Evidence-Based Practice Proposal – Section D: Solution Description.

Evidence-Based Practice Proposal – Section D: Solution Description.


This paper discusses the process of implementing BSR during shift handoff as the preferred evidence-based solution to improve the safety of patients, quality of care, and nurse satisfaction in acute care settings. It describes the selected solution, organization culture, methods, and the outcome impact.Evidence-Based Practice Proposal – Section D: Solution Description.


Proposed Solution

The proposed solution for implementation is bedside shift reporting during patient shift handoff. Dorvil (2018) defines bedside shift reporting as the process of delivering shift handovers from nurse-to-nurse at the patient’s bedside. The process promotes responsibility, accountability, and information interchange. Nurses schedule bedside handovers within a cycle of 24 hours with a seamless transfer of medical, technical, and nursing knowledge between incoming and off nurses at the patient’s bedside. Bedside shift reports ensure that information shared among healthcare providers from one shift to another is of high quality and increases the ability to take note of important changes in a patient’s status.Evidence-Based Practice Proposal – Section D: Solution Description.

Although nurses in the organization have some background knowledge about bedside shift reporting, since it is a newly introduced intervention in practice in the healthcare organization, it will be necessary to conduct training before the actual implementation. As suggested by Boshart, Knowlton & Whichello (2016), training will aim at introducing the bedside shift report concept to nurses, to address potential concerns related to the proposed intervention, and to recruit nurses who will serve as the frontline champions when implementing bedside shift reporting in the required units.Evidence-Based Practice Proposal – Section D: Solution Description.

Organizational Culture

The author will implement the proposed solution in an acute care setting that provides inpatient healthcare services to hospitalized patients with both acute and chronic illnesses. The acute care setting has a learning and patient safety culture as demonstrated in its vision, mission, and organizational goals. To add on, the institution has a philosophy anchored on values, processes, and practices that inspire continuous learning, competency, and multidisciplinary collaboration among healthcare providers.

Collaboration does not only promote teamwork but also promotes communication among healthcare team members with clear and common goals in the management of patients. Collaboration also improves healthcare staff responsiveness, increases the rates of patient satisfaction, and reduces issues related to quality and patient safety (Dorvil, 2018). It is also commendable that the institution’s management uses a transformational leadership style by incorporating all healthcare staff in decision-making. It is for the same reasons that the organization has continuously implemented other evidence-based projects to improve patient safety, healthcare quality, and increase efficiency in healthcare delivery.Evidence-Based Practice Proposal – Section D: Solution Description.

Expected Outcomes

Since training healthcare staff will be part of the process of implementing the proposed solution, outcomes from the training sessions will be nurses embracing bedside shift report by showing willingness to adopt it, healthcare providers sharing knowledge about bedside shift report, and nurses expressing appreciation for the chance to visualize a patient in another nurse’s presence. According to Lincoln (2016), bedside shift handoff promotes transparent communication between patients and healthcare providers. It also promotes patient-centric care by directly integrating patients in the decision-making process of their care and this ultimately improves the quality of care, patient safety, and increased nurse satisfaction. Evidence-Based Practice Proposal – Section D: Solution Description.

Method to Achieve Outcomes

There will be an initial one-week training session on bedside shift reports by an external trainer to introduce the bedside shift report concept to nurses, address potential concerns on bedside shift reports, and recruit champion nurses. During training, there will be the formation of an implementation team comprising of nurses from different units within the healthcare organization with specific roles and responsibilities. The implementation team will oversee the entire implementation process of guiding and facilitating the change, collecting baseline and outcome implementation data on patient and nurses perception using surveys, and patient safety data using safety and incident forms, analysis, policy formulation, and continuous evaluation and monitoring.Evidence-Based Practice Proposal – Section D: Solution Description.

A potential barrier to implementing this project is increased fear of violating HIPPA laws among nurses when performing bedside shift reports and unwillingness to implement it in practice since it is time-consuming. However, the author plans to address this fear through training when introducing the concept of bedside shift reports. Besides, during admission, each patient will consent to bedside shift reports after receiving the required education.Evidence-Based Practice Proposal – Section D: Solution Description.

Outcome Impact

Bedside shift report provides a good platform to exchange information in the care transitioning process and facilitates the transfer of responsibilities from one caregiver team to another by involving patients in the process (Natafgi et al., 2017). Therefore, it is expected that post-implementation, there will be an improvement in the quality of care, and increased nursing competency resulting in increased satisfaction among nurses. By incorporating patients in the decision-making process, it will promote patient-centric care and patient safety.Evidence-Based Practice Proposal – Section D: Solution Description.

PICO Question

In an acute care hospital (Population), does bedside shift report (Intervention) compared to traditional report at the nurses’ station (Comparison) improve quality of care, safety and nursing satisfaction (Outcome)?Evidence-Based Practice Proposal – Section D: Solution Description.

Proposed solution:

Implementing bedside shift report during shift handoff on patients.

Potential Barriers

There will always be barriers when implementing change.  Change is difficult even when the change is positive.  Appropriate education is one method to overcoming the change.  Nurses are concerned with HIPPA violations by performing bedside shift report.  This can be addressed by communicating with patients on admission why bedside shift report is completed and ask for their permission to include them and discuss when it would not be appropriate to share information in the patients’ room. Evidence-Based Practice Proposal – Section D: Solution Description. Having open communication to discuss questions and concerns related to bedside shift report can decrease anxiety about protecting patient’s privacy.  Another barrier is some nurses feel bedside shift report will take longer.  This is when data will be important to share with staff.  Nurses need clear understanding of the barriers and be open to changing their behaviors.  Communicating the why behind the change instead of just communicating the change is imperative.  Providing evidence-based practice data allows for a greater acceptance.Evidence-Based Practice Proposal – Section D: Solution Description.

Ethical Considerations

One ethical consideration of bedside shift report is a breach of patient privacy.  All of the patient rooms are private, so breach of privacy would not be with another patient but possibly amongst family members. There are ways to get around this by communicating with patients in private at some point to ask for permission to discuss in front of family or if their wish is to safeguard their privacy. Evidence-Based Practice Proposal – Section D: Solution Description.

The American Nurse Association Code of Ethics states “the nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population” (ANA, 2015).  Nurses must provide patients with opportunities to participate in the planning of their care.  Performing bedside shift report to include the patient directly touches this provision of nursing ethics.  Nurses must collaborate in the care they provide.  Performing bedside shift report and including the patient allows for trust, respect, transparency, shared decision-making and open communication between nurses and patients which supports the practice change (ANA, 2015).Evidence-Based Practice Proposal – Section D: Solution Description.