Roles of Community Nurses Explained

1.0 Introduction

Community nurses are nurses who directly with the population and do their work in the community rather than in acute care hospitals. Their places of work could include; people’s homes, a community hospital, the custody suite of a police station, a care home or even a school (Barrett et al. 2016). They combine primary healthcare and nursing practice to provide preventive care, interventions, health education and health services to the communities they work in. Community nurses play different roles which are dependent on the category to which they belong. Advanced nurse practitioners are able to provide complete care for their patients based on for pillars which are research and development, clinical practice, facilitating learning and evidence and through leadership (Seymer,Almack and Kennedy, 2010). Care home nurses are those who care for persons in the people’s residential homes and those who care for persons in nursing homes. Community children’s nurses are responsible for the provision of expert care to the children in the home setting. Community mental health nurses are specialist services which support persons with mental health problems in a range of settings (Luker et al. 2000). Community learning disability nurse works to support those with learning disabilities to access necessary health attention and to support those who care for the individual such as their family members and their caregivers. Community midwife is responsible for the provision of midwifery support to women and up to 10 years old new-borns, either in the house or in the community clinic. Criminal justice nurses work with prisoners in prison to provide them with a wide range of medical services and are experts on mental and physical health (Hellesø, Fargamoen, 2010).

Community nurses are specialists in disease prevention, they aim to contain and prevent the spread of communicable diseases such as flu. Community nurses work with a variety of patients from diverse backgrounds and therefore must be very adaptable and hospitable. They must therefore be able to communicate effectively with the persons and be knowledgeable on how to explain things related to the illness to the patient and their families. The community nurse needs to explain to the care givers what they can do for the patient. The nurse must be patient in order to effectively deal with patients some whom even their speech has been interfered with following the condition. Community nursing is important to the healthcare system in that they reduce unnecessary admissions to hospital therefore availing space in those hospitals for persons who need more critical care (Luker et al. 2000). Community nursing also allows the patient to receive more patient centred dignified care and to develop close relationship with the nurse. A close relationship with the nurse is in most cases beneficial to the wellbeing of the individual. In community nursing there is more consistency in the nurse who serves the patient (Karlasson et al. 2013). Community nursing safeguards the dignity of the patient which is one of the key pillars of healthcare. This is because the community nurse is able to empathize with the patient. Since in community nursing there is a close relationship between the nurse and the patient, transitions are often challenging. The other problem faced with community nursing is the fact that there is no coordination of care or appropriate accessibility of the information on the care of the patient. This is especially so because each community nurse works independently (Meadows, 2009). There is therefore a need to improve the efficiency of care for the patients by ensuring the smooth handover from one community nurse to another through availability of the patient’s health records (Meadows, 2009). Failure in the handover of communication between healthcare professionals has been found to be detrimental for healthcare (Smeulers, Lucas and Vermeulen, 2014). They often cause the occurrence of adverse events which are not related to the natural cause of the patient’s illness and which may cause serious physical or psychological injury and may result into death. Failure of handover from one community nurse to other leads to a wasteful and poor utilization of resources. It also causes health professional a lot of time trying to recover relevant and correct pieces of information (van Sluisveld et al. 2015). The challenge of getting the right information to the right professional either within or across professional boundaries, remain a great challenge which must be addressed. Some of the consequences of poor handover include repeat of tests, delays in diagnosis and treatment, delayed and sometimes missed communication of test results, incorrect treatments and errors in medication (Manias et al. 2016).

Literature Review

Clinical Handover

This refers to the transfer of accountability and responsibility of clinically relevant information such as laboratory results, medications, referrals and discharges from one healthcare professional to another (Smeulers, Lucas,Vermeulen, 2014). Clinical handover enables the transmission of accurate information about the kind of care the patient is receiving, their treatment, their health needs, clinical monitoring assessment and evaluation and the patient’s goal plan (Alvaro et al. 2006). The information handed over should be the most current and must be unambiguous. The handover may be for just a part or the whole of the patients care. Clinical handovers occur when the patient is being admitted, transferred or discharged, when there is a change in shifts and when there are transfers between healthcare professionals. Handovers can be done on a face to face meeting, through phone and electronic handover tools (Halm, 2013). The venue can be at the patient’s bedside, a common staff area or in a reception area of a clinic or hospital. Handovers in community nursing are between an incoming and an outgoing nurse (Manser, Foster, 2011). Bedside handover enables the achievement of patient centered care and indicates that professionals in the nursing field are committed to achieving patient centered care. The patient can be involved in correcting any miscommunications occurring in the passage of information between the nurse. It also accords the patient a sense of dignity since they are being involved in creating in their care. Some patients however prefer to remain quiet during the entire handing over session (McMurray et al, 2011). In the context of bedside handing over, the nurse is engaged with patients as a reflexive, critical listener and is thus able to build a trusting relationship (Brown et al., 2006).

Patient-centred care is therefore patient-empowering, and patients are able to choose the extent of their involvement in care depending on their knowledge, preferences, abilities, and rights. The lack of widespread use of bedside handover can be attributed to the structure and function of most practice settings, where the expert model of practice is reinforced rather than partnerships between nurses and patients (McMurray et al, 2011) In most cases during the handover the outgoing nurse is in a hurry to give succinct information and leave the patient’s bedside while the incoming nurse may have lots of questions which are sometimes not well viewed by the outgoing nurse (Poletick, Holy, 2010). Another problem arises when the outgoing nurse thinks that the incoming nurse is familiar with the patient while that is not the case (Poletick, Holy, 2010). Improper clinical handover result into patient dissatisfaction, affects the flow of patients through the system negatively and increases the number of readmissions (McMurray et al, 2011). When handing overs are done verbally, the result is often lengthy, subjective, vague and speculative information. The information is in most cases inaccurate and therefore unreliable (McMurray et al, 2011). Verbal handovers have been implicated to be a major source of error with only a small percentage of information reaching a person on the end of a series of handovers (Toccafondi et al. 2012).

Models of handing over

A national model for handover of patients from one nurse to another has not yet been formulated but one of the requirements of the nursing and midwifery council is that nurses be able to effectively communicate with each other during transitions to facilitate the transfer of information from the outgoing nurse to the incoming nurse (Gordon, Findley, 2011). The models currently existing have been developed by the nurses and nursing teams (Chaboyer, McMurray and Wallis, 2010). Due to the fact that different groups of nurses or nursing teams have come up with different models, there are very many handing over models some of which re ritualistic and non-patient centred. There has however been much research on the strength and limitation of some of these models, thus leading to a solution on which models are more appropriate. One of the handover models which has been reported in literature is the REED handing over. The letters of the REED model each represent an aspect of the model. R represents record. Record requires that as the patient is given care a record must be done at the same time in a patient record which is centrally shared. Evidence requires that during handover the nurse reads the patient record to confirm that the care being stated was given. Enquire this is where the incoming nurse asks the patient questions about their needs and care in order to compare it with the existing records. The last letter of this model stands for discuss, this is where the incoming nurse holds a conversation with the outgoing nurse to make sure that nothing has been missed during the 1st three steps of the handing over. Discussion with the outgoing nurse is also important as it ensures that the incoming nurse has a correct understanding of the patient’s condition, needs and care. In this model handing over takes place in two types both at the bedside of the patient and a general safety briefing in which the whole ward is involved. This model requires that there should be a shift leader who is knowledgeable about the whole ward as identified by the rotor. The outgoing shift leader is responsible for giving the safety briefing. This safety briefing outlines the resuscitating status of each patient, any patients who are at risk of falls or infections and any safety concerns or planning constrains which should be noted by the patient’s. Individuals who are not conversant with the REED model either because they are new in the organization or have been on a long annual leave can be given an individual support by the team leader. The bedside handing over involves meeting and greeting the patient using their preferred name, a confirmation of the identity of the patient both on the wrist band and the patient’s chart to ensure they are the same, this is followed by a visual note of the physical condition of the patient, ask the patient about their care needs, read the patient’s assessment sheet to find out about the care plans and medications and lastly check whether a registered nurse has signed the completion of recent assessments. For accessibility of the care plan a daily re-documentation of the care plan is necessary. This also solves problem of time wastage in the retrieval of the care plan for the patient. The incoming nurse can then communicate the information as per their understanding to the outgoing nurse to ensure that they have understood the information as it should be understood (Tuker, Fox, 214).

The family members of the patient can also be involved during bedside handing overs. This approach improves family centered care of patients and thus fulfills the core concepts of family centered care which are sharing of information, respect and dignity, collaboration and participation (Hunt, Marsden and O’CONNOR, 2012). This approach therefore improves both patient and family satisfaction. This is important because community nurses work with patients most of whom are in their homes and thus family members and caregivers play a critical role in the management of these persons (Anderson et al. 2015). The nurse may also get very important clinical information which may have otherwise not been given by patient. The presence of a family member during bedside handover must however be authorized by the patient (Klim et al. 2013). Standard operating protocols (SOPs) are available which can improve bedside handover. SOPs outline standardized solutions, strategies and tools which are important for the efficient delivery of handover communication. The SOPs are generally based on the leading available evidence which have been formulated to advance improvements in systems and reduce the risks of causing harm to the patient (Carr, Pearson, 2005). One of the SOPs of bedside handover requires that the patient’s family be involved in the handover process if the patient agrees to the same. The involvement of family members in bedside handovers made a provision for the family members to clarify information to the patient (Carr, Pearson, 2005). In bedside handover family members are also able to easily access patient information rather than having to chase nurses around for the same information (Anderson et al. 2015). This only needs the family members to be informed on when to visit in order to catch up with the handover session. In some cases the patient is not in a good position to participate in the handing over and the participation of family members become of great advantage to the process. Involving family during bedside handovers make it easy for family members to participate in giving care to the patient (Tobiano, Chaboyer and McMurray, 2013). Bedside handover promotes patient centered care which is used in this era as an indication of quality care. In most instances family members wish to give their best to the care of the patient. Participating in bedside handovers ensures that these people are satisfied with their involvement in caring for the patient (Carr, Pearson, 2005). Discharge information is key to family members and lack of it is often seen as setback in healthcare. Bedside handovers assist in availing this information to family members. With the information on discharge family members are in a good position to plan for patient care at home (Chaboyer, McMurray and Wallis, 2010).

The conceptual framework, known as the cooperative communication model, argues that the communication between humans is based on the underlying principle of being able to create a common ground of concepts. The Common grounds include the pertinent mutual knowledge, assumptions and beliefs that are necessary for interdependent action, and an ongoing process of updating and repairing and tailoring mutual understanding. The conceptual ground is built by three skills: the ability to share, inform and request for information; the ability to jointly share one’s attention and intentions with others and the ability to construct cultural knowledge which is common to all members participating in communication. In the behavior of human being the ability to join in the action plan of others intentionally and the motivation to share information that one has possession of is biologically coded. On the other hand the ability to construct a common ground in a certain task is determined by one’s culture and can be modified. In the event that a common ground has been achieved among the group members articulated messages can be conveyed through abbreviations which may only be understood among the communicating parties.Getting a common ground in communication reduces the need for explicit communications among participants and this is very interesting. Although very important, this highly effective ‘implicit coordination’ may result into potential threats to patient safety as verbal hints and abbreviations may not be as explicit to members of different teams or members of the same team who do not share the common ground and thus may result into miscommunications (Toccafondi et al. 2012)

2.0 Purpose and Scope of Review

The aim of this research is to generally maintain the quality of health care service delivery and general practice in health care which is purposed at ensuring the continuity of care and therein meeting the goals that are required in the organizations within the hospitals. The aim of the research has also been ultimately based on the research question. The research question being what has to be done to improve the efficacy of communication between community nurses in the hand over process. The research is therein aimed and purposed at providing the best evidence- based solutions towards the improvement of such communication. This research has looked at various topics and issues relevant to the research question. In regards to meeting its purpose, the research has looked at communication in its own sense. The research has then purposefully looked at clinical practice in general. Moreover, the research has looked at the relationship that exists between general clinical practice and communication. The research has eventually focused on the effect of communication in specific clinical practice; this includes community nursing. Eventually, the research has looked at the ways in which the communication between community nurses in hand over can be improved. Towards the limitations of its scope, the research has not focused on irrelevant and non- valuable information. Research has not been conducted outside the scope of the relevancy of its information.

2.1 Search Strategy

The systematic search strategy has been used in this research. Various other research articles have been reviewed in the process. There was need to identify and distinguish specific articles that dealt with the main issue in the research topic, which was the communication between the community nurses in handing over. There was thereof need to specifically identify articles with relevant background and detailed information on the main issue. Systematically, therefore, only articles with relevant information were reviewed and acknowledged in the research.

2.2 Findings

The findings were that generally, there is need to improve the communication between the nurses in hand over. From a general perspective, there is always the need to safeguard the continuity and continuance of care. It is generally important, on that note, to meet the reporting time for the nurses and to incorporate in them both teaching and learning skills to help them develop certain skills and components necessary for quality clinical supervision (Drew, 2008)

2.3 Summary

Generally, communication in clinical practice is one of the most important and significant tools for the creation and maintenance of quality service delivery. Health care services greatly depend on communication. The parties in an effective health care cycle require communication so as to ensure the professional delivery of its services, for instance, the health care professionals have to communicate and efficiently understand the patient, in order to be able to attend to them. In the same way, and in regards to this research question, communication between the professionals themselves have to be effective so as to enable the smooth running of services.

3.0 Research Proposal, Audit or Service Evaluation

Since before time, the improvement of population health has been the sole priority of community nurses. Community nurses have been continuously working to manage and provide care services across the entire classes of persons by diagnosing, identifying and examining the effect of certain conditions and diseases in society, and even further promoting wellness and quality life across a very wide range of settings. The impact and significance of community nurses is notable across the greater part of the community. There are a number of factors necessary for the achievement of utmost quality of health care service delivery. One of the most important of these factors is effective and comprehensive communication. In a bid to improve the efficacy of the communication between the staff in hand over, this research has tackled a number of areas.

3.1 Aim and Objectives, or Research Questions

Research question: What could be done to improve the efficacy of communication in handover by community nurses?

The main purpose of this research is therefore to look at the ways in which the efficacy of communication between community nurses in hand over can be improved. In doing so, the research has tackled and looked relevant information in regards to the same. The backed up information on various relevant topics and issues have proved to be valuable and useful in the course of the research.

3.2 Methodology

Community nursing has been extensively covered in many research articles. Many writers have defined community nursing to be health care nursing that is provided anywhere else apart from in acute hospitals. Nursing in its sense is a profession ultimately aimed at providing care to communities in general, single persons, families and communities. The main encompassed purpose is usually to maintain, attain or recover optimal quality of life. In such contexts, nurses could categorically be differentiated from other professionals in the health care sector. This basically lies in their approach towards training of individuals, patient care in general and the scope of the care practice. Nurses usually have different level of authority, therein practicing in many specialties. Community health nurses, as already defined, are thereof registered nurses who are purposefully trained and equipped to work in public settings. Public settings may include places such as county and public health departments and facilities, both private and public schools, business settings and organizations and jails or prisons (Dunphy et al, 2011). In order to be able to achieve the aims and objectives of this research, qualitative and quantitative methodology has been used. Literature review has formed one of the main bases for quality and quantity research in both general and specific topics. This research has ultimately based its source of information on a number of both general and specific articles on clinical practice, community nursing and general practice in the health care sector. This method of collection of information has, in many instances, proved its validity and information herein is therefore reliable and verifiable. Utmost reliability of information is foundationally based upon the reliability of the source. I have mainly focused on meta- analysis, evaluation and meta- synthesis of literature review. This is basically the systematic form of literature review. This research has in this sense combined findings and relevant information from several articles and studies and further analyzed these information and data in systematic and standardized statistical procedures (Aveyard, 2010). This is usually the deductive method of research approach; the relationships and patterns in regards to this topic have been identified and conclusions eventually drawn. From another angle, this research has also collected and combined information based on non- statistical techniques. This basically entails the integration, evaluation and interpretation of different findings and data from multiple qualitative articles and research studies. The result is usually an inductive research- based article

3.3 Study Design

The Study designs used in this research are mainly meta- analysis and systematic review. Specifically, meta- analysis is a procedure of combining data from various individual research studies. The statistical process in the research ultimately helps this research in the combining of findings from individual studies relevant to this research question. In regards to systematic review, this research has provided and disseminated conclusive and vivid summaries of various other clinical literature. In the conduction of this research, I have critically analyzed, assessed and evaluated many research articles and studies addressing the general topic of clinical practice and the specificity of the research question. In the process, I have used specific and organized methods of assembling, collecting and evaluating several bodies of literature on the research topic using set criteria. In this research, I have described and included the findings collected from the various articles reviewed and also further included pooled quantitative data (Wanchai et al, 2010). Systematic reviews and meta- analyses in this research have been based on findings on articles and research conducted with various other study design methods. The most common ones being Randomized controlled trials, cohort studies, case reports and series, case control studies and cross- sectional studies. Randomize controlled studies or trials and clinical experiments, or rather trials that are randomly performed on accepting participants and usually into two or more groups. Generally, there are various methods in which researchers can conduct these randomize studies. This study design method may not be intensively applicable in this research question but information derived from various other research on general clinical practice that relates to and is vividly relevant to this research question is reliable. Case reports and series comprise of reports conducted on patients or any affected individuals with a certain interest in the outcome. In case reports and series, there are no control groups involved. This therefore constitute first-hand information and is therein a significant basis of information in this research.

Other study design methods also involve the use of sample observations. Sampling involves either probability or non- probability sampling.

3.4 Audit Criteria or standards/Measures of Success

Information collected in this research have attained certain quality standards and measures. The aim of the measures for criteria is to ensure the use of relevant, informative and quality information in a research article. The first step under this is to consider the laid down things to achieve from the research (National Hospital Service, 2009). The research question in this research is aimed at determining the best ways in which the efficacy of communication in handover by community nurses can be improved.

Research Question: What can be done to improve the efficacy of communication in handover by community nurses?

The research is aimed at maintaining an effective nursing practice and facilitating quality health care continuity thereby meeting the goals of an organization, which is to ultimately maintain, continue and ensure consistency and safety in the health care services provided by nurses to their patients. The methods used in the continuance of the research should then be relevant and closely related to the rationale behind the choosing of the research question. The aim of the research question usually provides a very broad structure and foundation for the audit criteria and standards to be set. Various criteria and clinical standards have been investigated in this research. A completely acceptable and relatable rationale for the audit has been basically provided. Information obtained from the many sources have been validated and verified across many other sources and the results obtained ultimately founded. Audit on these research articles, reports and many other academic writings has been done on agreed standards and academic expectations. The writers of the articles have consequently been acknowledged and the origin of the pieces of information gathered stated. Further justification has been given and even statements of locally and internationally accepted standards provided. Further analysis and investigation has also looked at the sample collections and sizes, methods of collection of data, analyses, discussions and interpretations of collected data in regards to the information of the sources used. The selections of the samples used in the conduction of different researches have to be appropriate in regard to the research question. The same is necessary for any information derived from the samples or methods used to collect the data. There are various aspects of quality in relation to the audit criteria and standards, some of which include appropriateness to the research question, the effectiveness of the information gathered, timeliness, efficiency of the collection of data, acceptability in the same regard and equity; in regards to the methods used in the collection of data (National Hospital Service, 2009).

3.5 Method/s

Systematic literature review has been the main method used in this research. The research has combined and collected information generally relevant to the research question. Nurses generally participate in the development of care plans and collaboratively work with other people to improve the quality of life; people such as therapists, physicians, doctors and foundationally the patients themselves (Ferngren, 2009). The process of the research has entailed a systematic search of relevant data and information, invaluable and informative critiques on the information collected and the basic combination of the literature reviewed to demonstrate the existing gap in the research base. Moreover, the research has both fact and opinion based information in regards to the research question. A clear depiction of understanding of both the research methods used and the information derived from such research is also evident (Aveyard, 2010). This is also known as the secondary or archival study analysis. The methods for conduction of clinical researches are usually dependent on various factors: Time is one of the most important factors to consider. For instance, qualitative methods such as the conduction of interviews and observations in as much as they help in the collection of richer, better and more reliable information, are very time- costly. On another hand, the conduction of surveys may help collect information quickly, but the information received may lack stronger and better responses or detail. In nursing and general health care practice, the utilization of practice based on evidence is very significant. Its primary and most effective goal is mainly the improvement of decision making mainly in patient interventions aimed towards the delivery of quicker and more quality care while limiting the cost (Wyatt, 2019). Information and data obtained from first hand methods of collection of data is therefore more reliable that that contained in only secondary sources. First hand methods of collection of data include such methods as observations, experimentation, sampling, interviews and conduction of surveys. These methods are in most occasions referred to as qualitative data collection methods. In an argument, qualitative methods of collection of data are not only pertinent to a specific audience, but also the general audience (Panter, 2016). In regards to the improvement of communication in hand over of community nurses, first hand methods of collecting information seem more viable.

3.6 Sample

Various research articles and reports focused on sample populations and how the community nurses in the selected settings effectively performed their duties. There were two main sampling methods referred to in the multiple research articles: Probability sampling and non- probability sampling. Probability sampling basically means sampling that effects where there is a known chance of an individual being selected. In probability sampling, the individuals sampled are sampled independently of each other. In other terms, this kind of sampling is referred to as random sampling. Under non- probability sampling, the researchers carry out their research on individuals or persons who are easiest to access. This kind of sampling is usually referred to as convenience sampling.

3.7 Analysis

The improvement of the overall quality of life, reduction of stress and promotion of wellness in both personal and professional settings ultimately depend on the use of effective inter-personal communication techniques and strategies by the professional health care workers. These mainly include the nurses, as their relationships with the patients are usually more direct (Vertino, 2014). This research has effectively explored the concept of interpersonal communication in clinical practice and its direct and indirect relationship with the hierarchy of human needs, personal variables and the impact it makes to the internal and external variables. In order to achieve its aims and objectives, the research has also discussed the causes, effects and the consequences of ineffective interpersonal communication within the care settings. Communication is generally a significant part of the daily lifestyle. In very basic terms, the very lack of communication in the world would mean non-existence in this life time. Further analysis has indicated that strong and very positive relationships between the health care professional team and the patients’ team ensures the smooth running of the health care procedure. Effective communication within healthcare settings enable the following through with medical recommendations, self- management of chronic medical conditions and the adoption of necessary health preventive behaviors (Asnani, 2009). Within the health care profession, nurses develop professional care plans, they collaborate with other professionals and the patient so as to achieve certain quality and standards of health care. Others have defined nursing to be the promotion, maintenance, optimization and protection of abilities and heath. This basic definition further includes he prevention of diseases, injury and illness, the evasion or help towards evasion of undergoing suffering through diagnoses and treatment procedures and also the promotion and advocacy of the same for individual persons, families and societies in general (Royal College of Nursing, 2014). There are generally two types of nursing practices, specific practice and general practice. Specific practice may include cardiovascular nursing, hospice palliative care nursing, gerontological nursing and community health nursing. The conduction of this research has ultimately focused on community health nursing and how communication is significant in the practice, specifically during hand over.

3.8 Validity and Reliability

The sources of information obtained in the realization of this context have been conclusively cited and acknowledged. Based on the fact that every piece of information gathered in this research is evidently backed up, the information is accordingly valid and reliable. This research has collected, integrated, evaluated and analyzed data gathered from various validated sources of information. The result of the collection has been a systematically arranged and vividly organized information base.

3.9 Ethical and Governance Considerations

In the conduction of a research, certain ethical standards have to be met. Because of the various instances in history of unethical studies in health care research, official systems that help maintain certain acceptable standards have been put in place. These official systems can however be bureaucratic and inflexible when it comes to practice. In order to account for contextual, personal, methodological and practical considerations, certain core ethical standards and principles must be flexibly applied for autonomy, prevention of harm and promotion of justice and benefit. These core ethical principles of the aforementioned aspects form the basis of professional codes of the research (Slowther et al, 2006). When looking at the ethical considerations, the research looked at the ethical issues and dilemmas that apply throughout the whole process, this ranges from having and formulation of the research question to the dissemination and reporting of research findings. In regards to governance, this research has purposively maintained high standards and quality. The same standards are inclusive of the research ethical considerations.

3.9.1 Key Ethical Issues

In light of the above, it is clear that ethical issues form a very significant component of the modern research structure. This, of course, relates to both the subject matter in the research and the researcher. Clinical research involving human participants has raised a number of concerns from members of the general public. As a result of these concerns, lawyers, policy makers, scientists and even clinicians have established certain continuously practiced standards and ethical principles when involving human participants in the researchers conducted. One of the key issues in this research, consequently, is the use of the set acceptable standards in the collection and integration of information. In the conduction of research involving human subjects, the main role of researchers is to protect the health, life, dignity, integrity, self-determination, privacy and confidentiality of personal information of the research subjects. In a nutshell, it would always be the duty of the researcher to protect and promote the inherent rights and fundamental freedoms of the research subjects (Camille et al, 2016). Therefore, the key ethical issues in this research, when it comes to any matter or method that involves human participants, have been respect, justice and fairness and beneficence.

3.9.2 Ethical approvals and governance

Regulatory involvement in clinical human research has originated from various events in clinical research. As a result of the various regulatory involvements, research involving human participants and other highlighted sectors is governed by a number of provisions and guidelines. Some studies, in regards to approval, are highlighted as involving only negligible or low risk to human subjects and researchers. For such studies, the ethics approval process is relatively easier and simpler, they always only require the completion of a brief institutional form. Ethic approval applications usually require an inclusion of a well-developed protocol for research displaying the methodology, human participants, the collection of data methods, analysis and the identified ethical issues in the research.

3.10 Costings and Timescale

In regards to the cost and time implication, the cost and time used in the conduction of this research has been moderate. Comparatively, the costs implications of medical research are one of the major concerns. Some cost variations are usually due to factors outside the control of the researchers. For instance, access to funding of core issues and items and other indirect costs usually hosted by institutions.

Discussion

Health care nursing practice

Nursing is generally a healthcare profession that is focused to providing care to individuals, their families and the societies to aid in the recovery from illnesses or/ and the maintenance of optimal and quality health and life. Nurses perform various tasks and their wide scope of practice distinguishes them from other professional health care providers. In a nutshell, nurses play an integral part in the promotion of health and the prevention of illnesses by caring for all classes of persons, even the ones with both physical and mental disabilities. Nurses are again responsible for the ongoing care of individuals who are sick and they constantly assess their health status in order to help them throughout the whole recovery process. Some of the highlighted tasks of nurses include the assistance in health care research, supervising of training and education of other nurses, the participation in the general provision of health care with the other team members, engaging in teaching of healthcare, caring for the disabled and physically and mentally challenged individuals and ultimately the promotion of health and the quality of life together with preventing illnesses. This study has considered literature which are related to handover in nursing. A few article have been found which directly relate to handing over for community nurses. It can however be noted that although there are differences in the operations of community nurses and those of nurses in the hospital setting the principles of handover remain the same with just but a few alterations. This article has considered the literature related to handovers at the bedside. The bedside handover model has been indicated. The most appropriate method of handover in nursing as evidence by numerous literature is the bedside handing over. This model is appropriate for both clinical and community nursing. It provides opportunities for the incoming nurse and the outgoing nurse to meet and discuss the patient’s care. The outgoing nurse can vividly explain to the incoming nurse about the treatment of the patient any plans of care and general patent information. The incoming nurse can then ask questions about the thing they do not understand or on points which they need much more clarification. This handing over model is also good as it offers the patient an opportunity to participate in the handing over. The patient can help the incoming nurse with any information that might have been left out by the outgoing nurse. The patient becomes more satisfied with care even though there is a change of the nurse they are able to meet the new nurse who is introduced to them by the outgoing nurse. This improves patient centered care. The family members of the patient also get an opportunity to participate in caring for the patient in this case. They can assist in giving information in case the patient is not in a position to do this.

Several methods of achieving structured handing over exist in nursing. Structured handing over can address essential information in hand over (Klim et al. 2013). Examples of tools which have been adopted in various clinical settings to achieve effective clinical handovers are ISBAR which is an acronym for introduction, situation, background, assessment and recommendation and P-VITAL which is an acronym for presenting information, vital signs, input and output, treatments, admission or discharge criteria and legal (Bose et al. 2012). A study by Wilson (2012) showed that the implementation of P-VITAL lead to a reduction of errors in emergency department because these errors could be detected early enough. The study also indicates that the use of P-VITAL is cost effective and provides opportunities for learning. Some of the concerns nurses raised with the adoption of bedside handover is the question of patient privacy. This is especially so in clinical settings but is also the case in the setting of community nursing. Patients may desire that information about their health remains as confidential as possible and bedside handovers can compromise this important aspect of healthcare. A provision should be made for the discussion of private information in a private area rather than the bedside. This however should not mean that bedside handover be abolished. Effective communication at the bedside should therefore be considered as an integral part of nursing which needs training. The review of literature has indicated that currently there is no one handing over model that works for all the cases in community nursing. Several models can be used in conjunction with each other or customized as much as better handover outcomes can be achieved. More studies which will focus on handing over in community nursing are necessary as they would help to further understand which models are more effective.

Study Limitations

Although the conduction of a research studies of certain natures affect a large number of the population, researches can seldom study the entire population. Instead, researchers have to choose a subset or a certain part of the population. This aspect of research data collection can in certain occasions result into several errors. In certain instances, discrepancies may arise between the sample population used to conduct the research and the entire population itself.

Recommendations and Dissemination

A well- recognized contributor to patient dissatisfaction and harm in care settings is ineffective communication. Various researchers have suggested that clinical hand over is a very critical point where communication problems may arise (Eggins et al, 2015). Efforts made by clinical professionals to improve communication between nurses in hand over scenarios have been hindered by the deficiency of empirical communication data when it comes to handing over. For instance, the impossibility in the determination of the practicability and effective standardization handover protocols is because of the lack of actual communicative data. In order to curb these highlighted problems therefore, it is necessary

Conclusion

An instrumental role throughout the patient’s whole health care experience is played by effective and comprehensive communication. A very large portion of the communication burden evidently falls upon the nurses. Nurses have the duty and responsibility of conveying information to a number of individuals during the health care process. They are required to be able to clearly and understandably communicate even during periods of stress and intense pressure. Nursing hand over has been defined to be the practice of conveying responsibility of care from one nurse to another. Effective communication between the nurses’ handover is essential in all cases, especially in cases that involve patients with serious illnesses or fatal conditions. In order to preserve and ensure the safety and quality of the quality of patient experience, it is best to effectively communicate during hand over by the nurses.

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