A dramaturgical analysis of a paediatric team handover

Introduction: The paediatric team handover process is a crucial workplace practice and comprises the transfer of patient information from one shift to another involving medical professionals and students. A qualitative study was performed to analyse the feasibility, functionality, benefits and limitations of the dramaturgical approach when applied to examining a handover session. Methods: Data relating to one handover were collected and analysed from video and audio recordings, notes created by two independent observers and a de-identified copy of the handover sheet. Results: The dramaturgical constructs and subsequent findings allowed us to make informed inferences about the dynamics of the handover procedure. The directors/lead actors consisted of a consultant and a registrar. One consultant was transitory and the remaining 12 attendees were either major support, support or bit actors. The students (bit actors/audience) were included when a learning point was emphasised. The script was informal and improvised as the discussion emphasised certain facets of patient care or accentuated learning points. The staging involved the seating arrangement, a whiteboard, computer screen and ongoing data presentation. The performance suggested a handover of two halves: one emphasising learning and the other allocation of patient care responsibility. Conclusion: We concluded that the real-life drama occurring within a handover was feasibly analysed, with its functionality demonstrated, using the dramaturgical investigative system. The multifaceted recordings enabled researchers to review the ‘authentic’ handover system without censorship. These findings have implications for educational and organisational research.

Narrative, Written Sign-Outs and Interns' and Senior Medical Students' Confidence: A Randomized, Controlled Crossover Trial

Background Failures of communication during the transfer of patient care errors. Methods We created a new format for written sign-out material, based on aviation industry practice and cognitive psychology theory, designed to improve interns' and senior medical students' communication during transfers of patient care responsibility. We carried out a randomized, blinded, crossover trial, comparing a new, narrative, written sign-out report to a usual written sign-out. Thirty-two interns and fourth-year medical students rated their confidence across various clinical tasks and answered clinical questions regarding hypothetical patients presented to them in written, new, narrative sign-out compared with the customary format. Results There was no statistical difference in confidence when interns and senior medical students received usual versus narrative sign-outs. Conclusions Although a limited measure suggested some improvement in competence, the narrative format did not improve participants' self-rated confidence during patient-care transfer.

FURTHER COMMENTS

This is Dr. Wilson's wisdom, and–better still–the Wilson touch. It is this touch which is the essence of pediatrics and few could express it as simply and clearly as Dr. Wilson. From the vantage point of one who has spent most of his career dealing with issues on a community basis, I would like to add a few reactions. The first is the slightly sad reflection that part of this learning experience was hidden from Dr. Wilson until he had left Academia and research. It is not as if the kind of role which the public health nurse later filled with Dr. Wilson, the practitioner, did not exist 30 years ago. Public health nurses have performed this role for many years. Unfortunately, their contribution to child health care was excluded–perhaps even downgraded and scorned–by many of the hospital-trained and biomedically oriented professors of the times and by the generation of practitioners who were exposed to the models of their preceptors. I can remember the early impression of Dr. Wilson's humane perfectionism upon me very well. He approached children and families with the same innate understanding of the psychosocial aspects of health and disease that graces his words today. But would he have considered delegating responsibility, or working as a "team member," to formulate a joint plan in the past? In fact, I believe he once expressed himself against the whole concept of "team care" as divisory of patient care responsibility. The other reaction is to reinforce Dr. Wilson's emphasis on the contribution of the nurse to the quality of patient care rather than to increasing the numbers of patients seen.