Introduction
Effective communication is a cornerstone of safe nursing practice, particularly in clinical handovers where accurate information transfer can prevent errors and enhance patient outcomes. This essay reflects on the “Correct Clinical Handover” video, which demonstrates a structured handover process using the ISBAR framework (Identify, Situation, Background, Assessment, Recommendation) in a nursing context (Australian Commission on Safety and Quality in Health Care, n.d.). As a nursing student, I have selected the reflective framework outlined by Usher, Mather, and Byfield (2020) in Chapter 18 of Transitions in Nursing, specifically focusing on Figure 18.1 (p. 281), which adapts Gibbs’ Reflective Cycle. This cycle includes six stages: Description, Feelings, Evaluation, Analysis, Conclusion, and Action Plan. I will apply these stages to analyse the video’s depiction of communication, highlighting its importance in nursing.
Furthermore, this reflection identifies older adults as a population group at higher risk of harm from communication issues, due to factors such as age-related cognitive decline, sensory impairments, and complex health needs (World Health Organization, 2021). Drawing on evidence-based literature, I will discuss three to four communication strategies clinicians can employ to mitigate these risks. The essay aims to demonstrate an understanding of communication’s role in safe practice, supported by peer-reviewed sources, while adhering to a logical structure informed by the chosen framework. Through this analysis, the implications for nursing practice, particularly in handover scenarios, will be explored.
Description
In this initial stage of the reflective cycle, as described by Usher, Mather, and Byfield (2020), the focus is on objectively recounting the event without judgement. The “Correct Clinical Handover” video illustrates a nurse-to-nurse handover in a hospital setting, emphasising the ISBAR framework to ensure clear, concise information exchange. The scenario involves a patient with deteriorating vital signs, where the outgoing nurse describes the patient’s identity, current situation (e.g., elevated blood pressure), background (medical history), assessment (observations), and recommendations (e.g., escalate to medical review). Communication is portrayed as verbal, supported by documentation, and occurs in a quiet environment to minimise distractions. The video underscores the National Safety and Quality Health Service (NSQHS) Standard 6 on Communicating for Safety, which mandates structured processes to reduce miscommunication risks (Australian Commission on Safety and Quality in Health Care, 2017). This depiction aligns with nursing standards, where handovers typically last 5-10 minutes and involve active listening. However, the video does not explicitly address challenges with vulnerable populations, such as older adults, who may face barriers like hearing loss or confusion during transitions of care.
Feelings
Moving to the feelings stage (Usher, Mather, and Byfield, 2020), I experienced a sense of reassurance while watching the video, as it reinforced the structured nature of handovers I have observed in clinical placements. The clear communication made me feel confident about its potential to prevent errors, yet I also felt concern regarding real-world complexities. For instance, in busy wards, interruptions could undermine this process, potentially heightening anxiety for nurses. Reflecting on older adults, I felt empathy, recognising how age-related vulnerabilities might exacerbate feelings of exclusion if handovers overlook patient involvement. Literature supports this, noting that poor communication can evoke fear and helplessness in elderly patients (Grenier et al., 2016). Overall, the video evoked a mix of optimism about best practices and apprehension about applying them to high-risk groups, prompting me to consider my emotional readiness for such scenarios in future practice.
Evaluation
The evaluation stage involves assessing what was positive or negative about the experience (Usher, Mather, and Byfield, 2020). Positively, the video effectively demonstrates how ISBAR enhances clarity and accountability, reducing adverse events by up to 30% in some studies (Eggins and Slade, 2015). The structured approach ensures all critical details are covered, fostering team collaboration. However, a limitation is the video’s idealised setting, which may not reflect chaotic environments where communication breakdowns occur, such as during shift changes with high patient loads. For older adults, this is particularly problematic; evaluation of evidence shows that communication failures contribute to 20-30% of medication errors in this group, often due to misunderstood instructions (Australian Institute of Health and Welfare, 2020). On balance, the video is a valuable educational tool but could be enhanced by incorporating scenarios with vulnerable populations to highlight adaptive communication needs.
Analysis
In the analysis stage, deeper examination links the event to broader theory and evidence (Usher, Mather, and Byfield, 2020). The video’s emphasis on ISBAR aligns with human factors theory, which posits that standardised tools mitigate cognitive overload in high-stakes communication (Catchpole and McCulloch, 2010). However, analysing risks for older adults reveals specific vulnerabilities: age-related hearing impairment affects 33% of those over 65, leading to miscomprehensions, while cognitive issues like dementia complicate information processing (World Health Organization, 2021). Research indicates that ineffective handovers correlate with increased readmission rates in elderly patients, with one study finding a 15% higher risk when communication is unclear (Forster et al., 2003). Furthermore, complexity of health information exacerbates this; older adults often manage multiple comorbidities, making simplified, patient-centred communication essential. This analysis underscores that while the video promotes general safety, it must be contextualised within demographic-specific risks to prevent harm, as per NSQHS standards.
Conclusion
The conclusion stage synthesises lessons learned (Usher, Mather, and Byfield, 2020). From the video, it is evident that structured communication like ISBAR is vital for safe handovers, but its efficacy depends on adaptation to patient needs. For older adults, overlooking communication barriers can lead to adverse outcomes, such as delayed care or errors. In hindsight, the video could have included patient feedback loops to model inclusive practice. Personally, this reflection has highlighted the need for vigilance in communication, reinforcing that nursing competence involves not just technical skills but empathetic, tailored interactions. Evidence from systematic reviews confirms that targeted strategies reduce risks, emphasising the ethical imperative for nurses to prioritise vulnerable groups (Kripalani et al., 2007).
Action Plan
The final stage outlines future improvements (Usher, Mather, and Byfield, 2020). To enhance practice, I will incorporate evidence-based strategies for communicating with older adults during handovers. Specifically, three to four strategies include: (1) Using the teach-back method, where clinicians confirm understanding by asking patients to repeat information, proven to improve comprehension in elderly populations with a 12% reduction in errors (Schillinger et al., 2003); (2) Employing simple language and visual aids, such as written summaries, to address sensory and cognitive impairments, supported by randomised trials showing better adherence (Grenier et al., 2016); (3) Involving family or carers in discussions, which mitigates isolation and enhances accuracy, as evidenced by qualitative studies on elder care (Australian Institute of Health and Welfare, 2020); and (4) Conducting handovers at the bedside to include patients, fostering transparency and reducing miscommunication risks by 25% in geriatric settings (Jeffs et al., 2013). I plan to practice these in simulations and seek feedback, ensuring alignment with NMBA standards (Nursing and Midwifery Board of Australia, 2016). This action plan will prepare me for professional practice, prioritising safety for high-risk groups.
Conclusion
In summary, this reflective essay, structured by Usher, Mather, and Byfield’s (2020) adaptation of Gibbs’ Reflective Cycle, has analysed the “Correct Clinical Handover” video to underscore communication’s critical role in nursing. By describing the scenario, exploring feelings, evaluating strengths and weaknesses, analysing theoretical links, concluding key insights, and planning actions, the importance of tailored communication emerges clearly. Focusing on older adults highlights vulnerabilities like sensory decline and complex needs, addressable through strategies such as teach-back, simple language, family involvement, and bedside handovers. These approaches, grounded in evidence, can mitigate risks and improve outcomes. Ultimately, this reflection implies that nurses must integrate reflective practice to adapt communication, fostering safer healthcare environments. As nursing evolves, ongoing education on these elements will be essential for reducing harm in vulnerable populations.
(Word count: 1528, including references)
References
- Australian Commission on Safety and Quality in Health Care. (2017) National Safety and Quality Health Service (NSQHS) Standards. ACSQHC.
- Australian Institute of Health and Welfare. (2020) Older Australians. AIHW.
- Catchpole, K. and McCulloch, P. (2010) ‘Human factors in operative surgery: A critical review’, BMJ Quality & Safety, 19(6), pp. 447-452.
- Eggins, S. and Slade, D. (2015) ‘Communication in clinical handover: Improving the safety and quality of the nursing handover’, Journal of Advanced Nursing, 71(11), pp. 2560-2572.
- Forster, A.J., Murff, H.J., Peterson, J.F., Gandhi, T.K. and Bates, D.W. (2003) ‘The incidence and severity of adverse events affecting patients after discharge from the hospital’, Annals of Internal Medicine, 138(3), pp. 161-167.
- Grenier, A., Lloyd, L. and Phillipson, C. (2016) ‘Precarity in late life: Rethinking dementia through a lens on ageing and communication’, Ageing & Society, 37(8), pp. 1666-1693.
- Jeffs, L., Beswick, S., Acott, A., Simpson, E., Cardoso, R., Campbell, H. and Irwin, T. (2013) ‘Patients’ views on bedside nursing handover: Creating a space to connect’, Journal of Nursing Care Quality, 29(2), pp. 149-154.
- Kripalani, S., LeFevre, F., Phillips, C.O., Williams, M.V., Basaviah, P. and Baker, D.W. (2007) ‘Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care’, JAMA, 297(8), pp. 831-841.
- Nursing and Midwifery Board of Australia. (2016) Registered nurse standards for practice. NMBA.
- Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., Leong-Grotz, K., Castro, C. and Bindman, A.B. (2003) ‘Closing the loop: Physician communication with diabetic patients who have low health literacy’, Archives of Internal Medicine, 163(1), pp. 83-90.
- Usher, K., Mather, C. and Byfield, Z. (2020) ‘Chapter 18: Reflective practice for the graduate’, in Chang, E. and Daly, J. (eds) Transitions in nursing: Preparing for professional practice. 5th edn. Chatswood, NSW: Elsevier, pp. 279-294.
- World Health Organization. (2021) Global report on ageism. WHO.
