Issues in Mental Health Nursing

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/imhn20

Strategies for Implementing Consumer

Involvement in Nursing Handover on Acute Mental
Health In-Patient Units

Michael Olasoji, Virginia Plummer & Wendy Cross

To cite this article: Michael Olasoji, Virginia Plummer & Wendy Cross (2021) Strategies for
Implementing Consumer Involvement in Nursing Handover on Acute Mental Health In-Patient Units,
Issues in Mental Health Nursing, 42:10, 951-959, DOI: 10.1080/01612840.2020.1852460

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Published online: 16 Dec 2020.

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ISSUES IN MENTAL HEALTH NURSING
2021, VOL. 42, NO. 10, 951–959
https://doi.org/10.1080/01612840.2020.1852460

Strategies for Implementing Consumer Involvement in Nursing Handover on

Acute Mental Health In-Patient Units
Michael Olasoji, RN, PhDa,b , Virginia Plummer, RN, PhDb , and Wendy Cross, PhDb
a
Faculty of Health, Arts and Design, Swinburne University of Technology, Wantirna, Australia; bSchool of Health, Federation University
Australia, Berwick, Australia

ABSTRACT
Consumer participation in the process of care delivery is crucial to recovery-oriented care. Nursing
handover is an important process during the delivery of care on acute in-patient units. Despite
the importance of involving consumers in this process, it remains a relatively new concept within
mental health. This is due to the complexities involved in the provision of care within the mental
health setting. There is a paucity of research on how to successfully implement consumer involve-
ment in nursing handover within mental health settings even though this practice has been occur-
ring within generalist settings for some time now. This paper reports on the findings on the
implementation of consumer involvement on an acute in-patient unit. The views of consumers
and mental health nurses about the process have already being reported. This current paper
describes how a new handover system was implemented using a modified version of the model
for successful change to bedside handover by McMurray et al. which was based on Lewin’s force-
field model of unfreezing, moving and refreezing and Kotter’s model of change. The key elements
of successful implementation are discussed. There is a need to carefully design and implement
consumer involvement in nursing handover within acute in-patient units. There are lessons to be
learnt in the process adopted and described in this paper.

Introduction recovery oriented practice. This practice has been well estab-
lished in generalist settings where implantation also faced
Historically, implementing change within mental health
some initial challenges, these concerns were mostly those
acute in-patient units has always been challenging (Evans
expressed by nursing staff (Frazier & Garrison, 2014).
et al., 2012) with direct care staff such as mental health Bedside handover has been reported to have several bene-
nurses who spend most times with the consumers having fits in the generalist settings. A study by Mardis et al.
more pessimistic views towards change (Laker et al., 2019). (2016), investigated the impact of beside handover as a
In spite of this, acute in-patient units have witnessed means of identifying and mitigating errors that occur within
changes in certain aspects of care over the years. One of healthcare settings. Nurses reported greater understanding
these changes is the efforts geared towards reducing the use of the patient condition together with an improved patient
of restrictive interventions which were initially met with experience but there was no further attribution of outcomes
much criticism and opposition among mental health nurses to any single intervention. Bedside handover is a regular
(Muir-Cochrane et al., 2018). While this move towards elim- opportunity for patients and nurses to interact regarding
inating or reducing the use of restrictive intervention was patient progress and to transfer information and account-
widely welcomed by consumer groups, there was a lot of ability (Cohen & Hilligoss, 2010) in a range of clinical envi-
apprehension on the part of professionals, particularly men- ronments (Bruton et al., 2016).
tal health nurses who pointed out safety concerns (Wilson There is paucity of literature surrounding the benefits of
et al., 2017). This practice has now grown to be more involving consumers in nursing handover within mental
acceptable within acute in-patient units. The inclusion of health. The available studies by Olasoji et al., (2018, 2019,
people with lived experience as part of the workforce within 2020) reported that consumers valued the opportunity to be
mental health was not usual practice previously but is now involved in this important process of handover on acute in-
seen as an essential part of recovery oriented practice (Byrne patient units. It gave them the opportunity to clarify issues,
et al., 2016). they knew who they could go to at the start of the shift and
A relatively recent though still uncommon development it also facilitated an opportunity for shared decision making.
in mental health settings is the involvement of consumers in Implementing changes to nursing handover to involve
nursing handover on acute in-patient units in line with the consumers requires careful planning. Campbell and

CONTACT Michael Olasoji [email protected] Nursing Department of Health Professions, School of Health Sciences, Faculty of Health, Arts and Design,
Swinburne University of Technology, 369 Stud Rd, Wantirna South, VIC 3152, Australia.
ß 2020 Taylor & Francis Group, LLC
952 M. OLASOJI ET AL.

Dontje (2019) reported on efforts to implement changes in successful change to bedside handover in generalist settings
nursing handover in an emergency department. Lewin’s which consists of 8 steps; (i) establish a sense of urgency,
Theory of Planned Change was used in the design and (ii) create a powerful guiding coalition, (iii) share the vision
implementation of the change. During the process of imple- for outcomes of change, (iv) communicate the vision to
mentation, according to Campbell and Dontje (2019), the energise renewal, (v) remove obstacles to change encourage
nurse leadership needed to continue their active support and risk taking and creativity, (vi) plan for short term wins and
respond to the feedback of staff to determine their chal- rewards, (vii) ensure sustainability, reinvigorating with new
lenges, as without this, some nurses appeared to resist pro- changes and viii) anchor changes within the work culture.
cess change.
Clark et al. (2020) found that one of the crucial steps to
implementing bedside handover in a acute care unit, was for Setting
leadership to take the lead in the change by gaining buy-in The project was conducted at a public mental health hos-
from nursing staff, then developing an educational tool kit pital in Metropolitan Melbourne. The mental health unit of
to teach the nurses about bedside handover. Leadership buy- the hospital is an adult unit that provides care to people
in was an important element in the establishment of nurse between the age of 18 and 65 years. The unit delivers acute
bedside handover as they would help facilitate adequate mental health care for people from ages 18–65. The unit has
resourcing and sustainment. 29 beds consisting of low and high level care areas. The
The attitudes of mental health nurses’ towards con- ward is gazetted under the mental health act meaning it
sumer involvement in nursing handover pre and post the
treats people that are voluntary and involuntary.
educational implementation were also explored in the The unit provides care to consumers with serious mental
same Australian health service (Olasoji et al., 2019). It was
illness (such as schizophrenia, Bipolar, schizoaffective dis-
reported that an educational intervention positively influ-
order, major depressive disorders amongst others) as well as
enced the attititudes of mental health nurses towards
some high prevalence disorders. Other consumers with per-
involving consumers in the handover. Other areas
sonality disorders are also treated on the unit.
impacted as a result of training included, therapeutic
engagement. Olasoji et al., (2020), further explored the
benefits of consumer involvement in nursing handover on Lewin’s and Kotter’s models of change
acute inpatient unit following the implementation of this
new handover system. It is important that when delivering Lewin’s (1951) theory involves a 3-step model of change,
care to consumers that they are placed at the centre of these are; unfreezing, which creates a perception that change
such care playing an active role. One of the ways to is needed, moving, which involves the implementation of
uphold the principles of recovery oriented care is when the change and refreezing which is all about reinforcing the
the consumer’s voice is heard during the handover process new behaviour as a norm.
handover on acute mental health inpatient unit is very Kotter (1995) emphasised the need to establish a sense of
important (Olasoji et al., 2018). urgency whereby people are challenged to get out of their
Recent study by Mullen et al. (2020) noted the challenges comfort zone, create a powerful guiding coalition that would
faced by a mental health service while trying to implement have an oversight of the change, develop and communicate
consumer involvement in nursing handover within the men- a vision of what the change would bring and creating struc-
tal health acute in-patient unit and subsequent abandonment tures to support the change. Following this comes the imple-
of the process due to the barriers faced. Some of the barriers mentation of the change and anchoring it in the work
reported included a resistance from the nursing team due to culture to show performance improvement (Figure 1).
concerns about consumer safety, environmental and logis-
tical concerns. Application of change model within mental health
The aim of this paper is to report on the process regard-
ing implementing change for consumer participation in Step 1: Establishing a sense of urgency
nursing handover on acute in-patient mental health unit. This first step of the process describes the way in which the
This paper is a follow-up to previous papers that reported need to have a change to current practice in nursing hand-
on the views of consumers’ pre and post implementation of over on the acute in-patient unit evolved. A sense of
nursing handover involving consumers as well as the views urgency does not necessarily relate to speed but rather the
of mental health nurses about the process. importance of the change in relation to upholding principles
of consumer centred nursing care.
Hospitals are accredited in line with national accredit-
Materials and methods
ation standards. The national standards in mental health
This is a discursive paper highlighting processes and out- services (MHS) require all MHS to uphold the right of the
comes of a study to implement change from nurse to nurse consumers and their carer(s) to have their needs and feed-
only handover system to consumer involvement in nursing back considered in the planning, delivery and evaluation of
handover on adult acute mental health unit. The change was services. It also requires MHS to ensure the right of the con-
guided by McMurray et al. (2010) proposed model for sumer to be involved in all aspects of their treatment, care
 ISSUES IN MENTAL HEALTH NURSING 953

Figure 1. Model for successful change to consumer involvement in nursing handover in mental health.

and recovery planning is upheld (Australian Commission on mental health nurse, and two nurse academics who were a
Safety and Quality in Health Care, 2018). mental health nurse and a general nurse.
The driver for this need for change was the Chief Prior to commencement of an audit of existing policies
Nursing Officer (CNO) for the mental health service at the and procedure within mental health setting related to
implementation site. The CNO saw the need to ensure this nursing handover was carried out to determine if there were
accreditation standard was being met within the mental any contradictions to the proposed changes; none
health setting which led to the establishment of a govern- were found.
ance committee to look into the matter and to create It was decided to embed the change within evidence-
the change. based practice so ethical approval was sought from the hos-
pital’s Human Research and Ethics Committee (HREC). The
role of this governance committee (GC) included and the
mode of operation were as follows:
Step 2: Create the leadership structure
This step of the process includes the structures that were  The provision of leadership and oversight of the roll out
put in place to achieve the intended purpose which was a of the project
need to change handover practice. Following the establish-  Ongoing review of the progress of the project as well as
ment of a need for change, a governance committee was cre- dealing with any issues arising during the project
ated to guide the design, implementation and evaluation of implementation.
collaborative nursing handover within mental health. The  Consistent record keeping of all the group’s meetings
team consisted of the director of nursing, Nurse Unit with actions points. The group reviewed the data collec-
Manager, Consumer Consultant (lived experience consumer tion tools, training materials and evaluation of
employed by the hospital), practice development nurse, unit the project.
charge nurse (also known as associate Nurse Unit  Consumer participation was a very crucial part of the
Manager)s Representative, the project worker who was a design and implementation of the entire project. The
954 M. OLASOJI ET AL.

Table 1. Handover observational audit tool pre-implementation.

Item
Date of audit:
Total number of nurses:
Length of group handover:
Handover location
Number of interruptions during handover
Aspects of consumer care discussed (e.g. MSE, leave, medications, others.)
Were the views of the consumer reported during the Handover? Yes No
Auditor initials:

Consumer consultant on the project team played this perspectives about having consumer involvement in nursing
active role. handover (Olasoji et al., 2019). The analysis of data collected
from the consumers and nurses helped inform the training
Two members (Nurse Unit Manager and Project Worker) package that was eventually developed and delivered.
of the GC met regularly with the charge nurses of the unit
who constituted the nursing leadership team. This group
Step 3: Removing obstacles to change
who were also closest to the nurses that would ultimately
We sought feedbacks from the charge nurses (Associate
carry out this new handover system were a key part of the
Nurse Unit Manager) group about any issues related to
implementation and ultimately its success. During these
meetings, regular updates about the project and feedbacks introducing nursing handover involving consumers by the
from the group were sought. nursing staff on the ward. They noted that there was appre-
hension amongst nursing staff about moving towards a sys-
tem of handover on the ward that would involve consumers.
Initial data collection: Baseline observation of pre-imple-
We took this feedback on board to help shape a planned
mentation handover system. Baseline observation of current
claims, concerns and issues exercise that had been origin-
handover practice on the ward was collected as part of a
ally planned.
quality improvement project using an audit tool (see Table
1). Timing audits of current handover process was con-
ducted before the introduction of consumer involvement in Claims, concerns and issues. Prior to the commencement of
nursing handover. These audits were conducted by the staff training sessions on collaborative handover, feedbacks
Project Worker, Nurse Unit Manager and practice develop- were sought from the nurses using a “Claims, Concerns and
ment nurse. The audit component included, timing the dur- Issues activity.” CCI is derived from the Fourth generation
ation of the handover that took place between the morning evaluation work of Guba and Lincoln (1989). The activity
and afternoon nursing staff over a 14-day period as well as involves seeking the opinion of stakeholders (all health pro-
content of the handovers. The audit revealed that the aver- fessionals involved in care delivery) who will be directly or
age time taken to conduct the handover was 55 minutes and indirectly involved in and or affected by implementation of
during the handover there were a number of interjections a new handover system. The CCI framework allows partici-
by the nurses which at times had no significant bearing on pants to engage in a collaborative way to solve practice-
the care of the consumer being handed over. Some of these based issues using interactive and creative ways to explore
interjections include, nurses arguing about treating team as well gather relevant data about the issue under investiga-
decisions, need for changes. Handover time was not the tion (Williams et al., 2018). The claims are favourable asser-
right forum to raise these issues. Perhaps more importantly, tions that the participants, the concerns are unfavourable
there was no opportunity for the consumer to be involved assertions (which may highlight potential barriers) and the
in the handover since it was held behind closed doors. The issues address the “what” and “how” questions. The issues
perspective of the consumer was also not brought up during are raised through a better understanding of the claims and
the handover. concerns (Williams et al., 2018). Several issues were raised
Apart from assessing what was happening locally within during this activity, some of these issues are presented in
the service, we also conducted a benchmarking exercise with Table 2. There were more concerns raised than the claims
other Victorian mental health services that have trialed con- that highlight the apprehension leading up to the establish-
sumer involvement in nursing handover. We could not find ment of the new handover involving consumers.
any service that had successful implemented a sustainable
nursing handover involving consumers. Also, we could not Changing the language. The hospital setting where this pro-
find any guideline on how to establish such a program or ject was carried out had bedside handover occurring within
training package for nursing staff on how to undertake con- the general wards before the commencement of the project.
sumer involvement in handover. Undertaking similar style of handover was considered diffi-
We undertook interviews with consumers receiving care cult at the time within mental health setting. The notion of
on the ward at that time to explore their views and opinions “bedside” seemed foreign to mental health because consum-
about being involved in nursing handover (Olasoji et al., ers within this setting were not confined to beds. For the
2018). We also took a survey of nursing staff working on purpose of this paper we have adopted the use of “bedside
the ward using a newly developed instrument to seek their handover” when referring to handover within generalist
 ISSUES IN MENTAL HEALTH NURSING 955

Table 2. Claims, concerns and issues.

Claims Concerns Issues
 Good idea and in line with recovery  Not appropriate in mental health setting  Nothing about me without me
focussed care  Will lead to increased workload  Engage doctors and allied health in the process
 Good for consumers overall  Increase handover time  Create safe meeting rooms on the ward
 Contemporary  Environment - no enough rooms or spaces on  Avoid the use of jargons during handover
the ward
 Privacy issues
 Doctors and allied health meeting consumers
during the handover period
 Can cause harm/conflicts especially if the
person does not agree with you
 Language
 Unwell patients

settings while using patient involvement in nursing hand- Step 4: Communicating the vision
over when referring to mental health settings. One of the An information and communications strategy was developed
first step towards achieving the consumer involvement in by the working party which was dubbed the: “The 12 days of
nursing handover within the acute in-patient mental health Christmas Strategy” as the changes occurred during the
unit was then to change the language and align the project Christmas period. This strategy included sending out mes-
with relevant national and practice standards (Australian sages daily to all nursing staff that reflected elements of
Commission on Safety and Quality in Health Care, 2018). what was presented at the trainings. This was sent via email
Specifically, Action 6.8 of the standard requires clinicians to and posted in the nursing station daily to all the staff as a
support consumers and carers to be involved in clinical countdown to implementation. Figure 2 provides an
handover in accordance with the wishes of the consumer. example of one of the messages sent out to nursing staff.
The use of the “countdown” strategy was a way to ensure
Staff training and feedback session. There were no training that recency was maintained amongst the nurse that
packages on how to educate mental health nurses about attended the trainings. It was also a means of highlighting
involving consumers in nursing handover at the start of the the difference between current practice and the upcoming
project. The review of similar handover within generalist change of nursing handover that would involve
setting as reported by Jeffs et al. (2013) suggested the use of the consumer.
videos and role play for roll out of bedside handover within
generalist settings. The project team deliberated on possible
Step 5: Implementing change
scenarios on the unit as a result of consumer involvement in
Following this period of consultations with nursing staff
the nursing handover.
about the proposed changes, the morning and afternoon
A total of five clinical case scenarios were developed
nursing handover was changed to include the consumers.
reflecting the basic principles of nursing handover involving
The structure of the new handover process is represented in
consumers. These included, when a consumer does not
Figure 3. It was clear to nurses that even though involving
agree with their diagnosis, when the consumer does not
consumers in the handover was now standard practice
want to participate and where privacy concerns are involved.
ultimately the consumers has the right to refuse in partici-
Others included, when a carer was around and when nurses
pating. The ANUM groups emphasised the expectations sur-
undertake handover without any input from the consumer
rounding this process of the beginning of each shift.
even though present. Details of the training was reported in
Allocation of consumers to incoming nurses was done in
our previous publication (Olasoji et al., 2019). The case
such a way as to minimise nurses receiving handover from
scenarios provided exemplars of how to make sure the voice
multiple nurses while keeping in mind skills mix, gender
of the consumer is heard during handover, ways that nurses
preferences and ward acuity.
can avoid arguments and how to undertake handover when
consumers are not willing to engage in the process. Short
video vignettes were created from these scenarios. Step 6: Ensuring sustainability
The scenarios as well as the video role plays were co- Non-participant observational audit. Observational audits
designed with the consumer consultant who was part of the using an audit tool were carried out for a period of 6 weeks
project team. They provided critique on the authenticity of post implementation of the new handover system (Table 3).
the scenarios as well as ensuring that the language used dur- The audits were carried out by clinical nurse educators and
ing the interactions was recovery focussed. Some of the the project lead. Real time feedback was provided to nursing
scenes in the role play video featured the Consumer staff after the handovers on how the process was either well
Consultant and peer support workers who were working on done or where gaps occurred. Identified gaps in practice
the ward at the time. The training of nursing staff in before were fed back to the entire nursing staff by the nurse unit
the implementation of the new handover system occurred manager via bulk staff emails. The results of the audits were
over a period of 3 weeks. Details of the training which also discussed by the project governance committee meeting.
lasted for 1 hour has been previously reported (Olasoji et Some of the key observations are as follows: there was
al., 2019). reduction in the period of handover from 55 minutes
956 M. OLASOJI ET AL.

Figure 2. Daily communication prior to implementation.

Figure 3. Structure of handover involving consumers.

 ISSUES IN MENTAL HEALTH NURSING 957

Table 3. Handover observational audit tool post implementation.

Item
Date:
Consumer UR:
AM nurse:
PM nurse:
How long did the group handover go for?
How long did the individual handover go for?
Where did the individual handover occur?
Was the consumer informed about the handover prior to shift changeover? Yes No
Was the consent of the consumer sought before the handover? (Please circle) Yes No
During the handover was the consumer’s carer or relative present? (Please circle) Yes No
Did the nurse seek the consent of the consumer to include their carer? (If applicable) Yes No
Was there an active participation of the consumer during the handover? Yes No
Key issues discussed during handover:
(Please include examples of issues discussed such as mental state examination, risk assessment,
leave status, discharges, and requests for information.)
Post-handover the consumer involvement documented in the clinical notes? Yes No
Auditor initials:

(previous handover system) to an average of 45 minutes the reasons given for the failure include the perception that
(new handover system) thereby releasing time for consumer mental health services are different, the fear that such a pro-
care. It was noted that some consumers were active and led cess might make things worse for consumers, logistical and
the conversation, but some others needed promptings to environmental concerns.
engage in the process. Some of the handovers were occur- This paper presents strategies that were employed in a
ring in common areas. large public metropolitan acute in-patient unit to success-
fully implement nursing handover involving consumers. It
Anchoring change within the ward culture. The post imple- highlights the steps that were taken to ensure a successful
mentation evaluation of the nursing handover involving transition from a traditional style handover that only
consumers was undertaken 3 months after the system was involved nurses to a more contemporary style handover
introduced. The evaluation included seeking the views and where the consumer had active involvement in the process.
opinions of consumers and nursing staff as well as regular Similar strategies have been previously used within generalist
non-participant observational audits. The progress of the settings (McMurray et al., 2010).
new system was included as an agenda item on the unit First, it was important at the beginning of the process to
nursing staff meetings. create a sense of urgency or the need for change.
Maintaining the status quo when it comes to delivery of
Conclusion care is the path of least resistance. There is a need to chal-
lenge the status quo and move towards a model of care
This paper reports on steps taken towards the successful delivery that aligns with recovery-oriented practice. Similar
implementation of nursing handover involving consumers findings were reported by Small et al. (2016) in a bid to
on an acute in-patient mental health unit. establish bedside handover within the generalist setting, it
The delivery of mental health care within acute in-patient was initially driven by a need to change.
unit that aligns with recovery-oriented practice is crucial While a need for change might be identified as being cru-
and there are several opportunities available during the
cial, it can be difficult to prosecute the case for change with-
course of delivering care on acute in-patient units that could
out strong leadership. Leadership particularly within acute
have greater consumer involvement. One such activity is the
in-patient mental health unit plays a vital role in driving
handover of consumer care between mental health nurses at
change. For example, it has been reported that one of the
shift changeover. This activity offers a unique opportunity
keys to successful implementation of interventions to reduc-
to ensure the consumer is at the centre of the care delivered
and more importantly that their voice is heard in the pro- ing restrictive interventions within acute in-patient units is
cess of exchanging information about them between nurses. strong leadership drive or backing (LeBel et al., 2014; Muir-
Despite the benefits that exist when consumers are Cochrane et al., 2018). During the process of establishing
involved in nursing handover, their involvement remains a consumer involvement in nursing handover in this study,
challenge in many acute in-patient units due to the ethos there was a need to create a strong leadership structure that
that exists within mental health units of assuming consum- was able to drive and implement the change. This process
ers are either incapable or not interested in participating in was reported by Small et al. (2016) while establishing bed-
handover. While bedside (including the patient) handover side handover in a surgical orthopaedic trauma ward. Their
has become mostly routine within the generalist setting, it leadership team consisted of nurse managers, nurse educa-
has remained quite a challenge to implement within mental tors, resource nurses among others, their role was to per-
health. The inability to successfully implement nursing suade others to adopt the change. Unlike the present study,
handover involving consumers within mental health settings there was no consumer representative within Small’s leader-
has been previously reported (Mullen et al., 2020). Some of ship group.
958 M. OLASOJI ET AL.

Implementing change within practice comes with particu- collect data and then provide feedback to staff mem-
lar obstacles or barriers. Often staff are accustomed to a spe- bers concerned.
cific way of doing things and if change is to occur, it can We believe using a combination of Lewin (1951) and
become successful as people move out of their comfort Kotter (1995) to implement a change such as involving con-
zone. The change therefore must address the identified sumers in nursing handover on acute in-patient unit has the
obstacles. To engage stakeholders, we adopted a claims, con- potential to produce a sustainable practice change.
cerns, issues activity to identify their needs and trouble
shoot some of the challenges. This was very important for
those who would ultimately implement the change, namely
Relevance to clinical practice
the nursing staff. It is important to have the appropriate In many ways mental health care systems have over the
level of engagement and consultation and a feedback mech- years, set an example in delivering care that places the con-
anism to ensure the success of new initiatives. There was a sumer at the centre of the process. However, one area that
noted shift in attitude amongst nursing staff pre and post remains behind, particularly within acute in-patient units is
implementation of the change (Olasoji et al., 2019). the involvement of consumers in nursing handover. Delivery
Concerns raised about this type of handover being inappro- of mental health services that truly align with recovery-ori-
priate within a mental health setting prior to implementa- ented practice must surely include the communication of
tion, were eliminated post implementation. information about consumers between those that care for
The communication strategy utilised in implementing the them and with their active voice in the process. In order to
change was equally important. Sufficient time needs to be establish such a process, it is important that careful planning
allowed to adequately prepare staff prior to the formal is undertaken to ensure success. Mental health nurses have a
implementation of the change. This enables staff to be unique role to play in ensuring consumers remain at the
trained in preparation for the change in handover structure centre of their own care delivery, this can be achieved
and the actual implementation. We adopted a 12-day time- through a true collaborative care approach. The strategies
frame to cover the key points that were addressed in the presented in this paper have implications for implementing
training and for reminders and encouragement to be similar style consumer-centred practices in not just adult
applied. It was an opportunity also to ensure all nursing acute inpatient units but also adolescence and older adult
staff were captured across all shifts and to include those in-patient mental health units.
who worked part-time. It introduced the impending change
slowly but steadily leading to a sensitisation of the staff. It is
important to keep the message clear and also reinforce that Authorship statement
the change was a matter of priority for the organisation due All authors involved in this manuscript meet the authorship criteria
to the benefits that it had for consumers. McMurray et al. and are all in agreement with the manuscript.
(2010) reported a somewhat similar communication strategy
while implementing bedside handover on two acute care
hospitals. In contrast, a lack of clear communication was
Authors’ contributions
identified as one of the reasons for a failed implementation M.O.: project design, introduction, methodology, and discussions; V.P.:
of bedside handover as reported by Olson-Sitki et al. (2013). introduction, methodology, and edits; and W.C.: discussions, edits, and
One of the challenges in establishing a change within methodology.
practice is the issue of sustainability. Factors that could
potentially impact on sustainability include, lack of con- Disclosure statement
tinuous process management practices, negative nursing
The authors report no conflict of interest.
feedback, lack of leadership and staff engagement
(Hagman et al., 2013; Jeffs et al., 2014; Olson-Sitki et al.,
2013). It is very important to design the change in a way ORCID
that ensures it becomes embedded in practice and remains
Michael Olasoji http://orcid.org/0000-0003-2919-6580
sustainable. Post implementation evaluation and audits to
Virginia Plummer http://orcid.org/0000-0003-3214-6904
measure effectiveness need to occur regularly. This would Wendy Cross http://orcid.org/0000-0003-3297-0274
highlight potential areas for improvement (Jeffcott et al.,
2009). Olson-Sitki et al. (2013) reported using a compe-
tency checklist to complete real-time competency compli- References
ance with bedside handover post implementation. They Australian Commission on Safety and Quality in Health Care. (2018).
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