title: Characterizing the structure and content of nurse handoffs: A Sequential Conversational Analysis approach.
abstract: Effective communication during nurse handoffs is instrumental in ensuring safe and quality patient care. Much of the prior research on nurse handoffs has utilized retrospective methods such as interviews, surveys and questionnaires. While extremely useful, an in-depth understanding of the structure and content of conversations, and the inherent relationships within the content is paramount to designing effective nurse handoff interventions. In this paper, we present a methodological framework-Sequential Conversational Analysis (SCA)-a mixed-method approach that integrates qualitative conversational analysis with quantitative sequential pattern analysis. We describe the SCA approach and provide a detailed example as a proof of concept of its use for the analysis of nurse handoff communication in a medical intensive care unit. This novel approach allows us to characterize the conversational structure, clinical content, disruptions in the conversation, and the inherently phasic nature of nurse handoff communication. The characterization of communication patterns highlights the relationships underlying the verbal content of nurse handoffs with specific emphasis on: the interactive nature of conversation, relevance of role-based (incoming, outgoing) communication requirements, clinical content focus on critical patient-related events, and discussion of pending patient management tasks. We also discuss the applicability of the SCA approach as a method for providing in-depth understanding of the dynamics of communication in other settings and domains.
authors.affiliation: Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States. Electronic address: abrahamj@uic.edu.
authors.forename: Joanna
authors.initials: J
authors.lastname: Abraham
authors.affiliation: Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kannampallil
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, 1216 5th Avenue, New York, NY, United States.
authors.forename: Corinne
authors.initials: C
authors.lastname: Brenner
authors.affiliation: Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL 60612, United States.
authors.forename: Karen D
authors.initials: KD
authors.lastname: Lopez
authors.affiliation: Department of Internal Medicine, Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX, United States.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: Almoosa
authors.affiliation: Department of Internal Medicine, Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX, United States.
authors.forename: Bela
authors.initials: B
authors.lastname: Patel
authors.affiliation: Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, 1216 5th Avenue, New York, NY, United States.
authors.forename: Vimla L
authors.initials: VL
authors.lastname: Patel
mesh_terms: D003142:Communication; D006801:Humans; D007362:Intensive Care Units; D009726:Nurses; D062209:Patient Handoff; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: Care transitions; Communication; Communication errors; Conversational analysis; Intensive care; Nurse handoffs; Sequential analysis; Shift report