Critiquing a Systematic Review on Nursing Handoffs
Chamberlain College of Nursing
NR505: Advanced Research Methods: Evidence-Based Practice
Critiquing a Systematic Review on Nursing Handoffs
Systematic research reviews make it possible to pool a larger amount of data and produce larger sample sizes in hopes of synthesizing findings, making the information more valuable and leading to evidence-based practice. However, systematic reviews are not all created equal and therefore, it is important to critically assess each and every one. Riesenburg, Leitzsch, and Cunningham (2010) completed a systematic review on nursing handoffs in order to identify features of structured handoffs that are effective. Within the following text, a critique of this systematic review will be completed. The relevance to nursing practice, research rigor, clarity of presentation, summary of findings, and implications of the review will be discussed. Relevance of Nursing Handoffs to Practice
Although nursing care is a 24-hour service in the hospital setting, no nurse can stay in the hospital around the clock, so patients will inevitably be cared for by many different nurses during their hospitalization. Maintaining continuity of care is coveted, however some discontinuity is actually necessary; nurses change shift every 8 to 12 hours and therefore must handoff to an oncoming nurse. This discontinuity can create opportunities for error when clinical information is not accurately transferred between nurses. “An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (The Joint Commission, 2012, p.1). Also, incomplete handoffs or miscommunication in the hospital setting contributes to delays in treatment, inappropriate treatment, and increased length of stay (The Joint Commission, 2012). Effective handoff communication is a vital necessity to nursing practice, patient safety, and patient outcomes. This is recognized in the National Patient Safety Goals outlined by the Joint Commission in 2006, stating all health care providers are required to "implement a standardized approach to handoff communications including an opportunity to ask and respond to questions" (as cited in Riesenburg et al., 2010, p. 27). Developing ways in which to improve communication will always be a relevant topic within nursing. A Critique of Systematic Review’s Research Rigor
Riesenburg et al. (2010) provides a detailed description of methods used, therefore allowing the reader the ability to replicate methodology if desired. The databases searched are clearly listed, as well as the search terms used. At the start, researchers identified 2,649 articles within the time period of focus: January 1, 1987 to August 4, 2008; predefined inclusion criteria was used to further narrow the search to 95 articles (Riesenburg et al., 2010). Inclusion criteria comprised of articles that were in English, indexed in databases Ovid and/or PubMed, published in the specified time period, and concentrated on nursing handoffs in the United States (Reisenburg et al., 2010). Unfortunately, these criteria limit the results considerably. Melnyk and Fineout-Overholt (2011) find that research that excludes non-English literature and unpublished literature harbors bias. There is a tendency for research studies that contain positive results to be published. Therefore, excluding unpublished studies could mean that positive results are exaggerated because high-quality studies with negative results are not represented (Melnyk & Fineout-Overholt, 2011). This is called publication bias and is certainly an issue to consider in the appraisal of this systematic review. The 95 articles were later narrowed down to 20 research articles; anecdotal data abstracts, circumscribed reviews, letters, commentaries, and editorials were excluded from further review...
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Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: a guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkin.
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Riesenburg, L.A., Leitzsch, J. & Cunningham, J. M. (2010). Nursing handoffs: a systematic review of the literature. The American Journal Of Nursing, 110(4), 24-34.
The Joint Commission, Joint Commission Online. (2012). Joint Commission introduces new, customized tool to improve hand-off communications. Retrieved from http://www.jointcommission.org/assets/1/23/jconline_June_27_12.pdf
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