
and the relationships with primary care physicians (Mohr et al., 2019.).
Summary and conclusion
The transition from specialized care to primary care is subject to numerous instructions,
including medication and treatment plans, discharge documentation, as well as the multiple
modes of communication available between the various care teams. Miscommunication
concerning any one of the three sets of instructions is cause for adverse repercussions and could
delay the recovery process or trigger an unrelated complication. In addition to instruction
adherence, understanding o stakeholder perspective plays a vital role in the patient recovery
process. For instance, clarity and agreement of the roles and responsibilities of an
endocrinologist in treating a veteran diabetic reinforce their qualifications at the back of the
patient’s mind resulting in respect and obedience from the patient, two values important for
enhancing a patient’s discipline.
LITERATURE REVIEW
13
References
Allen, D., Braithwaite, J., Sandall, J., & Waring, J. (2016). Towards a sociology of healthcare
safety and quality. Sociology of Health & Illness, 38(2), 181-197.
Destino, L. A., Dixit, A., Pantaleoni, J. L., Wood, M. S., Pageler, N. M., Kim, J., & Platchek, T.
S. (2017). Improving communication with primary care physicians at the time of hospital
discharge. The Joint Commission Journal on Quality and Patient Safety, 43(2), 80-88.
Drews, F. A., Markewitz, B. A., Stoddard, G. J., & Samore, M. H. (2019). Interruptions and
Delivery of Care in the Intensive Care Unit. Human factors, 61(4), 564-576.
Freeman, T., Millar, R., Mannion, R., & Davies, H. (2016). Enacting corporate governance of
healthcare safety and quality: a dramaturgy of hospital boards in England. Sociology of
health & illness, 38(2), 233-251.
Ganz, F. D., Endacott, R., Chaboyer, W., Benbinishty, J., Nun, M. B., Ryan, H., … & Spooner,
A. (2015). The quality of intensive care unit nurse handover related to end of life: a
descriptive comparative international study. International journal of nursing
studies, 52(1), 49-56.
Kagan, I., Porat, N., & Barnoy, S. (2018). The quality and safety culture in general hospitals:
patients’, physicians’ and nurses’ evaluation of its effect on patient
satisfaction. International Journal for Quality in Health Care.
Mohr, D. C., Benzer, J. K., Vimalananda, V. G., Singer, S. J., Meterko, M., McIntosh, N., … &
Charns, M. P. (2019). Organizational coordination and patient experiences of specialty
care integration. Journal of general internal medicine, 1-7.
LITERATURE REVIEW
14
Pfeiffer, Y., & Schwappach, D. (2016). Taking up national safety alerts to improve patient safety
in hospitals: The perspective of healthcare quality and risk managers. Zeitschrift für
Evidenz, Fortbildung und Qualität im Gesundheitswesen, 110, 26-35.
Rattray, N. A., Sico, J. J., Cox, L. M., Russ, A. L., Matthias, M. S., & Frankel, R. M. (2017).
Crossing the communication chasm: Challenges and opportunities in transitions of care
from the hospital to the primary care clinic. The Joint Commission Journal on Quality
and Patient Safety, 43(3), 127-137.
Roney, L., Sumpio, C., Beauvais, A. M., & O’Shea, E. R. (2017). Describing clinical faculty
experiences with patient safety and quality care in acute care settings: A mixed methods
study. Nurse education today, 49, 45-50.
Salzwedel, C., Mai, V., Punke, M. A., Kluge, S., & Reuter, D. A. (2016). The effect of a
checklist on the quality of patient handover from the operating room to the intensive care
unit: a randomized controlled trial. Journal of critical care, 32, 170-174.
Sassaki, R. L., & Perroca, M. G. (2017). Interruptions and their effects on the dynamics of the
nursing work. Revista gaucha de enfermagem, 38(2).
Spooner, A. J., Corley, A., Chaboyer, W., Hammond, N. E., & Fraser, J. F. (2015). Measurement
of the frequency and source of interruptions occurring during bedside nursing handover
in the intensive care unit: an observational study. Australian critical care, 28(1), 19-23.
Wiig, S., Robert, G., Anderson, J. E., Pietikainen, E., Reiman, T., Macchi, L., & Aase, K. (2014).
Applying different quality and safety models in healthcare improvement work: boundary
objects and system thinking. Reliability Engineering & System Safety, 125, 134-144.
LITERATURE REVIEW
Yoong, W., Khin, A., Ramlal, N., Loabile, B., & Forman, S. (2015). Interruptions and
distractions in the gynecological operating theatre: irritating or
dangerous? Ergonomics, 58(8), 1314-1319.
15
Research Article Chart
Article 2:
Article 1:
Criteria and
Defining
Characteristics
Abstract
After reading the
abstract what do you
expect to learn from
the article?
Interruptions
and their
effects on the
dynamics of
the nursing
work
Nurses’ perception about
interruptions during the
workflow and their
implications on the
professional practice
environment.
Article 3:
Organizational
coordination
and patient
experiences of
specialty care
integration
The quality of intensive care unit
nurse handover related to end of
life: a descriptive comparative
international study
Successful coordination of
specialty care requires
understanding the perspectives
of patients, primary care
providers, and specialists—that
is, the specialty care “triad.”
This study used qualitative
methods to compare these
perspectives in an integrated
health care system, using
diabetes specialty care as an
exemplar.
Quality ICU end-of-life-care has been found to be
related to good communication. Handover is one
form of communication that can be problematic due
to lost or omitted information. A first step in
improving care is to measure and describe it.
© 2014. Grand Canyon University. All Rights Reserved.
Introduction:
Summarize the
following in
paragraph form.
• What is the
purpose of the
study?
•
What is the
scope of the
study?
Establish how interrupting
nurses in the workplace affect
their service delivery.
Comparing perspectives of the
“triad” in an integrated
healthcare system.
Describe the quality of ICU nurse handover related
to end-of-life care and to compare the practices of
different ICUs in three different countries.
A school hospital in Sao Paulo
with 133 nurses over a period
of one year.
VA medical center, VA New
England.
7 ICU units in 3 different countries; Australia (1),
UK (3) and Israel (3) covering 157 handovers.
Quality care for specialty
patients requires an
understanding of the
perspective of the patient,
primary care physician and the
specialist in charge.
Despite technological changes, handover has
survived as an important formal process of nursing
communication. Yet, there is little known about the
quality of ICU nurse to nurse handover
communication, especially associated with end-oflife care.
Care coordination is the
deliberate organization of
patient care between 2 or more
participants (including the
patient) to account for each
other’s actions and facilitate
the appropriate delivery of
health care services.
Practices of end-of-life-handover communication
vary greatly between units. However, room for
improvement exists in all areas in all of the units
studied.
•
The interruptive processes
What is the
rational for the have repercussions on the
working dynamics, on the
study?
caring process and on the
patient’s safety.
•
What is the
hypothesis or
research
question?
•
What key
concepts and
terms are
noted?
“In what situations, in what
form and at what frequency do
interruptions occur during the
care process? How do nurses
perceive their implications for
the work dynamics?”
Workflow; Time management;
Nursing staff; Nursing process
Handover, End of life, Communication, Nurse,
Intensive care unit
Care coordination, qualitative
methods, referrals and specialty
care.
© 2014. Grand Canyon University. All Rights Reserved.
•
Is a review of
the literature
provided?
Methods:
Summarize the
following in
paragraph form.
• What is the
population
being
sampled?
NO
NO
YES
The article samples a medical
center for the care of 102 cities
that belong to the Regional
Health Division of Rio Preto
(RHD 15). It has 708 beds and
makes an average of 89,025
monthly appointments. The
nursing team is composed of
242 nurses, 565 nursing
technicians and 481 nursing
assistants.
16 diabetic patients; 8 from an
Urban VA Medical center and
8 from a rural VA Medical
Center.
157 handovers that occurred in seven ICUs in three
countries; 45 UK, 46Australia and 66 Israel.
© 2014. Grand Canyon University. All Rights Reserved.
•
•
What data
collection
procedure is
presented?
Self-administered
questionnaires
What other
procedures are
described?
NONE
Results: Summarize
the following in
paragraph form.
What are the given
findings?
•
Are the
findings
supported by
graphs and
charts?
Interviews
Observation
Focus groups
Sampling
55 (42%) of the nurses have
reported being interrupted
more than 13 times during
their work activities, and also
that this discontinuity is more
frequent during the
documentation process
(n=118, 91.5%), followed by
patient/family guidance (n=58;
45%).
Interviews ranged from 16 to
45 minutes. Participant
characteristics are shown in
Tables 1 and 2. Clinicians
represented 23 different VHA
facilities in 10 different
Veterans Integrated Service
Networks (VISNs) across the
country. Six patients were from
the rural VAMC and 7 were
from the urban VAMC in VA
New England Healthcare
System
The highest levels of handover quality were in the
areas of goals of care and pain management while
lowest levels were for legal issues (proxy and
advanced directives) related to end of life.
Significant differences were found between
countries and units in the total handover score
(country: F (2,154) = 25.97, p = < .001; unit: F
(6,150) = 25.25.
YES
NO; Tabular representation of
data dominates therein.
NO; just tables.
© 2014. Grand Canyon University. All Rights Reserved.
•
What does the
analysis of
data state?
Conclusion:
Summarize in
paragraph form.
• What is the
summary of
the study?
When interruptions by external
stimuli occur, there is a
concentration breakdown,
raising the mental workload
and leading to reduced
performance. The instability
related to the interruptions and
associated with performing
tasks can induce errors such as
failures to fill in documents
that are relevant to the patient
and to the team.
Clinicians required excellent
coordination with each other,
but clinicians’ work suffered
from a lack of procedures and
protocols to clarify roles and
responsibilities related to the
organization of specialty care,
that is, “programming
approaches” in organizational
theory
The highest levels of handover quality were in the
areas of goals of care and pain management while
lowest levels were for legal issues
It has been proposed in this
We identified 4 overarching
The quality of communication related to end of life
study the mapping of
themes common to PCPs and
at handover in the ICU was found to be universally
interruptive processes
endocrinologists and 2
low in legal issues surrounding end-of-life (such as
contributing to examine its
overarching themes among
proxy status and advanced directives), moderate to
implications on the context of
patients with respect to what
high in pain management but varied in all other
professional practice. In the
was most important to
content areas related to end of life. Room for
nurses’ opinion, they are
successful specialty diabetes
improvement exists in all areas in all of the units
constant, recurrent and occur
care coordination.
studied. However the total handover score was
more frequently during the
higher when quality of care might be deemed at
documentation process
greater risk (if the nurses did not know the patient
(n=118, 91.5%) and during
or the patient was expected to die), indicating that
patient/family guidance (n=58;
nurses were exercising some form of discretionary
45%), affecting the care
decision making around handover communication.
dynamics, and patient’s safety.
They are caused mainly by
There is a global need for improvement of handover
telephone ringing (n=114;
practices in all areas related to end-of-life.
© 2014. Grand Canyon University. All Rights Reserved.
•
•
87%) and problem solving in
the unit (n=107; 81.7%).
What is the
conclusion of
the
hypothesis?
What are the
questions for
future
research?
References
• What are the
total number
of references
used in the
study?
•
List two of the
references
used.
A deeper look at the findings
of this research refers to how
professionals are dealing with
interruptions. Although the
nursing work is considered to
be interruptive, co