The Effect of an Interprofessional Delivery Program on the Quality of Safe Care of Nurses in the Field of Patient Handoff to the Intensive Ward in the Selected Hospital in 2023: a quasi-experimental study

The Effect of an Interprofessional Delivery Program on the Quality of Safe Care of Nurses in the Field of Patient Handoff to the Intensive Ward in the Selected Hospital in 2023: a quasi-experimental study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of an Interprofessional Delivery Program on the Quality of Safe Care of Nurses in the Field of Patient Handoff to the Intensive Ward in the Selected Hospital in 2023: a quasi-experimental study Fatemeh Saleh, Marzieh Pazokian, Mohammad Reza Haji Esmaili This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6001655/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and aim : The quality of safe care is one of the major concerns of nurses. The importance of transmitting the patient from the number of disasters and preventable events caused by poor communication between the people of the health team revealed, thus standardizing the delivery process is a tool to ensure the transfer of the high quality care process. The purpose of this study is to determine the impact of the Inter -Professional Delivery Program on the quality of safe care of nurses in the area of delivery of patients to the special department in selected Shahid Beheshti hospitals in 1402. Methods: This quasi -experimental study was held as a group before and after the nurses' selection and through inter -sector delivery training for three weeks in three separate sessions in WhatsApp social space. To collect data from Rashvand et al. (2015) (nursing skills evaluation, mental safety evaluation, physical safety evaluation, teamwork evaluation), Demographic Information Questionnaire, Patient Physiological Information Form, Checklist of duties of the delivery and reception nurse of the intensive care unit and the checklist of the Aid Assistance Duties were approved by a number of professors and supervisors of Shahid Beheshti University of Medical Sciences. To compare the scores before and after the intervention, if the normal data distribution was distributed, paired t-tests was used and otherwise the Wilkaxon test was used. The data analysis was done by SPSS software version 19. Results: A total of 70 special care nurses participated in the study. They were examined for age, employment history, gender, marital status, educational background, position, overall work history, work experience in a specialty, and history of taking courses on safe quality. The mean and standard deviation for intensive care unit delivery and receiving nurse before and after the test increased significantly. The score of the safe care quality questionnaire after the interprofessional delivery training program increased significantly compared to before the training program (P value < 0.05). Conclusion: Based on the results, the interprofessional handover program affects the quality of safe care for nurses. The score of the quality of safe care questionnaire was higher after the training program than before the program, and all dimensions of the quality of safe care questionnaire for nurses improved significantly. The difference before and after in the dimension of measuring nursing skills, assessing physical safety, assessing psychological safety, assessing teamwork, and in the total score increased, and the highest average score was related to the dimension of measuring nursing skills and the lowest score was related to the dimension of assessing psychological safety, and the results were statistically significant. Therefore, preparing a standard checklist for interdepartmental handovers is necessary to improve the quality of safe care for nurses in the special ward. Trial registration: It was registered under the clinical trial registration code IRCT 4 ID IRCT20231015059729N1. 4 Iranian Registry of Clinical Trials Interprofessional Handoff Intensive Care Unit Nursing Safe Care Patient Handoff Figures Figure 1 1. Introduction 1.1. Background The health care system needs to expand effective concepts in the care and treatment of patients, the achievement of which requires having key competencies such as effective communication, teamwork, and interprofessional collaboration between health care professionals (1). Interprofessional communication and communication with the patient, leads to awareness and recognition of the issues and problems of the patient and colleague (2). American hospitals lose more than 12 billion dollars annually due to inadequate communication (3). One of the times when information is exchanged is during the handing over of nurses' work shifts (4). Delivery is an important communication process among nurses that has an important impact on the quality and continuity of nursing care (5). Patient delivery is one of the top five priorities of the World Health Organization (1). Many countries, such as Belgium, the United Kingdom, China, Northern Ireland, the Netherlands, and Switzerland, have established national or regional standards for effective delivery (6). The methods of delivering the patient are always changing and are delivered face-to-face, using audio recorders and computers, however, these methods are mainly carried out in the nursing station or conference room, away from the patient's bedside and his or her participation (7). Oral delivery depends more on the way of communicating and presenting information, in which much of the information may be forgotten and not transferred leading to medical errors (8). According to the American Safety Committee, the weak transfer of information in the delivery process is the cause of 65% of irreparable accidents and background factors of 90% of them (9). An analysis of 750 deliveries in the PACU[5] post anesthesia care unit showed that many deliveries had insufficient and forgotten information (10). Twenty-four percent of nurses and 39% of doctors evaluate deliveries as ineffective and inconsistent (11). The main risk factors for ineffective delivery include lack of standard procedures, time pressure, discontinuities, unfavorable environment, multiple responsibilities, insufficient feedback between sender and receiver, and lack of safety culture (12). Inadequate delivery accounts for approximately 80% of side effects, along with significant costs for healthcare organizations (13). One study revealed that a standardized checklist reduced the time required to complete the delivery process and simultaneously reduced omission errors (14). Additionally, the implementation of a standardized checklist improved intraoperative deliveries by 43% and significantly reduced the total number of deliveries that were called incomplete (14). Standardizing the shift delivery process plays an important role in transferring high-quality care (15). Approximately one-third of healthcare costs are associated with the low quality of care provided (16). A global report in 2018 showed that between 4.8-7.5 million deaths occurred annually due to poor quality of care in low- and middle-income countries (17). Nurses spend the most time with patients and play an important role in ensuring the quality of safe care (18). The key themes of the quality of nursing care include achieving physical needs, providing psychosocial support, ensuring that the mental and spiritual needs of patients are paid attention to and their satisfaction with care, providing responsive and responsible nursing care to the needs of patients and ensuring that comprehensive care is provided. and is a holistic view of the patient (19). Empirical documentation showed that poor nursing performance was associated with increased reported missed nursing care and increased missed care with reported quality of nursing care and patient safety, adverse events, and mortality (20). Among the most sensitive departments of hospitals where nurses play an important role are intensive care units (21). Working in an intensive care unit puts more stress on nurses and affects the quality of their care (22). For intensive care unit nurses, accurate transmission of information with complete details is necessary to ensure the safe care of patients (4). It has been Reported that implementing a standardized handoff tool and process with interdisciplinary and interdepartmental collaboration improved critical patient transitions from the operating room to the NICU[6] (23). Effective communication during handover leads to the prevention of patient harm and improves the quality of care provided. Therefore, appropriate interprofessional collaboration affects effective handover and, consequently, the quality of safe patient care. Safe patient care is of great importance because it affects the quality of patient care, and to achieve this goal, interprofessional handover plays an important role in patient safety. It was also observed in the wards that some colleagues received their patients from behind the nursing station and, for example, without checking the patient for pressure ulcers or other issues, while a good handover ensures consistency and efficiency of nursing actions, makes the nurse understand the patient's needs, facilitates the care cycle, and ensures a safe and effective transfer of patient responsibilities between different nurses. Therefore, considering the gaps in standardized interprofessional collaboration for safe clinical handover of patients to different departments and the lack of a standard method of interprofessional collaboration in the field of safe clinical handover between medical staff and the necessity and need for an interdepartmental handover protocol, the research team understood the gap in interprofessional training to improve the quality of care provided in the field of handover, and therefore the members of the research team decided to promote interprofessional collaboration by providing a developed program for safe patient handover and prevent non-standard patient handover. Therefore, given the importance of the impact of interprofessional handover on the quality of safe patient care and the problems that were observed, this study sought to investigate this issue. [5] Post-anesthesia care unit [6] Neonatal intensive care unit 2. Materials and methods 2.1. Study design A quasi-experimental study was conducted with a pre-and post-intervention design (Figure 1). 2.2. Study environment and participants Intensive care unit of the selected hospitals of Medical Sciences in Tehran. The research population in the present study includes the content of interdepartmental handover reports of nurses present in special wards of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences. The inclusion criteria for reports during the delivery of nurses included the delivery of patients at the patient's bedside, and the delivery of nurses in the morning and evening shifts. The criteria for nurses to enter the research included having at least six months of work experience in a special department and one year of clinical experience, having delivered or delivered at least one patient in different shifts, and the willingness and full satisfaction of nurses to complete demographic information and participate in the study The criteria for excluding reports included reports of deliveries that were made during the night shift and Nurses should not be transferred or take leave or getting sick during the study. 2.3. Sample size The minimum required sample is 59 people. Considering a 10% drop in the sample size, the number of nurses is 65, and a 20% drop in the sample size is 70. It should be noted that two reports were submitted for each nurse, so the volume of the reviewed reports was at least 118. 2.4. Study Tools The tools that used in this study included a demographic information questionnaire that Including age, employment history, gender, marital status, educational background, position, overall work history, work experience in a specialty, and history of taking courses on safe quality care., the Safe Nursing Care Assessment Tool (ASNC) by Rashvand et al. Includes 32 items, 4 sections: assessment of nursing skills, assessment of psychological safety, assessment of physical safety, and assessment of teamwork and The questions are based on a Likert scale with option 5 always and option 1 never. The highest score is 365 and the lowest score is 73, which includes a range of poor performance (73 to 170), average performance (171 to 267), and desirable performance (268 to 365). A higher score indicates desirable performance of safe nursing care, researcher-made tools including the patient physiological assessment form that includes 27 sections including patient safety, determining the level of care, severity of the patient's condition, vital signs, pain assessment, patient's motor status, neurological assessment, cardiovascular system assessment, respiratory system assessment, skin assessment, digestive system assessment, urinary system assessment, patient fall risk assessment, etc., a checklist of tasks for the nurse delivering and receiving in intensive ward which include 14 and 18 statements respectively and in the form of yes or no. In order to validate the content of the forms and checklists mentioned, three supervisors and seven faculty members of the nursing school were given the questionnaires, and the content validity was examined qualitatively and quantitatively, and the reliability was confirmed through Cohen's kappa coefficient of 0.75 for the deliverer's checklist and 0.72 for the recipient's checklist. 2. 5 . Study procedures 2.5.1. Consent and confidentiality process After receiving the letter of introduction from the honorable vice-chancellor of the Faculty of Nursing and Midwifery, the researcher presented the letter of introduction to the president and director of the hospital and the director of nursing services to the selected centers and obtained the written consent from the respective centers. Informed written consent was obtained from the ward nurses to record their voice during interdepartmental delivery and completion of the demographic information questionnaire, and written consent was also obtained from the patients to record and convey their condition. 2.5.2. Intervention After obtaining permission from the Institutional Ethics Committee of the Faculties of Pharmacy, Nursing and Midwifery-Shahid Beheshti University of Medical Sciences (IR.SBMU.PHARMACY.REC.1402.112) and Obtaining the Iranian Clinical Trial Approval Code (IRCT20231015059729N1), submitting a letter of introduction to the research environment officials at Loghman Hospital and obtaining the necessary permits, by visiting the research environment, eligible participants were selected after introducing themselves, explaining the purpose of the study and obtaining written consent from them, using the convenient (accessible) sampling method while evaluating the necessary criteria for participation in the study. The researcher, while introducing himself to the research units, explained the objectives of the study and resolved existing questions and ambiguities. Then, the quality of safe care of nurses was completed by the Rashvand et al. (2015) questionnaire (nursing skills assessment, psychological safety assessment, physical safety assessment, teamwork assessment) by the head nurses for the nurses working in the desired departments. The sample under study is the inter-departmental handover reports of nurses working in intensive care units in selected hospitals of Shahid Beheshti University of Medical Sciences. After obtaining the consent of the head nurse, relevant departments, and the officials of each shift and obtaining written informed consent from the ward nurses to record their voices during inter-departmental handover and completing the demographic information questionnaire, the number of inter-departmental handovers in the morning and evening shifts in the special wards will be recorded. The researcher, having a list of the names of the inter-departmental handover patients, was present in the relevant wards and recorded the process of handover and handover of the patient from the special wards to the operating room or other wards and vice versa by the nurses and nursing assistants, and this process continued until the sample was completed. Written consent was obtained from the patients to record their handover. With the help of checklists, the nurses' handover methods were checked and recorded, and non-observed items were listed for interprofessional training. Subsequently, considering the need for interdepartmental handover, a training program was developed and the content approved by several supervisors and professors of the School of Nursing was held in several virtual training workshops. After three months, the quality of safe care was re-measured and compared. During this period, the researcher inspected the interdepartmental handover process in different shifts and notified the nurses if there were any problems. Virtual interdepartmental handover training sessions were held for three weeks in three separate sessions on the WhatsApp social space. During each session, explanations were provided for each chapter of the training manual in the form of audio files and sample questions for evaluation (Table1). Descriptive statistics (frequency, frequency percentage, mean, and standard deviation) were used for data analysis, and inferential statistics (paired t) were used to determine significance. SPSS version 19 software was used to analyze the data . 2.5.3. Harms Our study did not show any harmful effects after the mentioned intervention. 3. Results Seventy nurses participated in the study. 64.3% of them were women and 35.7% of them were men. Their average age was (32.97 ± 6.68). Their average employment history was (5.95±9.24). 45.7% of them were single and 54.3% of them were married and Half of the participants had completed safe care quality courses (Table 2,3,4,5,6). The next table shows the results of the check list of receiver delivery nurses before and after the educational intervention. Paired t-test was used to interpret the data. After the educational intervention, there was a statistically significant difference (Pvalue < 0.05). After the intervention, the difference in the average score of the total check list of the receiver delivery nurses was significant (Pvalue<0.001). The mean total score for receiver delivery nurses increased significantly from pre-test to post-test. The total difference between before and after was 21.900 and we had a change in both the average and the standard deviation in each part, which indicates that we have reached the goals (Table 7). The next table shows the results of the check list of delivery nurses before and after the educational intervention. Paired t-test was used to interpret the data. In this part, there is a significant difference between the scores obtained and it means that the total score has increased after the intervention. Among the participants after the training program was 42.73 compared to before the training program was 24.06, the difference between the two time periods was 18.671 (Table 8). In the next table, it can be seen that all dimensions of the quality questionnaire of nurses' safe care were significantly improved. The score of the safe care quality questionnaire after the training program (133.93 ± 18.231) was higher than before the program (130.49 ± 19.832). In the measurement of nursing skills, the difference before and after was 2.17, in the dimension of mental safety assessment, the difference between before and after was 0.4, in the dimension of physical safety, the difference between before and after was 0.357, in the dimension of team work assessment, we had 0.514 and in the total score section, we had an increase of 3.443. It was statistically significant (Pvalue<0.001) (Table 9). 3.3. Data analysis Descriptive statistics (frequency, frequency percentage, mean and standard deviation) were used to analyze the data, and paired t-tests were used to compare the scores before and after, due to their normality. Data analysis was performed with SPSS version 19 software by the respected professor of statistics. 3.4. Data interception At this time, the committee will not monitor certain data. However, to satisfy quality control requirements, researchers will conduct periodic data reviews until the end of the study. 3.5. Access to data The researcher, supervisor and statistical consultant will have access to the information. which is used only for data analysis purposes. 4. Discussion The aim of the present study, was to investigate the impact of an interprofessional delivery programme on the quality of safe care provided by nurses in the field of patient delivery to special departments in selected hospitals. We intend to improve this process. This study aimed to improve the quality of safe care provided by nurses in the area of patient delivery .In the present study, the average quality of safe nursing care was reported before the intervention. Nurses in the special wards of Loghman Hakim Hospital had a poor performance level in assessing the quality of safe nursing care before the intervention, which could be because clinical nurses did not use any tools to evaluate their own and their colleagues' performance and identify weaknesses in their performance.The highest level of performance in the dimensions of quality of safe nursing care before the intervention was reported for the nursing skills assessment dimension, physical safety assessment, Team performance assessment, and psychological safety assessment dimension, respectively. The average quality of safe nursing care was reported after the intervention. Nurses in the special wards of Loghman Hakim Hospital had a poor performance level in assessing the quality of safe nursing care after the intervention. The highest level of performance in the dimensions of safe nursing care quality was reported in the nursing skills assessment, physical safety assessment, Team performance assessment, and then psychological safety assessment, respectively.The results obtained had improved compared to before the intervention, but the nurses' performance level still showed a poor score. The results of the present study show that the intervention improved the quality of safe nursing care, and the results of the present study were significant. Other factors that affected the study results included failure to prioritize patient needs, fatigue and burnout, failure to share concerns with other nurses, development and implementation of self-made care routines, failure to pay attention to the importance of initial assessment, failure to monitor staff performance, need for more and sufficient time to implement the protocol, lack of sufficient cooperation from the nurse in front of the patient during handover, nurses' work experience, such that nurses with less work experience relied more on using the tools, reliance on their previous knowledge, etc. According to a review of the literature, , in most studies, the ISBAR[7] and SBAR[8] methods were used for delivery, for example, in the 2021 study, Krisna Yeti et al. used the SBAR tool for the delivery process and mentioned only limited aspects of the actions taken before, during and after delivery. The purpose of the present study were consistent with Olufemi Olawale study in 2024 so that The project was focused on educating staff on standardized communication tools to ensure patient information is transferred effectively and efficiently in the organization (24). Also in Citra Suraya et al. 2024 study Team STEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) effectively increases the patient safety culture, as evidenced by improved communication, handoffs, transitions, and a decreased frequency of reports regarding side effects (25). Similar to our findings, a standardized tool can contribute to different aspects of safe care For example, the study of Veronica Chaica et al. 2024 states that the results obtained highlighted four main aspects that underpin the usefulness of ISBAR as a tool for interprofessional and standardized communication (26). It was also concluded in the study of Sophia Agbomah et al. 2024 that it is possible to improve completeness, duration, and satisfaction through use of a standardized hand-off reference tool (27).In contrast to the present study in Marit Hegg Reime et al. study There were no significant improvements from baseline to post-intervention regarding adherence to the ISBAR communication scoring tool (28). The limitations of this study include the lack of studies conducted on interprofessional handover and the quality of safe care in the field of handover, limitations in comparing the results of the study with similar studies, and since this study was conducted only within the special wards of selected Shahid Beheshti hospitals, the generalizability of its results to other wards and hospitals is challenging. Also, the type of ward and intensive workload can cause limitations. [7] Identify, Situation, Background, Assessment and Recommendation [8] Situation, Background, Assessment and Recommendation 5. Conclusion The findings of the present study showed that the interprofessional handover program can affect the quality of safe care provided by nurses in the area of handover of patients to the special ward in fact, the results of our study showed one of the factors affecting the quality of safe care. The present study aims to create a holistic care perspective in intensive care unit nurses with the aim of improving their ability to identify and meet the comprehensive needs of patients, providing optimal care and achieving the highest level of health. This study also focused on the importance and necessity of using standard tools for interdepartmental handoffs. Nurses and nursing managers are the largest group of healthcare workers and are the foundation of the quality of care improvement process. Identifying errors and determining patient safety enhancement opportunities in every organization should be considered as the first step in planning. Nursing managers can take important steps in this area by managing situations that lead to reduced quality of care, addressing educational needs and improving the quality of care in nurses with in-service training programs for nurses, and identifying performance barriers in the area of safe quality of care. 6. Suggestions for future research · Studies should be conducted to provide solutions and implement various interventions to increase the quality of safe care in the performance of nurses. · Studies should be conducted on various dimensions of the quality of safe nursing care. · Studies should be conducted on existing interprofessional handover programs and their relationship to the level of quality of safe nursing care. · Studies should be conducted to investigate the impact of various dimensions of nurses' psychological and physiological health on the quality of safe nursing care. 7. Research limitations · Due to the lack of studies conducted regarding interprofessional handover and the quality of safe care in the field of handover, there are limitations in broadly comparing the results of the study with similar studies. · Since this research is conducted solely within the special wards of selected Shahid Beheshti hospitals, the generalizability of its results to other wards and hospitals is challenging. · The type of department and intensive workload can cause limitations. List of abbreviations IRCT, ISBAR, SBAR, PACU, NICU Declarations Acknowledgements The authors express their gratitude to the Clinical Research Development Unit of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, for their support and cooperation during the study. This study was reviewed by the Ethics Committee of Shahid Beheshti University of Medical Sciences with the ethics code IR.SBMU.PHARMACY.REC.1402.112. It was also registered under the clinical trial registration code IRCT ID IRCT20231015059729N1. ORCID iD was 0009-0008-2038-8205. Trial Id 73176 IRCT Id IRCT20231015059729N1 Registration date 2023-10-25, 1402/08/03 Membership number 59729 Availability of data and materials All supplementary materials, including additional figures and methods, are provided in the online supplementary files. For any inquiries regarding access to the data, please contact the corresponding author at [ [email protected] ] Conflict of interest No potential conflicts of interest were reported by the author(s). Funding This study received financial support from the Department of Shahid Beheshti University of Medical Sciences . Ethical Considerations After selecting the nurses for the current study and explaining how to use this information, they were assured that the information obtained from them would be confidential . All subjects were asked to provide informed consent before participating in the study. Code of Ethics IR.SBMU.PHARMACY.REC.1402.112 Consent for publication we confirm that all authors have given their consent for the publication of this manuscript . Author Contributions: Conceptualization: M.P Data curation: F.S Methodology: M.P Supervision: M.P M.H Writing original draft: F.S References Desmedt M, Ulenaers D, Grosemans J, Hellings J, Bergs J. Clinical handover and handoff in healthcare: a systematic review of systematic reviews. International Journal for Quality in Health Care. 2021;33(1):mzaa170. Keshmiri F, Hosseinpour A. The Correlation between Perception of Patient Safety and Professionalism and Adherence to Interprofessional Professionalism among Members of the Surgical Team. Journal of Medical Education and Development. 2022. Hua Y, Becker F, Wurmser T, Bliss-Holtz J, Hedges C. Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety. HERD: Health Environments Research & Design Journal. 2012;6(1):8-38. 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EFFECTIVE COMMUNICATION IN NURSING: A COMPREHENSIVE SYSTEMATIC REVIEW OF BEST PRACTICES. Journal Of Nursing Science Research. 2024;1(1):34-48. Chaica V, Marques R, Pontífice-Sousa P, editors. ISBAR: A Handover Nursing Strategy in Emergency Departments, Scoping Review. Healthcare; 2024: MDPI. Agbomah S, Summers S. Implementation of a Standardized Handoff Reference Tool from the Intensive Care Unit to the Operating Room. 2024. Reime MH, Tangvik LS, Kinn-Mikalsen MA, Johnsgaard T. Intrahospital Handovers before and after the Implementation of ISBAR Communication: A Quality Improvement Study on ICU Nurses’ Handovers to General Medical Ward Nurses. Nursing Reports. 2024;14(3):2072-83. Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6001655","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":417920851,"identity":"1a6ba5d9-0a16-4448-88e0-2054c2e799cd","order_by":0,"name":"Fatemeh Saleh","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Saleh","suffix":""},{"id":417920852,"identity":"de8e4712-3ecd-4925-be2b-f5f2f27fffa4","order_by":1,"name":"Marzieh Pazokian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYJACxgYDBgZ+Bh4ol5lYLZINpGkBEgYHeAipgwJz9uMPH84osMszPn/26GYeBjt5BnbeB3i1WPYkJBtuMEguNruRl3abhyHZsIGZ3QCvFoMDCcckHxgwJ267wWMG1MKcwMDMht9hBucftgG11Cdu7j8D0lJPhJYbyWySGwwOJ25gyAFpOUxYi+WMZ8yGMwyOJ84A+uXmHIPjhm2EtJjzpz982POnOrG//+yxG28qquX5+Y8RcBgGl4AdGFpGwSgYBaNgFGABAHu1P6UCTkxdAAAAAElFTkSuQmCC","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Marzieh","middleName":"","lastName":"Pazokian","suffix":""},{"id":417920853,"identity":"d7c3dc00-f8b6-4728-8449-577b4bac8ec8","order_by":2,"name":"Mohammad Reza Haji Esmaili","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Reza Haji","lastName":"Esmaili","suffix":""}],"badges":[],"createdAt":"2025-02-10 19:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6001655/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6001655/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77293668,"identity":"7ec96339-39cd-4e5d-a00e-16ee723c239b","added_by":"auto","created_at":"2025-02-27 06:55:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28178,"visible":true,"origin":"","legend":"\u003cp\u003eStudy process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6001655/v1/4389cfaa302f7b35870819a4.png"},{"id":77293940,"identity":"ef84e408-65dc-4906-9f33-7aaed0721964","added_by":"auto","created_at":"2025-02-27 07:03:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":626284,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6001655/v1/a3459ba7-6a14-4929-8abd-dc19d7f1d693.pdf"},{"id":77293670,"identity":"044dc51b-4d5a-44d8-b94b-595f8c284df8","added_by":"auto","created_at":"2025-02-27 06:55:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23202,"visible":true,"origin":"","legend":"","description":"","filename":"additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6001655/v1/904400e6320701d6c97b2782.docx"},{"id":77293669,"identity":"a7dbf743-12f4-45d3-8d38-95944a54ebe9","added_by":"auto","created_at":"2025-02-27 06:55:34","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":22537,"visible":true,"origin":"","legend":"","description":"","filename":"tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6001655/v1/ec61a41ecfc4a526ea5749e0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of an Interprofessional Delivery Program on the Quality of Safe Care of Nurses in the Field of Patient Handoff to the Intensive Ward in the Selected Hospital in 2023: a quasi-experimental study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e\u003cstrong\u003e1.1. Background\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe health care system needs to expand effective concepts in the care and treatment of patients, the achievement of which requires having key competencies such as effective communication, teamwork, and interprofessional collaboration between health care professionals (1). Interprofessional communication and communication with the patient, leads to awareness and recognition of the issues and problems of the patient and colleague (2). American hospitals lose more than 12 billion dollars annually due to inadequate communication (3). One of the times when information is exchanged is during the handing over of nurses\u0026apos; work shifts (4). Delivery is an important communication process among nurses that has an important impact on the quality and continuity of nursing care (5). Patient delivery is one of the top five priorities of the World Health Organization (1). Many countries, such as Belgium, the United Kingdom, China, Northern Ireland, the Netherlands, and Switzerland, have established national or regional standards for effective delivery (6). The methods of delivering the patient are always changing and are delivered face-to-face, using audio recorders and computers, however, these methods are mainly carried out in the nursing station or conference room, away from the patient\u0026apos;s bedside and his or her participation (7). Oral delivery depends more on the way of communicating and presenting information, in which much of the information may be forgotten and not transferred leading to medical errors (8). According to the American Safety Committee, the weak transfer of information in the delivery process is the cause of 65% of irreparable accidents and background factors of 90% of them (9). An analysis of 750 deliveries in the PACU[5] post anesthesia care unit showed that many deliveries had insufficient and forgotten information (10). Twenty-four percent of nurses and 39% of doctors evaluate deliveries as ineffective and inconsistent (11). The main risk factors for ineffective delivery include lack of standard procedures, time pressure, discontinuities, unfavorable environment, multiple responsibilities, insufficient feedback between sender and receiver, and lack of safety culture (12). Inadequate delivery accounts for approximately 80% of side effects, along with significant costs for healthcare organizations (13). One study revealed that a standardized checklist reduced the time required to complete the delivery process and simultaneously reduced omission errors (14). Additionally, the implementation of a standardized checklist improved intraoperative deliveries by 43% and significantly reduced the total number of deliveries that were called incomplete (14). Standardizing the shift delivery process plays an important role in transferring high-quality care (15). Approximately one-third of healthcare costs are associated with the low quality of care provided (16). A global report in 2018 showed that between 4.8-7.5 million deaths occurred annually due to poor quality of care in low- and middle-income countries (17). Nurses spend the most time with patients and play an important role in ensuring the quality of safe care (18). The key themes of the quality of nursing care include achieving physical needs, providing psychosocial support, ensuring that the mental and spiritual needs of patients are paid attention to and their satisfaction with care, providing responsive and responsible nursing care to the needs of patients and ensuring that comprehensive care is provided. and is a holistic view of the patient (19). Empirical documentation showed that poor nursing performance was associated with increased reported missed nursing care and increased missed care with reported quality of nursing care and patient safety, adverse events, and mortality (20). Among the most sensitive departments of hospitals where nurses play an important role are intensive care units (21). Working in an intensive care unit puts more stress on nurses and affects the quality of their care (22). For intensive care unit \u0026nbsp;nurses, accurate transmission of information with complete details is necessary to ensure the safe care of patients (4). It has been Reported that implementing a standardized handoff tool and process with interdisciplinary and interdepartmental collaboration improved critical patient transitions from the operating room to the NICU[6] (23). Effective communication during handover leads to the prevention of patient harm and improves the quality of care provided. Therefore, appropriate interprofessional collaboration affects effective handover and, consequently, the quality of safe patient care. Safe patient care is of great importance because it affects the quality of patient care, and to achieve this goal, interprofessional handover plays an important role in patient safety. It was also observed in the wards that some colleagues received their patients from behind the nursing station and, for example, without checking the patient for pressure ulcers or other issues, while a good handover ensures consistency and efficiency of nursing actions, makes the nurse understand the patient\u0026apos;s needs, facilitates the care cycle, and ensures a safe and effective transfer of patient responsibilities between different nurses. Therefore, considering the gaps in standardized interprofessional collaboration for safe clinical handover of patients to different departments and the lack of a standard method of interprofessional collaboration in the field of safe clinical handover between medical staff and the necessity and need for an interdepartmental handover protocol, the research team understood the gap in interprofessional training to improve the quality of care provided in the field of handover, and therefore the members of the research team decided to promote interprofessional collaboration by providing a developed program for safe patient handover and prevent non-standard patient handover. Therefore, given the importance of the impact of interprofessional handover on the quality of safe patient care and the problems that were observed, this study sought to investigate this issue.\u003c/p\u003e\n\u003cp\u003e[5] Post-anesthesia care unit\u003c/p\u003e\n\u003cp\u003e[6] Neonatal intensive care unit\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA quasi-experimental study was conducted with a pre-and post-intervention design\u0026nbsp;(Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Study environment and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntensive care unit of the selected hospitals of Medical Sciences in Tehran.\u0026nbsp;The research population in the present study includes the content of interdepartmental handover reports of nurses present in special wards of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences. The inclusion criteria for reports during the delivery of nurses included the delivery of patients at the patient's bedside, and the delivery of nurses in the morning and evening shifts. The criteria for nurses to enter the research included having at least six months of work experience in a special department and one year of clinical experience, having delivered or delivered at least one patient in different shifts, and the willingness and full satisfaction of nurses to complete demographic information and participate in the study The criteria for excluding reports included reports of deliveries that were made during the night shift and Nurses should not be transferred or take leave or getting sick\u0026nbsp;during the\u0026nbsp;study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Sample size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe minimum required sample is 59 people. Considering a 10% drop in the sample size, the number of nurses is 65, and a 20% drop in the sample size is 70. It should be noted that two reports were submitted for each nurse, so the volume of the reviewed reports was at least 118.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Study Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe tools that used in this study included a demographic information questionnaire that Including age, employment history, gender, marital status, educational background, position, overall work history, work experience in a specialty, and history of taking courses on safe quality care., the Safe Nursing Care Assessment Tool (ASNC) by Rashvand et al.\u0026nbsp;Includes 32 items, 4 sections: assessment of nursing skills, assessment of psychological safety, assessment of physical safety, and assessment of teamwork and The questions are based on a Likert scale with option 5 always and option 1 never. The highest score is 365 and the lowest score is 73, which includes a range of poor performance (73 to 170), average performance (171 to 267), and desirable performance (268 to 365). A higher score indicates desirable performance of safe nursing care, researcher-made tools including the patient physiological assessment form that includes 27 sections including patient safety, determining the level of care, severity of the patient's condition, vital signs, pain assessment, patient's motor status, neurological assessment, cardiovascular system assessment, respiratory system assessment, skin assessment, digestive system assessment, urinary system assessment, patient fall risk assessment, etc., a checklist of\u0026nbsp;\u0026nbsp;tasks for the nurse delivering and receiving in intensive ward which include 14 and 18 statements respectively and in the form of yes or no. In order to validate the content of the forms and checklists mentioned, three supervisors and seven faculty members of the nursing school were given the questionnaires, and the content validity was examined qualitatively and quantitatively, and the reliability was confirmed through Cohen's kappa coefficient of 0.75 for the deliverer's checklist and 0.72 for the recipient's checklist.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e. Study procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.1.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent and confidentiality process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter receiving the letter of introduction from the honorable vice-chancellor of the Faculty of Nursing and Midwifery, the researcher presented the letter of introduction to the president and director of the hospital and the director of nursing services to the selected centers and obtained the written consent from the respective centers. Informed written consent was obtained from the ward nurses to record their voice during interdepartmental delivery and completion of the demographic information questionnaire, and written consent was also obtained from the patients to record and convey their condition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.2. Intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter obtaining permission from the Institutional Ethics Committee of the Faculties of Pharmacy, Nursing and Midwifery-Shahid Beheshti University of Medical Sciences (IR.SBMU.PHARMACY.REC.1402.112) and Obtaining the Iranian Clinical Trial Approval Code (IRCT20231015059729N1), submitting a letter of introduction to the research environment officials at Loghman Hospital and obtaining the necessary permits, by visiting the research environment, eligible participants were selected after introducing themselves, explaining the purpose of the study and obtaining written consent from them, using the convenient (accessible) sampling method while evaluating the necessary criteria for participation in the study. The researcher, while introducing himself to the research units, explained the objectives of the study and resolved existing questions and ambiguities. Then, the quality of safe care of nurses was completed by the Rashvand et al. (2015) questionnaire (nursing skills assessment, psychological safety assessment, physical safety assessment, teamwork assessment) by the head nurses for the nurses working in the desired departments. The sample under study is the inter-departmental handover reports of nurses working in intensive care units in selected hospitals of Shahid Beheshti University of Medical Sciences. After obtaining the consent of the head nurse, relevant departments, and the officials of each shift and obtaining written informed consent from the ward nurses to record their voices during inter-departmental handover and completing the demographic information questionnaire, the number of inter-departmental handovers in the morning and evening shifts in the special wards will be recorded. The researcher, having a list of the names of the inter-departmental handover patients, was present in the relevant wards and recorded the process of handover and handover of the patient from the special wards to the operating room or other wards and vice versa by the nurses and nursing assistants, and this process continued until the sample was completed. Written consent was obtained from the patients to record their handover. With the help of checklists, the nurses' handover methods were checked and recorded, and non-observed items were listed for interprofessional training. Subsequently, considering the need for interdepartmental handover, a training program was developed and the content approved by several supervisors and professors of the School of Nursing was held in several virtual training workshops. After three months, the quality of safe care was re-measured and compared. During this period, the researcher inspected the interdepartmental handover process in different shifts and notified the nurses if there were any problems. Virtual interdepartmental handover training sessions were held for three weeks in three separate sessions on the WhatsApp social space. During each session, explanations were provided for each chapter of the training manual in the form of audio files and sample questions for evaluation (Table1). Descriptive statistics (frequency, frequency percentage, mean, and standard deviation) were used for data analysis, and inferential statistics (paired t) were used to determine significance. SPSS version 19 software was used to analyze the data\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5.3. Harms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study did not show any harmful effects after the mentioned intervention.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eSeventy nurses participated in the study. 64.3% of them were women and 35.7% of them were men. Their average age was (32.97 ± 6.68). Their average employment history was (5.95±9.24). 45.7% of them were single and 54.3% of them were married and Half of the participants had completed safe care quality courses (Table 2,3,4,5,6).\u003c/p\u003e\n\u003cp\u003eThe next table shows the results of the check list of\u0026nbsp;receiver delivery nurses before and after the educational intervention. Paired t-test was used to interpret the data.\u0026nbsp;After the educational intervention, there was a statistically significant difference (Pvalue \u0026lt; 0.05). After the intervention, the difference in the average score of the total check list of the\u0026nbsp;receiver delivery nurses was significant (Pvalue\u0026lt;0.001). The mean total score for\u0026nbsp;receiver delivery nurses increased significantly from pre-test to post-test. The total difference between before and after was 21.900 and we had a change in both the average and the standard deviation in each part, which indicates that we have reached the goals (Table 7).\u003c/p\u003e\n\u003cp\u003eThe next table shows the results of the check list of delivery nurses before and after the educational intervention. Paired t-test was used to interpret the data. In this part, there is a significant difference between the scores obtained and it means that the total score has increased after the intervention. Among the participants after the training program was 42.73 compared to before the training program was 24.06, the difference between the two time periods was 18.671 (Table 8).\u003c/p\u003e\n\u003cp\u003eIn the next table, it can be seen that all dimensions of the quality questionnaire of nurses' safe care were significantly improved. The score of the safe care quality questionnaire after the training program (133.93 ± 18.231) was higher than before the program (130.49 ± 19.832). In the measurement of nursing skills, the difference before and after was 2.17, in the dimension of mental safety assessment, the difference between before and after was 0.4, in the dimension of physical safety, the difference between before and after was 0.357, in the dimension of team work assessment, we had 0.514 and in the total score section, we had an increase of 3.443. It was statistically significant (Pvalue\u0026lt;0.001)\u0026nbsp;(Table 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics (frequency, frequency percentage, mean and standard deviation) were used to analyze the data, and paired t-tests were used to compare the scores before and after, due to their normality. Data analysis was performed with SPSS version 19 software by the respected professor of statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4. Data interception\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt this time, the committee will not monitor certain data. However, to satisfy quality control requirements, researchers will conduct periodic data reviews until the end of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5. Access to data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researcher, supervisor and statistical consultant will have access to the information. which is used only for data analysis purposes.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u0026nbsp;The aim of the present study, was to investigate the impact of an interprofessional delivery programme on the quality of safe care provided by nurses in the field of patient delivery to special departments in selected hospitals. We intend to improve this process. This study aimed to improve the quality of safe care provided by nurses in the area of patient delivery\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e.In the present study, the average quality of safe nursing care was reported before the intervention. Nurses in the special wards of Loghman Hakim Hospital had a poor performance level in assessing the quality of safe nursing care before the intervention, which could be because clinical nurses did not use any tools to evaluate their own and their colleagues\u0026apos; performance and identify weaknesses in their performance.The highest level of performance in the dimensions of quality of safe nursing care before the intervention was reported for the nursing skills assessment dimension, physical safety assessment, Team performance assessment, and psychological safety assessment dimension, respectively. The average quality of safe nursing care was reported after the intervention. Nurses in the special wards of Loghman Hakim Hospital had a poor performance level in assessing the quality of safe nursing care after the intervention. The highest level of performance in the dimensions of safe nursing care quality was reported in the nursing skills assessment, physical safety assessment, Team performance assessment, and then psychological safety assessment, respectively.The results obtained had improved compared to before the intervention, but the nurses\u0026apos; performance level still showed a poor score. The results of the present study show that the intervention improved the quality of safe nursing care, and the results of the present study were significant. Other factors that affected the study results included failure to prioritize patient needs, fatigue and burnout, failure to share concerns with other nurses, development and implementation of self-made care routines, failure to pay attention to the importance of initial assessment, failure to monitor staff performance, need for more and sufficient time to implement the protocol, lack of sufficient cooperation from the nurse in front of the patient during handover, nurses\u0026apos; work experience, such that nurses with less work experience relied more on using the tools, reliance on their previous knowledge, etc. According to a review of the literature, , in most studies, the ISBAR[7] and SBAR[8] methods were used for delivery, for example, in the 2021 study, Krisna Yeti et al. used the SBAR tool for the delivery process and mentioned only limited aspects of the actions taken before, during and after delivery.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e The purpose of the present study were consistent with Olufemi Olawale study in 2024 so that The project was focused on educating staff on standardized communication tools to ensure patient information is transferred effectively and efficiently in the organization (24). Also in Citra Suraya et al.\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e2024\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003estudy\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eTeam STEPPS (Team Strategies and\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eTools to Enhance Performance and Patient\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eSafety)\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eeffectively\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eincreases the patient safety\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eculture, as evidenced by improved\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ecommunication, handoffs, transitions, and a decreased frequency of reports regarding\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eside effects\u0026nbsp;(25).\u0026nbsp;Similar to our findings, a standardized tool can contribute to different aspects of safe care\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eFor example, the study of Veronica Chaica\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eet al. 2024\u0026nbsp;states that the results obtained highlighted four main aspects that underpin the usefulness of ISBAR as a tool for interprofessional and standardized communication\u0026nbsp;(26). It was also concluded in the study of Sophia Agbomah\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eet al. 2024 that it is possible to improve completeness, duration,\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eand satisfaction through use of a standardized hand-off reference tool\u0026nbsp;(27).In contrast to the present study\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e in Marit Hegg Reime et al. study There were no significant improvements from baseline to post-intervention regarding adherence to the ISBAR communication scoring tool (28). The limitations of this study include the lack of studies conducted on interprofessional handover and the quality of safe care in the field of handover, limitations in comparing the results of the study with similar studies, and since this study was conducted only within the special wards of selected Shahid Beheshti hospitals, the generalizability of its results to other wards and hospitals is challenging. Also, the type of ward and intensive workload can cause limitations.\u003c/p\u003e\n\u003cp\u003e[7] Identify, Situation, Background, Assessment and Recommendation\u003c/p\u003e\n\u003cp\u003e[8] Situation, Background, Assessment and Recommendation\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe findings of the present study showed that the interprofessional handover program can affect the quality of safe care provided by nurses in the area of handover of patients to the special ward in fact, the results of our study showed one of the factors affecting the quality of safe care. The present study aims to create a holistic care perspective in intensive care unit nurses with the aim of improving their ability to identify and meet the comprehensive needs of patients, providing optimal care and achieving the highest level of health. This study also focused on the importance and necessity of using standard tools for interdepartmental handoffs. Nurses and nursing managers are the largest group of healthcare workers and are the foundation of the quality of care improvement process. Identifying errors and determining patient safety enhancement opportunities in every organization should be considered as the first step in planning. Nursing managers can take important steps in this area by managing situations that lead to reduced quality of care, addressing educational needs and improving the quality of care in nurses with in-service training programs for nurses, and identifying performance barriers in the area of safe quality of care.\u003c/p\u003e"},{"header":"6. Suggestions for future research","content":"\u003cp\u003e\u0026middot; Studies should be conducted to provide solutions and implement various interventions to increase the quality of safe care in the performance of nurses.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Studies should be conducted on various dimensions of the quality of safe nursing care.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Studies should be conducted on existing interprofessional handover programs and their relationship to the level of quality of safe nursing care.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Studies should be conducted to investigate the impact of various dimensions of nurses\u0026apos; psychological and physiological health on the quality of safe nursing care.\u003c/p\u003e"},{"header":"7. Research limitations","content":"\u003cp\u003e\u0026middot; Due to the lack of studies conducted regarding interprofessional handover and the quality of safe care in the field of handover, there are limitations in broadly comparing the results of the study with similar studies.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Since this research is conducted solely within the special wards of selected Shahid Beheshti hospitals, the generalizability of its results to other wards and hospitals is challenging.\u003c/p\u003e\n\u003cp\u003e\u0026middot; The type of department and intensive workload can cause limitations.\u003c/p\u003e"},{"header":"List of abbreviations","content":"IRCT, ISBAR, SBAR, PACU, NICU"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their gratitude to the Clinical Research Development Unit of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, for their support and cooperation during the study. This study was reviewed by the Ethics Committee of Shahid Beheshti University of Medical Sciences with the ethics code\u0026nbsp;IR.SBMU.PHARMACY.REC.1402.112. It was also registered under the clinical trial registration code IRCT ID IRCT20231015059729N1. ORCID iD was 0009-0008-2038-8205.\u003c/p\u003e\n\u003cp\u003eTrial Id\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e73176\u003c/p\u003e\n\u003cp\u003eIRCT Id\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIRCT20231015059729N1\u003c/p\u003e\n\u003cp\u003eRegistration date\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2023-10-25, 1402/08/03\u003c/p\u003e\n\u003cp\u003eMembership number\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e59729\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll supplementary materials, including additional figures and methods, are provided in the online supplementary files. For any inquiries regarding access to the data, please contact the corresponding author at [[email protected]]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflicts of interest were reported by the author(s).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received financial support from the Department of Shahid Beheshti University of Medical Sciences\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter selecting the nurses for the current study and explaining how to use this information, they were assured that the information obtained from them would be confidential . All subjects were asked to provide informed consent before participating in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode of Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIR.SBMU.PHARMACY.REC.1402.112\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewe confirm that all authors have given their consent for the publication of this manuscript\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: M.P\u003c/p\u003e\n\u003cp\u003eData curation: F.S\u003c/p\u003e\n\u003cp\u003eMethodology: M.P\u003c/p\u003e\n\u003cp\u003eSupervision: M.P M.H\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Writing original draft: F.S\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDesmedt M, Ulenaers D, Grosemans J, Hellings J, Bergs J. Clinical handover and handoff in healthcare: a systematic review of systematic reviews. International Journal for Quality in Health Care. 2021;33(1):mzaa170.\u003c/li\u003e\n\u003cli\u003eKeshmiri F, Hosseinpour A. The Correlation between Perception of Patient Safety and Professionalism and Adherence to Interprofessional Professionalism among Members of the Surgical Team. Journal of Medical Education and Development. 2022.\u003c/li\u003e\n\u003cli\u003eHua Y, Becker F, Wurmser T, Bliss-Holtz J, Hedges C. Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety. HERD: Health Environments Research \u0026amp; Design Journal. 2012;6(1):8-38.\u003c/li\u003e\n\u003cli\u003eEtezadi T, Malekzadeh J, Mazlom SR, Tasseeri A. Nursing handover written guideline implementation: A way to improve safe performance of nurses in intensive care units. Evidence Based Care. 2012;2(2):7-18.\u003c/li\u003e\n\u003cli\u003eLee D-H, Lim E-J. Effect of a simulation-based handover education program for nursing students: A quasi-experimental design. International Journal of Environmental Research and Public Health. 2021;18(11):5821.\u003c/li\u003e\n\u003cli\u003eLe A, Lee MA, Wilson J. Nursing handoff education: An integrative literature review. Nurse Education in Practice. 2023:103570.\u003c/li\u003e\n\u003cli\u003eAbdollahi L, Jaberi PS, Rokhafrooz D. The effect of using SBAR model in shift handover on patient and nurse satisfaction in the emergency department. 2022.\u003c/li\u003e\n\u003cli\u003eDadashzadeh A, Dehghannezhad J, Heydarpoor Z, Gilani N, Fathollahzadeh A, Rahmani A. INVESTIGATING THE PATIENT HANDOVER PROCESS IN THE EMERGENCY DEPARTMENT FROM THE PERSPECTIVE OF PRE-HOSPITAL EMERGENCY PERSONNEL. Nursing And Midwifery Journal. 2022;20(6):459-68.\u003c/li\u003e\n\u003cli\u003eElnaz Parsarad A, Farahani AS, Jambarsang S. Auditing of nursing handover to next shift in Neonatal Intensive Care Unit of selected hospitals affiliated with Qazvin University of Medical Sciences. 2021.\u003c/li\u003e\n\u003cli\u003eKaltoft A, Jacobsen YI, Tangsgaard M, Jensen HI. ISBAR as a Structured Tool for Patient Handover During Postoperative Recovery. Journal of PeriAnesthesia Nursing. 2022;37(1):34-9.\u003c/li\u003e\n\u003cli\u003eHinding B, Deis N, Gornostayeva M, G\u0026ouml;tz C, J\u0026uuml;nger J. Patient handover\u0026ndash;the poor relation of medical training? GMS journal for medical education. 2019;36(2).\u003c/li\u003e\n\u003cli\u003eDusse F, P\u0026uuml;tz J, B\u0026ouml;hmer A, Schieren M, Joppich R, Wappler F. Completeness of the operating room to intensive care unit handover: a matter of time? BMC anesthesiology. 2021;21:1-8.\u003c/li\u003e\n\u003cli\u003eLeroy Q, Bonsall A. Implementation and Evaluation of an Evidence Based Handoff Tool for Use by Anesthesia During Transfer of Care of Post-CABG Patients to the Intensive Care Unit. 2023.\u003c/li\u003e\n\u003cli\u003ePalicka JJ. Standardization of Postoperative Patient Handoff Using the Situation Background-Assessment-Recommendation (SBAR) Checklist. 2023.\u003c/li\u003e\n\u003cli\u003eMalekzadeh J, Etezadi Jam T, Mazlom S, Taseiri A. A STANDARDIZED SHIFT HANDOVER PROTOCOL: IMPROVING NURSES\u0026rsquo;SAFE PRACTICE IN THE AREA OF MEDICATION AND INTRAVENOUS LINE IN INTENSIVE CARE UNITS. Nursing And Midwifery Journal. 2013;11(6):0-.\u003c/li\u003e\n\u003cli\u003eMoghadam F, Pazokian M, AbbasZadeh A, Zadeh EF. The relationship between moral distress and safe nursing care in emergency wards nurses. Journal of Nursing Education (JNE). 2020;9(4).\u003c/li\u003e\n\u003cli\u003eSherwood G, Barnsteiner J. Quality and safety in nursing: A competency approach to improving outcomes: John Wiley \u0026amp; Sons; 2021.\u003c/li\u003e\n\u003cli\u003eMotamedzadeh M, Sarvary MH, Ebadi A. Comparison of quality nursing safe care in corona and non-corona wards. Paramedical Sciences and Military Health. 2021;16(2):34-41.\u003c/li\u003e\n\u003cli\u003eAsgari Z, Pahlavanzadeh S, Alimohammadi N, Alijanpour S. Quality of holistic nursing care from critical care nurses\u0026apos; point of view. Journal of Critical Care Nursing. 2019;12(1):9-14.\u003c/li\u003e\n\u003cli\u003eCho SH, Lee JY, You SJ, Song KJ, Hong KJ. Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes. International Journal of Nursing Practice. 2020;26(1):e12803.\u003c/li\u003e\n\u003cli\u003eKalantari M, Sajadi SA, Pishgooie SAH. Evaluation of nurses \u0026lsquo;performance from nurses\u0026rsquo; viewpoints on providing safe care to patients in AjA hospitals in 2018. Military Caring Sciences Journal. 2019;5(3):173-81.\u003c/li\u003e\n\u003cli\u003eRezaee N, Salar A, Keykha A. Nurses\u0026apos; experience of nursing care in the intensive care unit: a qualitative study. Journal of Critical Care Nursing. 2020;13(2):46-53.\u003c/li\u003e\n\u003cli\u003eGallois JB, Zagory JA, Barkemeyer B, Knecht M, Richard L, Vincent K, et al. Handoff Tool Improves Transitions from the Operating Room to the Neonatal Intensive Care Unit. Pediatric Quality \u0026amp; Safety. 2023;8(5):e695.\u003c/li\u003e\n\u003cli\u003eOlawale O. Staff Education Program to Enhance Patient Handover Communication: Walden University; 2024.\u003c/li\u003e\n\u003cli\u003eSuraya CSC, bin Sansuwito T, Dioso RI, Wisuda AC. EFFECTIVE COMMUNICATION IN NURSING: A COMPREHENSIVE SYSTEMATIC REVIEW OF BEST PRACTICES. Journal Of Nursing Science Research. 2024;1(1):34-48.\u003c/li\u003e\n\u003cli\u003eChaica V, Marques R, Pont\u0026iacute;fice-Sousa P, editors. ISBAR: A Handover Nursing Strategy in Emergency Departments, Scoping Review. Healthcare; 2024: MDPI.\u003c/li\u003e\n\u003cli\u003eAgbomah S, Summers S. Implementation of a Standardized Handoff Reference Tool from the Intensive Care Unit to the Operating Room. 2024.\u003c/li\u003e\n\u003cli\u003eReime MH, Tangvik LS, Kinn-Mikalsen MA, Johnsgaard T. Intrahospital Handovers before and after the Implementation of ISBAR Communication: A Quality Improvement Study on ICU Nurses\u0026rsquo; Handovers to General Medical Ward Nurses. Nursing Reports. 2024;14(3):2072-83.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Interprofessional Handoff, Intensive Care Unit, Nursing Safe Care, Patient Handoff ","lastPublishedDoi":"10.21203/rs.3.rs-6001655/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6001655/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and aim\u003c/strong\u003e: The quality of safe care is one of the major concerns of nurses. The importance of transmitting the patient from the number of disasters and preventable events caused by poor communication between the people of the health team revealed, thus standardizing the delivery process is a tool to ensure the transfer of the high quality care process. The purpose of this study is to determine the impact of the Inter -Professional Delivery Program on the quality of safe care of nurses in the area of\u003cbr\u003e\n\u003cbr\u003e\ndelivery of patients to the special department in selected Shahid Beheshti hospitals in 1402.\u003cstrong\u003e\u003cbr\u003e\nMethods: \u003c/strong\u003eThis quasi -experimental study was held as a group before and after the nurses' selection and through inter -sector delivery training for three weeks in three separate sessions in WhatsApp social space. To collect data from Rashvand et al. (2015) (nursing skills evaluation, mental safety evaluation, physical safety evaluation, teamwork evaluation), Demographic Information Questionnaire, Patient Physiological Information Form, Checklist of duties of the delivery and reception nurse of the intensive care unit and the checklist of the Aid Assistance Duties were approved by a number of professors and supervisors of Shahid Beheshti University of Medical Sciences. To compare the scores before and after the intervention, if the normal data distribution was distributed, paired t-tests was used and otherwise the Wilkaxon test was used. The data analysis was done by SPSS software version 19.\u003cbr\u003e\n\u003cstrong\u003eResults:\u003c/strong\u003e A total of 70 special care nurses participated in the study. They were examined for age, employment history, gender, marital status, educational background, position, overall work history, work experience in a specialty, and history of taking courses on safe quality. The mean and standard deviation for intensive care unit delivery and receiving nurse before and after the test increased significantly. The score of the safe care quality questionnaire after the interprofessional delivery training program increased significantly compared to before the training program (P value \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Based on the results, the interprofessional handover program affects the quality of safe care for nurses. The score of the quality of safe care questionnaire was higher after the training program than before the program, and all dimensions of the quality of safe care questionnaire for nurses improved significantly. The difference before and after in the dimension of measuring nursing skills, assessing physical safety, assessing psychological safety, assessing teamwork, and in the total score increased, and the highest average score was related to the dimension of measuring nursing skills and the lowest score was related to the dimension of assessing psychological safety, and the results were statistically significant. Therefore, preparing a standard checklist for interdepartmental handovers is necessary to improve the quality of safe care for nurses in the special ward.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eIt was registered under the clinical trial registration code IRCT\u003csup\u003e4\u003c/sup\u003e ID IRCT20231015059729N1.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e Iranian Registry of Clinical Trials\u003c/p\u003e","manuscriptTitle":"The Effect of an Interprofessional Delivery Program on the Quality of Safe Care of Nurses in the Field of Patient Handoff to the Intensive Ward in the Selected Hospital in 2023: a quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-27 06:55:26","doi":"10.21203/rs.3.rs-6001655/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ada1178c-685c-43ed-9fff-612db67f7347","owner":[],"postedDate":"February 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-27T06:55:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-27 06:55:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6001655","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6001655","identity":"rs-6001655","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}