Elsevier

Journal of Biomedical Informatics

Volume 59, February 2016, Pages 76-88
Journal of Biomedical Informatics

Characterizing the structure and content of nurse handoffs: A Sequential Conversational Analysis approach

https://doi.org/10.1016/j.jbi.2015.11.009Get rights and content
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Highlights

  • We describe SCA (Sequential Conversational Analysis), a mixed-method approach.

  • SCA combines conversational analysis with temporal pattern analysis.

  • Useful for highlighting temporal relationships within verbal content.

  • SCA is used to describe relationships in nurse handoff communication.

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.

Keywords

Conversational analysis
Sequential analysis
Care transitions
Communication
Communication errors
Nurse handoffs
Intensive care
Shift report

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