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dc.contributor.authorHolden, Tina
dc.date.accessioned2019-12-02T14:00:35Z
dc.date.available2019-12-02T14:00:35Z
dc.date.issued2019-12
dc.identifier.urihttp://hdl.handle.net/10675.2/622782
dc.description.abstractHand-off communication is associated with 80% of hospital errors. Situation awareness (SA) has been targeted as a strategy to reduce errors and enhance patient safety when providing hand-off communication. Few studies have focused on the influence of SA in hand-off communication in the intensive care unit where the risk of errors is high. The purpose of this study was to develop a substantive theory of critical care nursing hand-off. The study was guided by Endsley’s SA framework. A qualitative study design using Straussian grounded theory methods was used to develop a substantive theory related to critical care nursing hand-off. Data collection strategies included observation of 20 critical care nursing hand-offs followed by 34 semi-structured interviews and took place from 2017 to 2019 in a medical and surgical ICU at two academic tertiary care facilities. Data analysis was conducted using constant comparative analysis and was guided by Endsley’s model of SA. Results revealed that hand-off is a basic social process with a core category of handing-off awareness. The process contained four phases: interactive, reflective, maintenance, and preparatory. The interactive phase was characterized by communication between the giver and receiver of hand-off. During that phase, the 10 critical elements of hand-off were passed on to the receiver. These critical elements included the code status, past medical history, story, systems assessment, trends, changes, rationale, level of organ support, and anticipation. Handing off these elements in a way that flows with logical order affects awareness. Nursing behaviors of the giver associated with handing off awareness are linked to the critical elements. For the receiver, these behaviors include arriving prepared, reporting the critical elements, controlling flow, and making connections between the critical elements. Behaviors for the receiver include being an active listener, validating information, and asking questions within the flow of information. In the reflective phase, the resilient nurse bridges gaps in awareness. The maintenance phase is characterized by nursing actions that support hand-off information recall. In the maintenance phase, SA is maintained through artifacts. Artifacts are tools used by nurses to aid in the cognitive function of hand-off. The preparatory phase is characterized by information synthesis and organization. The four phases of hand-off are re-occurring and are influenced by individual and organizational factors. Individual factors include a nurse’s personal process, experience, socialization, and emotional intelligence. Organizational factors include unit policies, unit artifacts, and safety culture. Theory and research implications include the need for future research to further expand the framework of SA in hand-off, the use of qualitative methods to provide insight into complex areas of healthcare, and the need for educational interventions on SA hand-off. Practice implications include evaluation of current hand-off practices in the ICU and evaluation of organizational influences on hand-off. The study concludes that the theory of handing-off awareness in the ICU is a continuous process that occurs over four phases in a repetitive cycle that starts again with each shift change. The critical elements, flow, nursing behaviors, time, and external factors influence the ability of the nurse to achieve optimal SA.
dc.publisherAugusta University
dc.subjectNursing
dc.subjectcommunication, hand-off, intensive care unit, patient safety, situation awareness
dc.titleAcquiring Situation Awareness through Hand-Off in a Critical Care Environment
dc.typedissertationen_US
dc.typedissertationen
dc.contributor.departmentNursing
dc.language.rfc3066en
dc.date.updated2019-12-02T14:00:35Z
dc.description.advisorZadinsky, Julie K
dc.description.degreePh.D.
dc.description.committeeBourgault, Annette
dc.description.committeeBuchman, Timothy G
dc.description.committeeGibson, Robert
dc.description.committeeJohns, Robin
dc.description.committeeNeSmith, Elizabeth
refterms.dateFOA2020-05-29T19:50:18Z
dc.description.embargo05/25/2020


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