First Advisor

Dr. Lora Claywell

College

Rueckert-Hartman College for Health Professions

Degree Name

Doctor of Nursing Practice

Document Type

Thesis - Open Access

Number of Pages

81 pages

Abstract

Background: Pediatric hematology/oncology patients are highly complex and providing care to these patients requires effective communication and coordination. Purpose: This project explored the perceptions of handoffs and transitions of team, at a quaternary pediatric health care system, with a descriptive, cross-sectional, non-experimental survey using convenient sampling. The goal was to identify the three top themes of team member perceptions to drive improvement efforts. Sample: 411 team members were invited to participate in survey; 124 completed the survey, a 29% participation rate. Methodology: The project employed quantitative methodology using quantitative data collection with a Likert-style survey to rank handoff experiences within the service line. Sixteen questions were divided into four domains, information, responsibility, accountability, and teamwork. The survey tool was validated by a 10 member panel of subject-matter experts. The tool exceeded Lawshe’s Content Validity Index (>0.70- 0.80) with the score 0.9375. Two open-ended questions probed barriers to handoffs, and ideal characteristics of handoffs. Data Analysis: Descriptive findings considered role, focus of work, location of work, and years of work. Nonparametric testing in SPSS used Kendall’s tau (τ), Friedman’s (χ²) ANOVA, and Cronbach’s alpha for analysis. Findings: Two strengths were identified: 1. Team members frequently consider risk to patients of harm during transitions and 2. Team members demonstrate a personal accountability to get the information in handoffs. Shared goals and shared plan of care were identified as low performers. Conflict resolution and role understanding emerged as needs from open-ended comments. Recommendation: These findings support three themes for future work to improve handoffs. The data supports developing a shared mental model of how goals and plan of care moves with the patient across the service line, and care continuum, along with clear contact information for clarification needs. Handoffs are not just about the transfer of information, there are many correlating factors that influence this process. Attending to the relationships and the team dynamics will be an important focus of this project.

Date of Award

Spring 2021

Location (Creation)

Denver, Colorado

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