led at each hospital by a trained ‘clinical champion’ who was an
experienced front-line clinician that provided ‘real time’ education
for other staff, as well as supported adoption by role modelling use of
the tools for their colleagues and promoting their continued use10.
Ethics approval was obtained at both hospitals and the affiliated
university. Two focus group interviews were conducted at each site.
Participants were 17 nurses who worked on the permanent roster
in the PACU for at least two shifts per week (Table 2). The first
focus groups were held prior to introduction of the PACU handover
improvement tools and the second were held between three and five
months after implementation to allow for uptake of the tools.
Semi-structured questions were used to guide the focus groups.
Focus group discussions were audio-taped, transcribed verbatim and
de-identified for analysis. Transcripts were analysed independently
by two researchers using the qualitative framework method4
that was
informed by the three key concepts of the PARiHS model for guiding
implementation of evidence-based practice: ‘Evidence’, which refers
to the sources of knowledge that guide clinicians’ practice including
research or training, and knowledge gained from practical experiences;
‘Context’ is described as the quality of the environment or setting in
which health care is taking place or research is being implemented
into practice and; ‘Facilitation’ which refers to the external and
internal processes that inspire and guide the process of change1
.
Results and discussion
Overall, the handover improvement tools were perceived as being
well suited to PACU, the nurses’ needs and as filling a gap in current
practice; suggesting support for the adoption of the handover
practice improvement7,22. Despite this finding, participants reported
different perceptions of their adoption and plan for ongoing use of
the handover tools at the two hospitals. PACU nurses at Hospital
1 reported they had adopted the handover improvement tools
and planned to maintain their use. Alternatively, PACU nurses at
Hospital 2 reported limited use of the tools and a reluctance to adopt
them into their practice, despite seeing merit for their use in practice
improvement.
Handover improvement tools provided EVIDENCE for the PACU practice
improvement
Prior to implementation of the PACU handover improvement tools,
PACU nurses reported previous clinical experience was the dominant
form of evidence they used to guide their handover practices. In the
post-implementation focus groups, PACU nurses reported the handover
improvement tools provided them with a useful source of knowledge
about desirable handover practices, even when their previous practices
persisted. Nurses’ exposure to the PACU handover improvement tools
appeared to influence their expectations of handover.