Grant: Master's Award: Canada Graduate Scholarships

Statement of the Issue: The 2004 Canadian Adverse Events Study showed that transitions in care “are high in risk and provide ample opportunity for error” (Baker et al., 2004). The study reveals that 1 out of 13 adult patients admitted to a Canadian hospital encounter an adverse event and that 37% of adverse events are ‘highly’ preventable (Baker et al., 2004). Nurses report that after a patient handover they are working with missing or misunderstood information (Meissner et al., 2007, Gogan, 2013). It is not uncommon for healthcare organizations to attempt to modify the behaviour of the individual, referred to as the ‘bad apple’ fallacy” (Russ, et al., 2013), rather than modify the system to meet human needs. Recently, there has been a focus on the link between the sciences of human factors, such as situational awareness, to design systems to support nurses in their work (Russ, et al., 2013). Situational awareness involves perception, comprehension, and projection of information. A recent concept analysis reveals that, “situational awareness needs to be… studied systematically and… recognized as a key factor in the delivery of safe patient care (Fore & Sculli, 2013). More knowledge is required to understand the role situational awareness training for nurses working within acute medical units. Research Objectives: For my major research project I have arranged to conduct an exploration of situational awareness training and an observation of the human factors elements involved in patient handover for nurses in Fraser Health. The arena of study includes four large-scale acute medical units in two acute care hospitals in the Fraser Health Authority. Central research question: What role does situational awareness training play in communication effectiveness during patient handover for nurses working in acute medicine units? Sub-questions: 1) What are the human factors associated with the patient handover process across acute medical services? 2) What flexibilities are required within the handover process to facilitate effective communication during patient handover by acute medicine nurses? Methodology: This research project will be conducted using the systematic methodology of grounded theory, which will allow for the discovery of theory related to situational awareness training and patient handover through the analysis of data. Situational awareness education during handover will be provided to all nurses employed in the arena of study over a pre-determined period of time. Study participants will be Registered Nurses and Licensed Practical Nurses. Approximately 30 to 35 interviews will be conducted during a 3 to 4 month period. Interviews will include open-ended questions and structured dichotomous questions. This will allow an in-depth exploration of the impact of situational awareness training on handover. Interview data will be themed and analyzed using a content analysis approach, with both pre-set and emergent codes. Coded data will be collated according to study relevant concepts and then to categories. In addition to survey data, I will be conducting overt observations of 20 to 25 nursing handovers to gain knowledge around the human factors elements involved overall in the handover process. These will be done both pre and post intervention Significance of the Study This research project will add to current knowledge in the role of situational awareness training in the patient handover process for nurses working in acute medical units. In addition, the results will add to the knowledge base on which specific aspects of human factors and flexibilities in processes are associated with the patient handover process for acute medicine unit nurses. Such knowledge can be applied to develop communicati