Summary of Board Handover - The development, implementation and evaluation of a shared care mod

Of the two wards that opted to use board handover as a communication strategy to inform staff of changes in patient’s management one ceased using it at 12 months post implementation. Board handover was not found to improve patient care requirements or communication.

4.16 Chapter Summary

The objective of the staff results chapter was to present the pilot study findings, determine demographic characteristics, establish staff values and investigate the impact the SCM had on staff workload, culture of support, team approach to provision of nursing care, and specific interventions of nursing rounds, bedside and board handover.

The pilot study findings indicated the SCM supported staff in the delivery of care and highlighted components that influenced the level of support. It also demonstrated a high level of satisfaction with the methodology and enabled support for the main study to be obtained from the NEC.

In the main study, content analysis for the three reflective practice exercises demonstrated staff values represented in five themes consisting of: provision of good patient care, culture of learning and development, healthy environment that supports practice, provision of good nursing care and effective management of care. The culture of learning and development theme was identified in both the heart of practice

and nurse assured reflective practice exercises. In addition, provision of good nursing care or good patient care themes were identified reflecting the patient or nurse perspective of what each wanted to be assured of.

Qualitative and quantitative analysis to investigate the impact the SCM had on staff workload demonstrated staff had difficulties managing workload while using the patient allocation model and these continued post implementation of the SCM. At three months there was a statistically significant increase in workload for the hospital overall and Critical Care Division as staff adjusted to using the SCM. However, as staff became more familiar with the SCM by 12 months there was a return to baseline measures for the hospital and all divisions with the exception of Critical Care Division which continued to report a statistically significant increase in staff workload. Consequently, the SCM was not found to ensure workloads were more manageable. However, when an experienced nurse worked with a less experienced nurse, either in pairs or teams, workload was found to be statistically significantly more manageable at the hospital level and the Rehabilitation/Orthopaedic Division. No statistically significant association was found between the impact of time over the study period and the types of implementation.

A positive influence by the SCM on the culture of support was demonstrated with qualitative analysis at all study points indicating staff acknowledged positive learning and development benefits associated with the SCM. However, quantitative analysis at three months demonstrated the SCM had a statistically significant negative impact on the culture of support for the hospital overall and the Rehabilitation/Orthopaedic Division. At the 12 month study point quantitative analysis detected no difference from baseline measures. No statistically significant association was found between time and intensity of implementation over the study period. The SCM was not found to statistically significantly improve the culture of support for nursing staff. However, when nurses were paired with a more experienced nurse a significant effect on learning opportunities was found for the hospital and Rehabilitation/Orthopaedic Division.

Despite the SCM promoting a team approach in the organisation and provision of nursing care a statistically significant effect was not found. Nor was there a

statistically significant effect for the type of implementation method or over time. At 12 months post implementation of the SCM, qualitative analysis demonstrated a reduction in the number of negative comments and concerns but some resistance to using the SCM remained.

Qualitative analysis throughout the study periods demonstrated staff resistance or dislike for the SCM components of nursing rounds, bedside and board handover. This resulted in a number of wards choosing to cease these interventions during the study period. Quantitative analysis demonstrated no statistically significant improvements to patient care was found for nursing rounds, nor statistically significant effect found on improving handover of patient care requirements or communication for bedside and board handover. In addition no statistically significant association was found between the time and the intensity of implementation over the study period. Of these three SCM components, the only statistically significant effect found was for the nursing rounds for the intensive implementation method. At the 12 months study period only wards from the Medical Division and Rehabilitation/Orthopaedic Division, who received this method of implementation, choose to continue to use nursing rounds as part of their SCM.

The next chapter, chapter five provides the qualitative and quantitative analysis from patient surveys and quantitative analysis from the AIMS and patient complaints databases. The impact the SCM had on patients’ satisfaction, patients’ complaints and adverse incidents is reported.

5CHAPTER FIVE

IMPACT OF SHARED CARE MODEL ON PATIENTS

This chapter presents the pilot study findings, and then outlines the results of the qualitative and quantitative analysis from the patient surveys and quantitative analysis from the AIMS and patient complaints databases. The analysis enabled demographic characteristics to be determined, and investigated the impact the SCM had on patient satisfaction, patient complaints and adverse incidents. Each of the variables investigated concludes with a summary of findings.

5.1 Pilot Study

Patients who were discharged from the pilot wards in the two weeks following three months implementation of the SCM were contacted by either the researcher or an assistant and invited to participate in a telephone survey. Of the 39 patients discharged, 27 were contactable and six agreed to participate resulting in a response rate of 22%. Results showed 100% satisfaction with personal care, 87% satisfaction with clinical care and 76% satisfaction with discharge management. The purpose of the survey was to assist with developing the patient satisfaction survey. Consequently, no comparisons could be made with pre SCM patient satisfaction levels.

Falls had been identified as both wards’ principal incident type so a comparative measure was made using the same three months in the previous year as those for the three months of implementation of the SCM. Results showed there were 11 falls during the period the SCM was in use compared to 16 for the comparative period.

5.1.1 Summary of Pilot Study

The low response rate from the telephone survey meant no conclusive findings could be drawn regarding patient satisfaction with nursing care. This also highlighted the need to include a postal survey to increase the response rate in the main study. There was a reduction in the number of patient falls when the SCM was used, compared to the same period 12 months previously when the patient allocation model was used.

5.2 Main Study

5.2.1 Demographics

Of the 2133 surveys distributed, 1799 discharged patients were eligible to participate, that is, in their place of residence, English speaking and able to complete the questionnaire. Of these 1156 completed the survey resulting in a response rate of 64%. The highest response rate came from contacting participants by phone, with 740 (89%) of the 840 discharged patients agreeing to participate compared with 416 (43%) of the 959 sent a postal survey.

Table 5.1 shows the hospital’s and divisions’ categorical demographics of the patients’ responses for each of the two survey periods. Not all respondents completed all the demographic questions. Within the Surgical Division and the hospital overall, there was a statistically significant increase in the proportion of patients at 12 months who were tertiary educated, (p = 0.009) and (p = 0.030) respectively. In the Medical Division, there was a statistically significant increase in the proportion of patients who had a partner (p = 0.044).

The hospital’s and divisions’ continuous demographics of the patients’ responses for each of the two study periods are shown in Table 5.2. Not all respondents completed all the demographic questions. The only statistically significant difference found between the two study periods was for the reduction in the variable of days in hospital (p = 0.001) at the hospital level.

Table 5.1

Hospital and Division's Patient’s Demographic Categorical Characteristics at each Study Point

Hospital Medical Specialties

Pre SCM N=483 12 month post SCM N=550 Pre SCM N=130 12 month post SCM N=145 Variables N (%) N (%) P N (%) N (%) P Female 206 (42.7) 221 (40.2) 0.436 58 (44.6) 60 (41.3) 0.293

Aboriginal or Torres strait islander 15 (3.10) 17 (3.09) 0.895 6 (4.6) 5 (3.4) 0.875

With partner 251 (51.9) 298 (54.2) 0.175 58 (44.6) 83 (57.2) 0.044

Tertiary educated 48 (9.9) 68 (12.3) 0.030 9 (6.9) 14 (6.2) 0.248

Employed 132 (27.3) 121 (22.0) 0.111 24 (18.4) 21 (16.5) 0.554

Rehabilitation and Orthopaedic Surgical Pre SCM N=202 12 month post SCM N=228 Pre SCM N=101 12 month post SCM N=71 Variables N (%) N (%) P N (%) N (%) P Female 91 (45.0) 93 (40.8) 0.130 34 (33.6) 30 (42.2) 0.370

Aboriginal or Torres strait islander 3 (1.5) 6 (2.6) 0.669 5 (4.9) 4 (5.6) 0.904

With partner 100 (49.5) 114 (50.0) 0.988 54 (53.4) 35 (49.2) 0.425

Tertiary educated 24 (11.9) 30 (13.2) 0.538 6 (5.9) 12 (16.9) 0.009

Employed 51 (25.2) 59 (25.9) 0.528 36 (35.6) 20 (28.1) 0.227

Cancer and Neurosciences Critical Care Pre SCM N=23 12 month post SCM N=28 Pre SCM N=27 12 month post SCM N=78 Variables N (%) N (%) P N (%) N (%) P Female 7 (30.4) 14 (50.0) 0.155 6 (22.2) 24 (30.7) 0.383

Aboriginal or Torres strait islander 0 1 (3.5) 0.270 0 1 (1.2) 0.457

With partner 14 (60.8) 14 (50.0) 0.333 15 (60.0) 52 (66.6) 0.284

Tertiary educated 3 (13.0) 4 (14.3) 0.580 2 (7.4) 8 (10.2) 0.549

Table 5.2

Hospital and Division's Patient’s Demographic Continuous Characteristics at each Study Point

Hospital

Pre SCM 12 month post SCM

Years N Median IQR N Median IQR P

Age 467 56 29 535 60 30 0.115

Days in hospital 450 6.0 12 493 4.0 9.0 0.001 Number of admissions 418 1.0 2.0 488 1.0 2.0 0.767

Medical Specialties

Pre SCM 12 month post SCM