الفهرس 
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Abstract
Based on the main study findings, the recommendations proposed are as follows:
The bedside nursing handover style should be the style of choice to be applied whenever possible.
Nurses should have regular training in the process of handover, and this should cover:
o Preparation of relevant and concise patient information reports,
o Effective communication
o Use of ISBAR tool,
o Patient safety indicators.
Head nurses and their assistants should also have training in the administration and evaluation of nursing handover.
Interactions with the patients during handover is of major importance, but should be very focused to avoid loss of time.
The environment should be very well prepared with no external or internal interruptions during handover.
Staff nurses’ perceptions of the handover process and their related feedback should be regularly assessed by head nurses and their assistants and be used for improvement.
The evaluation of methods of clinical handover needs to be linked to measures of patient safety, particularly relating to miscommunication such as falls, medication errors or pressure ulcers.
Important areas for future research include developing a minimum dataset requirement for handover and the design and development of technological solutions to improve the quality, standardization, and efficiency of handover data.
Summary
Worldwide, potentially preventable adverse events during hospital care are still common causes of mortality and serious morbidities for patients. Safety improvements has been a real challenge to health care organizations over the last two decades. Continuity management in inpatient care is essential for safe and effective care to minimize medical errors. Good communication is critical in nursing team to achieve this. Nursing handover ensures such continuity of care throughout entire patient hospital stay. The accuracy and completeness of this process are determinants of patient safety. Several handover styles are used by nurses, namely oral, written, and bedside. The influence of these different styles used on patient safety is deemed to be studied.
This study aim was to examine the influence of three different nurses’ handover styles on selected patient safety indicators. The selected patient safety indicators are hospital-acquired infections, decubitus ulcer, patient fall, and medication errors. The three handover styles are oral, written, and bedside.
This comparative record-based prospective study was conducted at the critical care units of Mahalla General Hospital. The Medical, Surgical, and Pediatric ICUs using the oral, written, and bedside handover styles respectively, were selected. All 18 head nurses and their assistants and 130 staff nurses in these units were included in the study sample. Additionally, the hospital records provided the data pertaining to the selected patient safety indicators in these units.
Data were collected using an interview questionnaire for head nurses and their assistants’ opinions about the handover process; an observation checklist (for oral and bedside handover), an audit checklist (for written and bedside handover) for staff nurses including ISBAR tool to assess their actual practice of handover and related perception; and a data abstraction form for the patient safety indicators. The tools were pilot tested. Data were collected through interviewing for head nurses and their assistants, observing and auditing for staff nurses, and abstraction of indicators during a 6-month up period from the beginning of January to the end of June 2020.
The main study results were as following:
Staff nurses in the oral, written, and bedside handover study groups had almost equal median age (26.0-27.0). The oral group had significantly more males (p=0.001), and diploma degree nurses (p=0.01).
Significantly less nurses in the written group reported having attended training courses in handover (p=0.003).
All head nurses and their assistants were females with bachelor’s degree, with previous training in handover.
Only 44% of staff nurses in the oral group had adequate application of ISBAR, compared to 92.5% in the written group and 100.0% in the bedside group (p<0.001).
In total, 60% of the staff nurses in the oral group had adequate application of the handover process, compared to 87.5% of those in the written group, and 95.0% in the bedside group (p<0.001).
Overall, the bedside group had lower perception of the handover interaction/support (p<0.001), while the oral group was lowest in the perception of the area of patient participation (p<0.001).
In total, staff nurses in the written handover group had the highest perception of the handover process (85.0%), compared to 52.5% in the bedside group (p<0.001).
A significant moderate positive correlation was revealed between staff nurses’ scores of ISBAR and handover process scores (r=0.460).
Significant weak positive correlations were found between staff nurses’ scores of handover process and their age (r=0.275), and level of qualification (r=0.203).
In multivariate analysis:
o The written or bedside handover approaches and the previous attendance of training courses in handover were significant positive predictors of the score of ISBAR application.
o The written or bedside handover approaches and the previous attendance of training courses in handover, in addition to staff nurse age were significant positive predictors of the score of handover process application.
According to head nurses and their assistants’ views, the most adequate practice was in the bedside group (100.0%), and lowest in the oral group (33.3%).
Patient safety indicators:
o The incidence of medication errors was highest in the oral handover group, and lowest in the bedside group.
o The incidence of total medication errors was lowest in the bedside handover group (p<0.001).
o Bed sores incidence was zero in the bedside group, compared to 0.72% in the oral group.
o The incidence of patient falls was zero in all groups.
o The incidence of acquired infections (total and ICU) was lowest in the bedside group and highest in the oral group (p<0.001).
o The mortality rate / 100 patient*day was lowest in the bedside group (0.05) and highest in the oral group (0.53) (p<0.001).
In conclusion, the adequate application of ISBAR and handover process is lowest in oral handover style and highest in bedside style. The incidence of medication errors and of acquired infections are highest in the oral handover group, and lowest in the bedside group.
The study recommends the bedside handover style to be applied whenever possible. Staff nurses should have regular training in the process of handover. Head nurses and their assistants should also have training in the administration and evaluation of nursing handover. Interactions with the patients during handover is of major importance. The environment should be well prepared with no interruptions during handover. Staff nurses’ perceptions of the handover process should be regularly assessed and used for improvement. Important areas for future research include developing a minimum dataset requirement for handover and the design and development of technological solutions to improve the quality and efficiency of handover data.