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1. NRS 493 GCU Identification & Application of Research in Nurse Practice
Literature Review
NRS 493 GCU Identification & Application of Research in Nurse Practice Literature Review
ON NRS 493 GCU Identification & Application of Research in Nurse Practice Literature
ReviewIn nursing practice, accurate identification and application of research is essential to
achieving successful outcomes. The ability to articulate research data and summarize
relevant content s the student’s ability to further develop and synthesize the assignments
that constitute the components of the capstone project.Provide a synopsis of the review of
the research literature articles provided. Using the “Literature Evaluation Table,” determine
the level and strength of the evidence for each of the eight research articles you have
selected. The articles may include quantitative research, descriptive analyses, longitudinal
studies, or meta-analysis articles. A systematic review may be used to provide background
information for the purpose or problem identified in the proposed capstone project. NRS
493 GCU Identification & Application of Research in Nurse Practice Literature ReviewWhile
APA style is not required for the body of this assignment, must use solid academic writing,
and in-text citations and references should be presented using APA guidelinesPICOT
Question: Among patients admitted to the hospital (P) how do nurses’ bedside shift reports
(I), compared totraditional reports outside of patients’ rooms (C), affect the occurrence of
adverse events (O) during hospital stay (T)?Population: Patients admitted to the
hospitalIntervention: Nurses’ bedside shift reportsComparison: Traditional reports outside
of patients’ roomsOutcome: The occurrence of adverse eventsTime: During hospital
stay*See Literature Review attachment and Capstone Articles 1-8. (Articles 1,3,4,7,8 Web
Link Provided). Capstone Articles 2,5,6 AttachedSeparate Document:Create a list of
measurable outcomes for your capstone project intervention (Improving Patients’ Quality
of Care through Bedside Shift Report).Write a list of three to five outcomes for your
proposed intervention. Below each outcome, provide a one or two sentence rationale.While
APA style is not required for the body of this assignment, must use solid academic writing,
and in-text citations and references should be presented using APA guidelinesNRS 493 GCU
Identification & Application of Research in Nurse Practice Literature
Reviewattachment_1attachment_2attachment_3attachment_4attachment_5attachment_6att
achment_7attachment_8Unformatted Attachment PreviewLiterature Evaluation Table
Student Name: Change Topic (2-3 sentences): Topic: Improving Patients’ Quality of Care
through Bedside Shift Report. Criteria Article 1 Article 2 Article 3 Article 4 Author, Journal

2. (PeerReviewed), and Permalink or Working Link to Access Article Reference: McAllen, E.R.,
Stephens, K., SwansonBiearman, B., Kerr, K., Whiteman, K (April 9, 2018) “Moving Shift
Report to the Bedside: An EvidenceBased Quality Improvement Project” OJIN: The Online
Journal of Issues in Nursing Vol. 23, No. 2. Reference: Bigani, D. K., & Correia, A. M. (2018).
On the Same Page: Nurse, Patient, and Family Perceptions of Change-of-shift Bedside
Report. Journal of Pediatric Nursing, 41, 84–89. Reference: Grimshaw, J., Hatch, D., Willard,
M., & Abraham, S. (2016). A Qualitative Study of the Change-of-Shift Report at the Patients’
Bedside. The Health Care Manager, 35(4), 294–304. https://doi.org/10.1097/hcm.
0000000000000125 Reference: Ford, Y., Heyman, A., & Chapman, Y. L. (2015). Patients?
Perceptions of Bedside Handoff. Journal of Nursing Care Quality, 29(4), 371–378.
https://doi.org/10.1 097/ncq.000000000 0000056 Web Link: https://ojin.nur
singworld.org/ MainMenuCat egories/ANA Marketplace/A NAPeriodicals/ OJIN/TableofC
ontents/Vol23-2018/No2May2018/Articles- Web Link: Permalink:
https://journals.lww.com/he https://lopes.idm.oclc althcaremanagerjournal/Abs
.org/login?url=https:// tract/2016/10000/A_Qualita search.ebscohost.com
tive_Study_of_the_Change_ /login.aspx?direct=tru of_Shift_Report.3.aspx
e&db=edo&AN=130 462037&site=edslive&scope=site&cus tid=s8333196&group
id=main&profile=eds 1 © 2015. Grand Canyon University. All Rights Reserved. Web Link:
https://journals.lww .com/jncqjournal/A bstract/2014/10000/ Patients__Perceptio
ns_of_Bedside_Ha ndoff__The_Need.1 0.aspx PreviousTopics/Moving -Shift-Reportto-
theBedside.html Article Title and Year Published Moving Shift Report to the Bedside: An
Evidence-Based Quality Improvement Project On the Same Page: Nurse, Patient, and Family
Perceptions of Change-of-shift Bedside Report A Qualitative Study of the Change-of-Shift
Report at the Patients’ NRS 493 GCU Identification & Application of Research in Nurse
Practice Literature ReviewBedside Patients’ Perceptions of Bedside Handoff The Need for a
Culture of Always Year Published: 2016 Year Published: 2015 Year Published: 2018 Year
Published: 2018 Research Questions (Qualitative) /Hypothesis (Quantitativ e) Purposes/Ai
m of Study Design (Type of Quantitative , or Type of Qualitative) Setting/Sam ple Methods:
Intervention /Instruments Analysis Key Findings Recommend ations Explanation of How
the Article s EBP/Capsto ne Project © 2017. Grand Canyon University. All Rights Reserved.
Criteria Article 5 Author, Journal (PeerReviewed), and Permalink or Working Link to Access
Article Reference: Schirm, V., Banz, G., Swartz, C., & Richmond, M. (2018). Evaluation of
bedside shift report: A research and evidencebased practice initiative. Applied Nursing
Research, 40, 20–25. https://doiorg.lopes.idm.oclc.org/10. 1016/j.apnr.2017.12.004 Article
Title and Year Published Article 7 Article 8 Reference: Foster-Hunt, T., Parush, A., Ellis, J.,
Thomas, M., & Rashotte, J. (2015). Information structure and organization in change of shift
reports: An observational study of nursing hand-offs in a Pediatric Intensive Care Unit.
Intensive & Critical Care Nursing, Permalink: 31(3), 155–164. https://lopes.idm.oclc.org/
https://doilogin?url=https://search.eb org.lopes.idm.oclc.org/1 scohost.com/login.aspx?di
0.1016/j.iccn.2014.09.00 rect=true&db=edselp&A 4 N=S0897189717301118&
site=edsPermalink: live&scope=site&custid=s https://lopes.idm.oclc.or
8333196&groupid=main g/login?url=https://searc &profile=eds1 h.ebscohost.com/login.a
spx?direct=true&db=cc m&AN=103357319&sit e=ehost-live&scope=site Reference: Radtke

3. K. (2015). Improving patient satisfaction with nursing communication using bedside shift
report. Clinical nurse specialist CNS, 27(1), 19– 25. https://doi.org/10. 1097/NUR.0b013
e3182777011 Reference: Ofori-Atta, Judymae MSN, BSN, RN; Binienda, Maura BSN, RN;
Chalupka, Stephanie MSN, EdD Bedside shift report, Nursing2019: August 2015 Volume 45
Issue 8 – p 1-4 doi: 10.1097/01.NU RSE.000046925 2.96846.1a Evaluation of bedside shift
report: A research and evidence-based practice initiative Improving Patient Satisfaction
With Nursing Communication Using Bedside Shift Report Year Published: 2018 Article 6
Information structure and organization in change of shift reports: An observational study of
nursing hand-offs in a Pediatric Intensive Care Unit Year Published: 2015 Web Link:
https://pubmed.n cbi.nlm.nih.gov/2 Web Link: 3222024/ https://journals.l
ww.com/nursing /Fulltext/2015/0 8000/Bedside_s hift_report__Im plications_for_p
atient.20.aspx Year Published: 2015 Research Questions (Qualitative) /Hypothesis © 2017.
Grand Canyon University. All Rights Reserved. Bedside shift report Implications for patient
safety and quality of care Year Published 2015 (Quantitativ e) Purposes/Ai m of Study
Design (Type of Quantitative , or Type of Qualitative) Setting/Sam ple Methods:
Intervention /Instruments Analysis Key Findings Recommend ations Explanation of How
the Article s EBP/Capsto ne © 2017. Grand Canyon University. All Rights Reserved. ANA
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publication that addresses current topics affecting nursing practice, research, education,
and the wider health care sector. COLUMNS TABLE OF CONTENTS Home ANA Periodicals
Previous Topics LETTERS TO THE EDITOR OJIN Table of Contents CONTINUING ED Vol 23
2018 ANA HOME No2 May 2018 Articles Moving Shift Report to the Bedside Moving Shift
Report to the Bedside: An Evidence-Based Quality Improvement Project ^md Edward R.
McAllen, Jr., DNP, MBA, BSN, BA, RN Kimberly Stephens, DNP, MSN, RN, DNP Brenda
Swanson-Biearman, DNP, MPH, RN Kimberly Kerr, MSN, RN Kimberly Whiteman, DNP, MSN,
RN, CCRN-K Find Out More… Abstract Announcements New Column in OJIN! Permission to
Reprint OJIN Articles Planning a conference or class? Call for OJIN Manuscripts on a
previous topics… Benefit for Members Members have access to current topic More… Letter
to the Editor The delivery of healthcare in the United States has been static for the past
century with care delivered through problem-based visits in an office or hospital setting.
This model has not adapted to changing demographics and makes healthcare inaccessible to
many. In this model, disparities in healthcare access are multifactorial. Continue Reading…
View all Letters… A Midwestern, 532-bed, acute care, tertiary, Magnet® designated
teaching hospital identified concerns about fall rates and patient and nurse satisfaction
scores. Research has shown that the implementation of bedside report has increased
patient safety and patient and nurse satisfaction. NRS 493 GCU Identification & Application
of Research in Nurse Practice Literature ReviewAn evidence-based practice change
incorporating bedside report into standard nursing care was implemented and evaluated
over a four-month time period on three nursing units. Fall rates, HCAHPS and Press Ganey®
scores, and nurses’ response to a satisfaction survey were measured before and after the
project implementation. This article begins with the background of the problem and
literature review, and then presents the project methods, measures, and data analysis.

4. Results demonstrated that patient fall rates decreased by 24%, and nurse satisfaction
improved with four of six nurse survey questions (67%) having percentage gains in the
strongly agree or agree responses following implementation of bedside report. HCAHPS and
Press Ganey® results demonstrated improvement in Press Ganey® scores on two of the
three nursing units. In this project, implementation of bedside report had a positive impact
on patient safety, patient satisfaction, and nurse satisfaction. The authors conclude with
discussion of findings and implications for nursing management. Citation: McAllen, E.R.,
Stephens, K., Swanson-Biearman, B., Kerr, K., Whiteman, K (April 9, 2018) “Moving Shift
Report to the Bedside: An Evidence-Based Quality Improvement Project” OJIN: The Online
Journal of Issues in Nursing Vol. 23, No. 2. DOI: 10.3912/OJIN.Vol23No02PPT22 Key Words:
bedside report, shift report, handoff, patient safety, patient satisfaction, nurse satisfaction,
evidence-based nursing practice, patient centered care, quality improvement, teamwork,
work redesign, leadership, and organizational culture. In April 2011, the Centers for
Medicare and Medicaid (CMS) enacted a hospital Value Based Purchasing (VBP) program
that began to measure and pay for hospital quality performance (Medicare.gov, n.d.). By
2015, CMS focused on four domains: clinical process of care, patient experience of care,
outcome, and efficiency. Patient safety and patient and nurse satisfaction are scored within
these domains. For a health system to be successful and maintain its viability and future
growth, patient safety and patient and nurse satisfaction are key components
(Medicare.gov, n.d.). Hospital leaders and healthcare organizations are making concentrated
efforts to change their environments to assure patient safety and patient and nurse Bedside
shift report (BSR) enables accurate and timely communication between nurses, includes the
patient in care, and is paramount to the delivery of safe, high quality care. Hospital leaders
and satisfaction. healthcare organizations are making concentrated efforts to change their
environments to assure patient safety and patient and nurse satisfaction. In the literature,
changing the location of shift report from the desk or nurses’ station to the bedside has been
identified as a means to increase patient safety and patient and nurse satisfaction. Shift
report, when completed at the patient bedside, allows the nurse to visualize and assess the
patient and the environment, as well as communicate with and involve the patient in the
plan of care. Bedside shift report (BSR) enables accurate and timely communication
between nurses, includes the patient in care, and is paramount to the delivery of safe, high
quality care. Background A Midwestern, 532-bed, acute care, tertiary, Magnet® designated
teaching hospital identified that fall rates were above the national average. Patient
satisfaction, as A team of nursing measured by Press Ganey®, consistently scored below the
administrators, target range of 90%, and the Hospital Consumer directors, staff Assessment
of Healthcare Providers and Systems nurses, and a (HCAHPS) scores for questions related to
nursing patient communication were below 85%, or the 90th percentile. representative was
Nurse satisfaction scores, as measured by the National assembled to Database of Nursing
Quality Indicators (NDNQI), were review the 69.7%, below the overall goal of 75%. A team
of nursing literature and make administrators, directors, staff nurses, and a patient
recommendations representative was assembled to review the literature and for practice
make recommendations for practice changes. This article changes. begins with the
background of the problem and brief literature review, and then presents the project

5. methods, measures, and data analysis. We conclude with results and discussion of our
findings and implications for nursing management. Literature Review The team completed
a literature review based upon the following PICO question: Does the implementation of
BSR as compared to standard shift report at the nurses’ station increase patient safety and
patient and nurse satisfaction? The practice of shift report at the bedside is not a new
concept and is well documented in the literature. Numerous studies the positive impact of
BSR on patient fall rates, as well as patient and nurse satisfaction (Cairns, Dudjak, Hoffman,
& Lorenz, 2013; Evans, Grunawalt, McClish, Wood, & Friese, 2012; Jeffs et al., 2013; Laws, &
Amato, 2010; & Sand-Jecklin & Sherman, 2013). NRS 493 GCU Identification & Application
of Research in Nurse Practice Literature ReviewPatient participation in the report is
paramount to delivery of safe, high quality care. After the literature review, the team
defined BSR as the accurate and timely communication between nurses and also between
the nurses and the patient. Patient participation in the report is paramount to delivery of
safe, high quality care. Furthermore, through reading and discussion of the articles, the
team concluded that report, when completed at the patient bedside, allows the nurse to
visualize and assess patients and the environment, with better communication and patient
involvement in care. Methods Written approval to conduct the quality improvement project
was obtained from the university and hospital institutional review boards (IRB). The team
completed a gap analysis to determine evidence-based best practices for shift report as
compared to the current practice. At baseline, shift report was done in a conference room, at
the desk, or in the hallways. BSR was not a practice on any of the units. Report was not
standardized, though all nurses had some preferred form of communication. The team
completed a gap analysis to determine evidence-based best practices for shift report as
compared to the An organizational assessment completed using the current practice.
strengths-weaknesses-opportunities-threats (SWOT) format revealed that the practice
change to BSR was feasible and congruent with the hospital’s nursing model, Jean Watson’s
theory of transpersonal caring (Watson, 1999), and Kristen Swanson’s middle range theory
of caring (Swanson, 1993). The team selected the Iowa Model of Evidence-Based Practice to
Promote Quality Care (Titler, 2011) and Kotter’s Eight Stage Process for Major Change
(Kotter, 1996) to guide implementation and sustain progress. Tests of change in Plan, Do,
Study, Act (PDSA) cycles were used to evaluate the practice change in real-time and make
necessary adjustments throughout implementation (The Deming Institute, n.d.). Three units
were selected for implementation of the practice change based upon the directors’ desire
and willingness to participate. The populations served on the chosen nursing units were
patients undergoing general surgery, and those with orthopedic and neuroscience
diagnoses. Members of these units volunteered to be part of the BSR team. Scripted Report
The team developed two scripts to use for report: one for medical units and one for surgical
units. Scripts were created with input and consensus of staff, based upon the We
incorporated Introduction, Situation, Background, Assessment, fictitious patient
Recommendation, Question (ISBARQ) format (Heinricks, information that Bauman, & Dev,
2012). We incorporated fictitious patient aligned with typical information that aligned with
typical patient conditions patient conditions from each area. See Figure 1 for a sample of
script from each area. content. Confidential aspects of report (e.g., abnormal laboratory and

6. radiology test results indicative of poor prognosis) that had not been discussed between the
patient and physician were discussed nurse-to-nurse, prior to completing BSR. Figure 1.
Medical Unit Nurse Script ISBARQ: Introduction, Situation, Background, Assessment,
Recommendation, Questions INTRODUCTION: Off-going nurse introduce the oncoming
nurse SITUATION: Patient name Reason for admission Code status BACKGROUND:
Pertinent history Laboratory and X-ray results Other testing results Consults ASSESSMENT:
Assessment to include pertinent findings for assigned patient population Medications and
treatments Pending tests White board update Safety and Environmental Check IVs, Drains,
Pain Mobility Environmental scan: clutter, side rails, visual assessment of room safety
RECOMMENDATION: Pertinent information from Plan of Care Follow up tests to be
completed QUESTIONS: Thank the patient and ask if he/she has any questions. Education
Staff education included reading two journal articles (Cairnes, Dudjak, Hoffman, & Lorenz,
2013, and Evans, Grunawalt, McClish, Wood, & Friese, 2012), and watching a recorded clip
created by the team (six staff nurses, two directors, two video personnel) to demonstrate
the BSR process. The clip utilized the scripts used in the training of staff. Educators helped
to determine the information that should be shared confidentially via nurse-to-nurse
communication and what was to be included in BSR. The BSR began with the outgoing nurse
introducing the oncoming nurse to the patient, followed by an assessment of the patient and
environment. The patient assessment NRS 493 GCU Identification & Application of Research
in Nurse Practice Literature ReviewThe BSR began included a general overview of the
patient’s condition and with the outgoing significant aspects of care (e.g. wound sites;
dressings; nurse introducing abnormal breath or heart sounds; intravenous sites, the
oncoming solutions, and rates; or anything considered out of the nurse to the ordinary).
Nurses surveyed the room for safety issues, patient, followed by including the bed and side-
rail position and presence of an assessment of clutter, and ensured that necessary items
were within the patient and patient reach. Prior to leaving the room, they updated the
environment. white board in the room, reviewed pain medications, and inquired of patients,
“Do you have any questions?” Following the education, staff members were given script
cards to use during report. They had time to practice giving report using the ISBARQ format
before demonstrating competency to a staff champion or BSR team member. Tests of
Change The PDSA framework was utilized throughout the project and allowed staff input
into the ongoing The PDSA framework was utilized throughout the project and allowed staff
input into the ongoing process of BSR. During implementation of the project, we identified
multiple items that required small process changes or what are called “linked process
changes” (Taylor et al. 2013, p.5). These are defined as “two or more (PDSA) cycles with
lessons learned from one cycle linking and informing a subsequent cycle” (Taylor et al.
2013, p.5). process of BSR. One example of a linked change that occurred was script changes
based upon the patient; nurse familiarity with the history; and management of patient
requests for privacy. Staff members were encouraged to discuss BSR process issues with
BSR team members, who made frequent rounds throughout the project. To maintain
consistency, suggested changes were discussed with BSR team members prior to
implementation. Most requested changes were minor, such as asking patients how they
would prefer to be addressed by staff. Changes were passed on to other nurses during unit

7. rounds or through directors and champions at change of shift report. Measures Audits A
BSR audit tool was implemented to assure compliance to the BSR process, including
verifying that report was completed at the bedside; introducing the oncoming nurse;
scripting in ISBARQ; updating the white board; and reviewing care. Shift report time audits,
measured from the beginning of report until all handover communication ended, were
completed pre-implementation and post-implementation. A direct comparison of mean
report times was completed on pre-implementation versus post-implementation shift
times. An example of the audit report is illustrated in Figure 2. Figure 2. BSR Shift Report
Time Audit Tool BSR Process Audit Tool Number of nurses/shift Time Report
Shift/Date/Time Nursing Unit: Number of Nurses /Shift Report Start time Report End time
Total time Census Auditor Falls The number of patient falls was obtained through the
hospital incident reporting system and converted into a fall rate using the standard
calculation of 1,000 patient days: the total number of falls divided by the number of patient
days times 1,000 (AHRQ, 2013). The number of falls in the four-month period before BSR
implementation was compared to the number of falls in the f …NRS 493 GCU Identification
& Application of Research in Nurse Practice Literature Review