Transforming Synergy Care Delivery Model into an Effective Nursing Shift Report Tool

Abstract

Background: The complexity of hospitalized patients with acute and chronic illnesses poses challenges for effective communication among nurses. Nursing shift report (NSR) plays a crucial role in communicating and planning patient care to ensure continuity, quality, and safety of patient care. Suboptimal shift reports may misdirect nursing surveillance and fail to recognize/interpret serious patient complications. A preliminary study involving interviews of staff nurses on current shift report practices revealed that NSRs lacked structure, was task-oriented and inconsistent. Nurses desired a standardized, efficient and systematic shift report. Our study aimed to develop a NSR tool using the American Association for Critical Care Nurses (AACN) Synergy model, systematically capturing the holistic care needs of patients and their families. Method: The Synergy Model-integrated NSR tool was developed with thirteen staff nurses working at seven different units in a hospital. The nurses were first educated about the Synergy model and its eight patient characteristics (Vulnerability, Stability, Resiliency, Predictability, Resource Availability, Participation in Care, Participation in Decision-making, Complexity). Then nurses integrated the patient characteristics into the NSR tool. Results: Identified were unit specific and common care elements across units to be included onto a NSR, matching them with each patient characteristics. A synergy rating scale was incorporated into the tool to allow nurses to score patient's conditions and care needs. The total sum would help nurses quickly judge the overall severity of the patient's condition. Nurses felt that structured and focused information of the tool would prevent information being left out of the reporting process. Conclusion/Implications: Nurses perceived the new NSR tool would be an effective, systematic process with widespread implications for improvements in quality of care and patient safety. The conversion of this paper-based shift report into a mobile shift reporting tool is in progress to support safe, efficient, and patient-centered bedside handoffs.