Optimizing the Implementation of Nursing Round and Nursing Handover

in Fatmawati Hospital Jakarta

Nani Asna Dewi1*, Krisna Yetti Malawat 2,3, Rita Herawati 4,5
1
Postgraduate Student, Faculty of Nursing, Universitas Indonesia
2
Department Basic Science Nursing and Fundamental Nursing, Universitas Indonesia
3
Indonesian Hospital Ethics Committee Assembly, Indonesia
4
Nurse Practitioner at Fatmawati Hospital Jakarta, Indonesia
5
Surveyor at Hospital Accreditation Commission, Indonesia
*E-mail: [email protected]

Abstract
Nursing is an integral part of medical services in a hospital, and its mission is to provide the continuum of care
based services throughout the life cycle. Nursing round and nursing handover are substantial elements in
providing nursing services and ensure patients’ safety. Optimizing the implementation of the nursing round and
nursing handover aims to refresh, renew, and optimize required instruments. Therefore, renewing nurses’
knowledge and commitment is required to adopt a better change as mentioned in the hospital’s vision and
mission, i.e. continuum of care. This research employed an analysis study with Fishbone analysis. The results
reveal that the nurses’ knowledge of nursing round management increases by 49.25%, and their experience of
conducting nursing round increases by 39.13%. It indicates a fine enhancement and proves that the
implementation of nursing round and handover is effective to enhance the nurses’ knowledge of nursing round
management because, in this round, nursing handover is directed and monitored. The commitment of top
management plays a significant role in optimizing this program. Therefore, the current issue of patient centre
care is well accommodated.

Keywords: Optimization, service management, care management, handover, round

INTRODUCTION manage nursing services. He knows that

the nursing round is a part of the nursing
Health is basic right of individual and is process (3).
regulated in the law stating that providing
healthcare must be appropriate and Nursing round is a proactive plan of
prioritize quality of the service. Nowadays, nursing which provides chances to solve
nursing service in hospitals has a strategic problems and plan collaboratively (4). A
and crucial position in determining the useful method of nursing services
quality of health services. Therefore, a improves services for patients and
reliable nurse manager who can provides feedback on nursing care for
understand and facilitate the work of nurses (3). Nurses often say they feel
executive nurses in providing nursing unsupported in the clinical situation
services is required (1). Nursing round and and that these rounds give them an
nursing handover are synergic series which opportunity to ask for advice or seek help
can improve the quality of health services. and support about patient care or
management issues on the ward, giving
Management role and function are needed them a feeling of confidence. Other health
in managing nursing round, starting from professionals can also see the matron to
planning, organizing, instructing, resolve problems and seek advice and
supervising, and monitoring. Therefore, support. It is important that the matron is
nurse manager can increase the quality and seen to be approachable by staff of all
standards of health care services (2). A grades. Often staff do not want to raise
nurse manager has the ability to lead and
issues because they feel they should know In nursing round, intense communication
how to handle all the situations they are between nurses and patients occurs. It
faced. They need to feel confident that results in collaboration which alleviates
they are not going to be belittled or nursing errors (5). Synergic
criticised (5). communication with nursing handover
becomes the most essential in conducting
In nursing round, nurses visit patients to handing over responsibility of care for
gain information, make a nursing plan, patients.
discuss nursing problems, and evaluate the
nursing care . Nursing round will improve Nursing handover is a professional and
nurses’ skill and knowledge, and enable accountable process of handing over the
them to know the needs or problems of responsibility of all cares for patients or
service management in the field, i.e. from a group of patients for others or a
Matron rounds (5). Nursing round is a professional group. This is conducted
strategy to develop autonomy, take a temporarily or permanently, and thus,
decision, create the team’s effective patients receive satisfaction from the
relation, and provide nurses’ professional nursing care (8). Nursing handover is
status (6). It impacts on health service planned as a way to provide relevant
satisfaction of both patients and nurses. information for each nurse in each shift
handover. Furthermore, it provides
By implementing nursing round, patients’ direction to inform the patients’ condition,
satisfaction will increase five times more aims and plan of nursing, treatment, and
than not implementing it (Febriana, 2009). care priority (9).
posits that nurses’ satisfaction is
influenced by several factors, such as Nursing handover is a routine performed
autonomy, organization policy, assignment by a nurse during shift handover to
requirements, interaction, professional continuously monitor patients’ care in a
status, and retain (6). Therefore, a role of hospital (8). Nursing shift handovers
top management which can motivate and consider to be a pattern of communication
facilitate round is required. that is applied in everyday clinical nursing
practice, in order to be fulfilled the goals
Nurses conduct nursing round for patients, of organization, continuity, consistency
and it is required to solve the patients’ and safety of care that nurses provide to
problems. Consequently, the patients’ basic patients (8). Communication errors
need is fulfilled, the nurses’ autonomy frequently occurs in nursing handover, and
increases, and the nurses’ performance thus, it becomes a priority aiming to
satisfaction increases (7). Nursing Round protect patients’ safety (10) and prevent
has enabled shared by learning across all any unexpected occurrence. In Fatmawati
levels of nursing staff, information giving, hospital, nursing handover is an essential
clinical updates and case review providing element of assessing the quality of nursing
opportunity for focused professional care. Therefore, it becomes one of
development which has the potential to achievements of quality indicators in
have a positive effect on patient care (7). nursing.
National Standards for Hospital
Accreditation Year 2018 explains patients’
safety goal 2, point 2.2 as increasing
effective communication among care
providers. Joint commission international
(JCI) point IPSG 2.2 posits that hospitals
are responsible for developing and
applying a communication process for that nursing round and nursing handover
nursing handover (1). Effective, punctual, are already implemented, but their quality
accurate, completed, unambiguous, and is not optimally achieved.
understandable communication will
decrease errors and increase patients’ In Fatmawati Hospital, nursing round and
safety (10). nursing handover have run well, but they
are not optimally implemented. Therefore,
There are four indicators which become several efforts and innovations to improve
the assessment for nursing handover in nursing round and nursing handover are
Fatmawati hospital, they are punctuality, required. It is expected that they can
communication patterns of situation, provide suggestions to improve the quality
background, assessment, and of nursing care services in the hospital.
recommendation (SBAR), leadership, and
documentation. These four indicators are RESEARCH METHOD
monthly assessed and recapitulated by
This research employed study analysis
nursing section who are responsible for
method with fishbone diagram approach
monitoring and evaluation. The document
consisting of man, method, machine,
is utilized as data for accreditation
material, money, and environment to
standards, and it functions as
investigate the root of the problem of
communication as well as an indicator of
nursing round and nursing hand over in a
quality services.
hospital. The next stages were literary
The existence of nursing handover can review and analysis to create a
assist communication in nursing recommendation. This study was an
management. It results in data required by innovation project licensed with number
nursing section, nurses, or other health No. DM 01.01/VIII.2/1359/2019 by
sections to plan patients’ healthcare (2). Fatmawati Hospital Jakarta.
Nursing shift handovers are a regular
feature of the everyday clinical nursing The first phase was problem identification
practice, a ritual for the nursing team through interview, observation, and
which happens every time a shift change is questionnaire. The questionnaire was
performed (11). distributed to 76 nurses as research
respondents. The collected data from the
Nursing handover as a part of nursing interview, observation, and questionnaire
process is a crucial factor in providing were then categorized and analyzed. The
care, and it requires a specific skill, critical analysis was conducted by employing root
thinking, and ability to communicate and cause analysis with fishbone diagram, and
document (12). When nursing handover determining problems of nursing
occurs, communication is performed management was conducted by employing
accurately and completely, and it is Focus Group Discussion (FGD). It was
documented to protect the patients’ safety agreed that the principal problem of
and prevent any unexpected occurrence nursing management would be resolved
during nursing care (13). together by employing an innovative
change in Fatmawati Hospital. This
Nursing care is influenced by nurses’ innovation program was initiated in detail
ability to communicate patients’ care. This in the form of Plan of Action (POA)
influences the quality of available created together during focus group
information as mentioned in SBAR when discussion. Consequently, the program
nursing handover occurs. In the interview, became a joint work program to improve
the head of nurses and the head of the quality of nursing in Fatmawati
monitoring and evaluation section explain Hospital. To solve nursing problems, this
research employed plan, do, check, and though they are not optimally
action approach (PDCA). implemented. Nursing round in the
hospital includes case reflection which is a
small part of nursing round (7), while the
FINDINGS AND DISCUSSION intended round in this research is nursing
round in which top management performs
Fatmawati Hospital has 1100 health
round to investigate the function of
workers consisting of 1027 nurses with
management in the field (5). Fishbone
various academic background, such as
analysis reveals several problems which
master in nursing, nursing specialist,
will be resolved in nursing round and
nurse, vocational nurses, and health care
nursing handover by employing
schools (14). Nursing round has already
questionnaire distributed to 76 nurse
been conducted in Fatmawati Hospital
participants.
The result of the questionnaire distributed nursing round increases by 39.13%, (from
to the nurses in Teratai Installation Unit 62.72 % to 87.27 %). It indicates a
reveals that the nurses’ knowledge of significant improvement. This
nursing round management is 60.91, after implementation conducted through
conducting innovation and implementing socializing round, creating guideline draft,
nursing round and it increases by 90.91%. SPO, arranging instruments, and drawing
In other words, it improves by 49.25%. round plot is effective to enhance the
The nurses’ experience of implementing nurses’ knowledge of nursing round and
improve patients’ safety
It facilitates patient information exchange

Handover in nursing shift is a primary

element in communication among nurses.
and professional responsibility transfer. information of nursing handover result in
Errors or derelictions in exchanging consequences for the patients’
sustainability and safety. The result of the
questionnaire of nursing handover reveals
that the nurses’ knowledge of four
indicators of nursing handover increases
by 22.12% (from 75% to 91.59%).

It indicates a significant improvement handover which become an initial step are

because the implementation of nursing composed. Then, the commitment from
handover in the form of SPO draft, toolkit nursing staff, either managerial staff or
forms, socialization, and simulation of duty nurse, in Fatmawati Hospital is
nursing handover in the patient room is required.
considerably effective to improve the
nurses’ knowledge of it. The result of the Nursing section as top management is
focus group discussion indicates a change expected to be involved in and commit to
in the beginning of nursing handover improve and facilitate the program. As the
implementation from the afternoon shift to result, the program will be in line with the
the evening shift or from 8.30 p.m. to 9 standards, and it can motivate the
p.m. Meanwhile, delivering nursing implementation of the program(15)
handover for patients with intensive care
The hospital’s perception about optimizing
requires 3-5 minutes and for other patients
nursing round and nursing handover
with non-intensive care requires 1.5
process must be similar. Therefore, it is
minutes (8)
expected that the director of Fatmawati
This is in line with the assessment result Hospital will legalize the draft of
for the completeness of nursing handover guidance, SOP, plot, and instruments.
conducted by nursing section for 80-90%, Then, they can be socialized to all room
while the target is 100%. This research leaders as well as team leaders as a form of
reveals several problems, such as the hospital’s follow up. Socialization
ineffective time, overdue start of nursing aims to improve the nurses’ understanding
handover, and non-optimal technique of and decrease their confusion over the
SBAR, leadership, as well as nursing implementation of nursing round and
handover documentation. Duty nurses as nursing handover process when providing
the assistance of head of nursing always nursing care.
motivate and guide nurses to conduct
CONCLUSION
nursing handover carefully and correctly.
This agrees with the function of Nursing round and nursing handover in
management in guiding nursing staff (2). Fatmawati Hospital have been
implemented, but they are not optimal
The program of optimizing nurses’ roles
because the guidance and SOP of their
and functions in providing nursing care is
implementation are not revised.
required, starting from planning,
Optimizing the program by preparing
organizing, directing, supervising, and
multiple-required equipment such as
monitoring. Therefore, a well-prepared and
guidance, SPO, plot, and instruments is
sustainable process plot is needed in this
necessary.
program. In this innovation, a draft of
guide book, SOP, plot, and instruments Support and commitment from the
related to nursing round and nursing managerial staff, as well as nurses’
readiness and commitment to create 6. Aitken LM, Burmeister E, Clayton S,
change, are necessary. Moreover, Dalais C, Gardner G. International
socialization and simulation can elevate Journal of Nursing Studies The impact
nurses’ insight into nursing round and of Nursing Rounds on the practice
environment and nurse satisfaction in
nursing handover.
intensive care : Pre-test post-test
The quality of nursing services is a duty comparative study. Int J Nurs Stud
and responsibility of all parties, and thus, it [Internet]. 2011;48(8):918–25.
Available from:
is expected that optimizing the
http://dx.doi.org/10.1016/j.ijnurstu.201
implementation of nursing round and 0.10.004
nursing handover can run effectively. 7. Haigh R. Development and
Periodic monitoring and evaluation of implementation of nursing grand
assessing the implementation of nursing rounds in a cancer centre.
round and nursing handover become 2016;15(5):24–30.
crucial elements to achieve the hospital’s 8. Athanasakis. Synthesizing Knowledge
quality. Training in conducting nursing about Nursing Shift Handovers :
round and nursing handover, workload Overview and Reflections from
evaluation, and creating conducive Evidence-Based Literature
working environment can become the Synthesizing Knowledge about Nursing
Shift Handovers : Overview and
strategy to improve the quality of nursing,
Reflections from Evidence-Based
It is recommended that the hospital Literature Efstratios Athanasakis ,
BSc , RN. 2014;(January 2013).
director make a policy in the form of
9. Kilic SP. The Approaches and Attitudes
decree to implement nursing round and of Nurses on Clinical Handover.
nursing handover. Therefore, the guide 2017;10(1):136–46.
book, SPO, plot, and instruments become 10. Kerr D, Klim S, Kelly A, Mccann T.
legal documents underlying the Impact of a modified nursing handover
implementation of nursing round and model for improving nursing care and
nursing handover in Fatmawati Hospital. documentation in the emergency
department: A pre- and post-
REFERENSI implementation study. 2016;89–97.
11. Athanasakis E. Synthesizing
1. Komisi Akreditasi Rumah Sakit. Knowledge about Nursing Shift
Standar Nasional Akreditasi Rumah Handovers : Overview and Reflections
Sakit. 2017;Edisi 1. from Evidence-Based Literature.
2. Basiony BM. Management 2013;6(3):300–14.
Development Strategy For Developing 12. Delrue KS. An Evidence Based
Nurse Intern ’ S Managerial Skills. Evaluation of the Nursing Handover
2018;17(5):1–12. Process for Emergency Department
3. Sastre-fullana P, Morales-asencio JM, Admissions. 2013;
Sesé-abad A, Bennasar-veny M, 13. Spooner AJ, Dip G, Leanne ICU, Hons
Fernández-domínguez JC, Pedro- BHN. Implementation of an Evidence-
gómez J De. Advanced Practice Based Practice Nursing Handover Tool
Nursing Competency Assessment in Intensive Care Using the
Instrument ( APNCAI ): clinimetric Knowledge-to-Action Framework.
validation. 2017; 2018;1–9.
4. Rutherford BP, Moen R, Taylor J. 14. Fatmawati BKR. BYK pro Rakorkep
STEPS. 2009;109(11):5–17. Feb 2018. 2018.
5. Close A, Castledine G. Clinical nursing 15. Chase LK. Nurse manager
rounds part 1 : matrons ’ rounds. competencies. 2010;
2005;14(15):816–7.