Using focused ethnography to explore and describe the process of nurses’ shift reports in a psychiatric intensive care unit

• Published in: Journal of clinical nursing 2018-08, Vol.27 (15-16), p.3104-3114
• Main Author: Salzmann‐Erikson, Martin
• Format: Article
• Language: English
• Subjects: Ethnography; focused ethnography; handover; Health-Promoting Work; Hälsofrämjande arbete; in-patient; inpatient; Intensive care; Mental health; mental health nursing; Nurses; Nursing; patient handoffs; psychiatric nurses; Qualitative research; reporting; shift reports
• ISSN: 0962-1067; 1365-2702; 1365-2702
• DOI: 10.1111/jocn.14502

Aims and objectives To explore and describe the cultural routine of shift reports among nursing staff in a psychiatric intensive care unit and further to develop a taxonomic, thematic and theoretical understanding of the process. Background Lack of communication among healthcare staff is associated with risks for medical errors. Thus, handovers and shift reports are an essential and integral routine among nurses to pass on information about the patients’ health status. Previous studies within the field have highlighted the benefits of structured reporting tools. However, shift reports as a cultural activity within the nursing tradition have been given less attention, not the least in psychiatric care. Methods Focused ethnography was used. The data comprised 20 observational sessions. The observations ranged over a time span of 5 months and were conducted in a psychiatric intensive care unit in Sweden. Results The process of shift reports encompassed the following three phases: (a) getting settled, (b) giving the report and (c) engaging in the aftermath. The results demonstrate that the phases entail different cultural activities, which take place in different areas of the ward and that the level of formality varied. Conclusions Shift reports are not an isolated event with clear boundaries. The study enriches the understanding of shift reports as a “fuzzy process”. The individual phases were found to be tied to cultural connotations, such as activities, places and roles with certain meanings for staff members. Relevance to clinical practice The new insights are useful for nurses in overcoming an uncritical adoption of the biomedical tradition regarding pace and tone during shift reports. The reporting nurse has the potential to transform shift reports from a monologue with a foreclosed style to a more dialogical interaction with colleagues that focuses on the patients’ needs rather than the needs of staff.