Modelo de handover de enfermagem com a participação do paciente na terapia intensiva: uma tecnologia para a segurança da comunicação

Abstract

Introduction: Communication failures during nursing handover can result in adverse events for patients. Patient participation is an effective strategy to mitigate these failures, although there are challenges in understanding its importance by both healthcare professionals and patients themselves. Objectives: General: To develop a nursing handover model with patient participation, aiming to promote effective communication. Specific: To analyze patients’ and professionals’ perceptions regarding nursing handover with patient participation; to develop, based on these perceptions, a proposed model for nursing handover with patient participation; to discuss the applicability of this technological tool for nursing handover as a safety barrier to reduce communication errors. Method: Qualitative research, based on the patient safety and patient-centered care conceptual framework, conducted in the Coronary Care Unit of a university hospital in Rio de Janeiro. Twenty-two semi-structured interviews were conducted with nursing professionals and sixteen with hospitalized patients, along with systematic observation during the handover process. Data were analyzed using thematic content analysis, in an inductive model, and through the principles of thick description for observational data. Results: Nursing professionals understood the importance of patient participation in the care process and the benefits of the bedside handover model for patient safety. However, they showed resistance to implementing the handover with patient participation, demonstrating that they were not prepared for this new model due to a lack of knowledge about its operation and their beliefs about handover. Patients indicated little familiarity with a care model in which they could be protagonists in decision-making. But, for the most part, they are interested in learning more about their health status and interacting with the nursing team. The proposed model involves two main stages: patient and team preparation, and handover implementation. During hospitalization, patients record any questions in a “Hospitalization Diary”, which nurses read before handover. The handover model occurs during the shift change from day to night, lasts three to five minutes per patient, and follows the SBAR structure, with patient participation at two points: after the SBA stages and after the R stage. Conclusion: Including patients during nursing handover can significantly reduce communication errors, increase patient safety, and ensure quality care. Therefore, the argument is made that this handover model with patient participation is a barrier with the potential to promote patient safety and, at the same time, patient-centered care. Its implementation requires prior testing and assessment, the development of professional skills, leadership engagement, and organizational commitment to a safety culture.