Bedside Shift Handover in Open-Box ICUs: Nursing Perspectives and Challenges from a Focus Group Study

Bedside Shift Handover in Open-Box ICUs: Nursing Perspectives and Challenges from a Focus Group 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 Bedside Shift Handover in Open-Box ICUs: Nursing Perspectives and Challenges from a Focus Group Study Francisco Paredes Garza, Aramid José Fajardo Gomes, Ana Sofia Noviais Rosinhas, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6136762/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Backgrounds: Patient handovers are critical moments in healthcare, particularly in intensive care units (ICUs), where communication failures can jeopardize patient safety. While structured communication tools such as SBAR (Situation, Background, Assessment, Recommendation) are widely promoted, their implementation in complex healthcare settings remains challenging due to contextual and organizational barriers. This study examines Portuguese ICU nurses' perceptions of bedside shift handovers and the application of structured communication tools in an open-architecture unit. Methods: This qualitative study employed thematic analysis to identify key themes. Twenty-four ICU nurses from a polyvalent ICU in Portugal participated, selected via convenience sampling with a minimum of two years of professional experience. Four online focus groups (OFGs) were conducted, each comprising six participants with diverse age and experience profiles. Sessions, lasting 50 to 70 minutes, were held via Google Meet, with informed consent obtained beforehand. A semi-structured discussion guide, developed from a comprehensive literature review, ensured thematic consistency and facilitated in-depth discussions. Interviews were recorded, transcribed verbatim, and analyzed using a deductive thematic analysis following Braun and Clarke’s methodology. To enhance credibility, the study adhered to COREQ guidelines and implemented investigator triangulation.. Results: Five main themes emerged: 1) Limited university training compels nurses to engage in self-directed learning and hinders the adoption of standardized methodologies.; 2) Although structured tools like SBAR are encouraged, they are often perceived as insufficient for complex ICU patients, leading to reliance on alternative non-validated approaches such as head-to-toe and ABCDE; 3) Bedside handovers enhance patient safety by enabling direct patient visualization and real-time clarifications; (4) Nurses express concerns regarding patient anxiety, frequent interruptions, and potential discomfort during bedside handovers.; (5) The open ICU layout compromises patient privacy and rest, particularly during morning shifts. Conclusions: Despite its benefits in improving patient safety and information accuracy, bedside shift handovers face persistent barriers, including inadequate formal training, resistance to change, and infrastructure constraints. Integrating clinical communication training into nursing education and optimizing ICU environments to protect patient privacy and comfort are essential. Addressing these factors is crucial to strengthening international nursing practice and ensuring the effectiveness of structured handover processes in critical care settings. patient handoff qualitative research critical care nursing Backgrounds The term "handover" refers to "the communication of information related to a patient, their diagnosis, and treatment at the moment when the responsibility for the care of a patient is transferred from one healthcare provider to another" [ 1 ]. Handover is one of the most common processes among healthcare professionals (HPs), taking place in various settings (in-hospital, out-of-hospital), locations (hallway, break room, bedside), and at different times of the day (morning/afternoon/night) [ 2 ]. Despite being a routine procedure, it represents one of the highest-risk moments for patient safety due to significant variability and lack of standardization [ 3 ]. Patient safety assessment is not only conducted through scientific instruments and methodologies [ 4 ] but also through the perceptions of professionals and patients [ 5 ]. In line with this subjective perspective, the Agency for Healthcare Research and Quality [ 6 ] conducted a survey among HPs regarding their perceptions during shift changes, concluding that these transitions pose a safety concern due to substantial information loss. Several factors play a crucial role in patient safety during handovers, including the standardization of the process [ 7 ], working conditions [ 8 – 9 ], the location of the handover [ 10 ], unit infrastructure [ 11 ], lack of training or inexperience of professionals in the handover process [ 12 ], and the presence of patients during the process [ 13 ]. The most recent report from the Joint Commission International (JCI) indicates that 67% of communication errors occur during patient handoffs, the critical transition of care responsibility between healthcare providers. These errors have a significant impact on healthcare management, contributing to increased patient morbidity and mortality. [ 14 ]. This issue is particularly significant in highly complex units such as intensive care units (ICUs), which exhibit characteristics conducive to transfer errors, including a high turnover of professionals, multiple interprofessional consultations, the complexity of patient care, and the advanced technology used in the unit. Additional external distracting factors include the volume of complex information and acoustic pollution (noise, parallel conversations, alarms), which hinder communication and may increase the likelihood of transmission errors [ 15 ]. International organizations such as the Australian Commission on Safety and Quality in Health Care [ 16 ] o European countries like Portugal through the National Plan for Patient Safety 2021–2026 [ 17 ], advocate for enhancing patient safety through effective communication among healthcare professionals and standardizing information transfer processes. One solution proposed by the American AHRQ [ 18 ] is the use of the bedside shift report methodology, which involves conducting handovers at the patient’s bedside using a structured communication tool, such as SBAR (Situation, Background, Assessment, Recommendation) [ 19 ]. This methodology has proven effective in reducing adverse events through triple-checking involving the patient, enhancing patient empowerment during recovery, improving the quality of the information transmitted, and increasing satisfaction among professionals, patients, and families [ 20 ]. However, it is not without drawbacks, as concerns have been raised regarding patient privacy and interruptions during communication [ 21 ]. It is essential to understand the specific characteristics of different settings and the contextual factors that may hinder care practice through prior assessments—such as surveys, audits, inspections, interviews, or observations [ 22 ]. These evaluations will facilitate addressing and improving deficiencies in the work environment if application or implementation is not feasible. Therefore, the primary objective of this study is to determine the perceptions of nursing professionals in a Portuguese ICU regarding the bedside shift report methodology in an open-architecture unit. A secondary objective is to explore their perceptions of the communication structuring tool used during handovers and the training received regarding such tools and/or methodologies. Methods Design The study adopted a qualitative design, with thematic analysis guiding the data interpretation process. Data collection was conducted through online focus groups (OFGs), allowing for an in-depth exploration of participants' attitudes, knowledge, and experiences in healthcare settings has been supported by Kitzinger [ 23 ]. This technique enables discussions on specific topics through group dialogues among participants using written, audio, and/or video formats on online platforms that facilitate synchronous interaction (with audio and video), thus allowing the phenomenon under investigation to emerge vividly within the group [ 24 ]. The COREQ checklist has been used to optimise the reporting of this qualitative study [ 25 ]. Setting and participants The study included nursing staff from the multipurpose ICU of a public hospital in the Northern region of Portugal. This unit comprises 36 open-box beds divided into three units according to patient complexity levels [ 26 ]: two level II units (moderate complexity) and one level III unit (high complexity). The total staff consists of 96 nurses working shifts across both units. Following initial contact with unit managers, a purposive sampling [ 27 ] strategy was employed, applying the following inclusion criteria to ensure participant relevance: 1) Active ICU nurses with at least two years of experience, based on Patricia Benner’s model [ 28 ], which classifies them as competent nurses—those who perform actions confidently and make decisions grounded in previous experiences, and 2) Voluntary agreement to participate in the study. No exclusion criteria related to sex or age were applied to maintain both homogeneity and heterogeneity, thus promoting open discourse and avoiding potential group discussion barriers. The goal was to collect the broadest range of information possible rather than compare different groups. No participant declined participation. The research team held a preliminary meeting to define the organizational strategy for the OFGs, setting an initial sample size of 24 participants, in line with other qualitative studies of similar nature [ 29 ]. Accordingly, four groups were formed, each comprising six participants of varying ages and professional experience, as per Krueger & Casey’s [ 30 ]. Each OFG was moderated by the principal investigator (PI) of this paper, who held no contractual relationship with the participants and refrained from disclosing any preconceived opinions about the research topic.Meeting dates and times were shared one month in advance via an online document. Prior to participant confirmation, following Krueger & Casey’s [ 30 ] recommendations, the researchers contacted participants by phone one month before the meetings to provide information on: the purpose and rationale of the study; the PI’s research interests, meeting schedules (allowing participants to select options convenient to their availability), and the possibility of receiving feedback, as financial compensation was not feasible. This process facilitated efficient planning and ensured consensus, eliminating the need for later adjustments. Upon confirming their participation, volunteers received an access link to Google Meet—a platform enabling synchronous audio and video communication. Meetings were initially scheduled for 50 to 70 minutes to address all key topics and foster discussion [ 31 ]. Sessions were digitally recorded, with written consent from participants, for subsequent transcription and analysis. Instrument and Data Collection and Instrument Data collection took place in October 2024 during four online sessions held in the morning and/or afternoon to accommodate participant availability. The PI facilitated all sessions. Prior to data collection, the research team was composed of six members (two women and four men, including the PI) with backgrounds in various disciplines. The team, from Spain and Portugal, included three nurses with ICU experience and three senior researchers.Together, they developed a discussion guide (Table 1 ), ensuring that the question were semi-structured, open-ended, clear, brief, concise and focused on specific concepts [ 32 ]. This guide was informed by previous research on perceptions of bedside shift reports in a tertiary hospital ICU with mixed infrastructure (including both open and closed boxes) and similar patient complexity levels [ 11 ]. During the OFGs, group dynamics were observed and registered, focusing on aspects such as participant proactivity, non-verbal communication, and subtle elements (e.g., tone, pauses, pitch), which were further examined during the recordings’ playback. Table 1 Interview guide questions for focus groups 1. Do you believe that nursing professionals have sufficient training to conduct an adequate information transfer during shift handovers? 2. Do you use any methodology or structure to carry out the information transfer during shift handovers? 3. ¿Are you familiar with the bedside handover methodology? What benefits or disadvantages do you perceive in this methodology? 4. Could the bedside handover methodology be implemented in the unit where you work? 5. Do you think that work shifts or unit infrastructure would influence the implementation of bedside handovers in your unit? Data Analysis Data were manually analyzed following Braun and Clarke’s thematic analysis framework, employing a deductive approach to systematically identify and classify emerging themes. [ 33 ]. The process began with the transcription of the interviews by the principal investigator, with support from the team to resolve potential linguistic ambiguities. Subsequently, each researcher independently read the transcripts to familiarize themselves with the content, followed by a detailed reading to systematically group data and code emerging themes. Through a triangulation process, a unique coding system was established to systematically capture relevant data, and a thematic map was developed, distinguishing between Level 1 codes (primary study themes) and Level 2 codes (subthemes derived from the primary ones). Discrepancies in coding were discussed until agreement was reached, when a value > 0.61 on Cohen's Kappa coefficient was exceeded, [ 34 ]. This process ensured rigour and consistency in the interpretation of the data. Finally, the final themes were determined and compiled into a comprehensive report of the findings. Rigor The researchers are experienced in qualitative methodology and in the field of ICU nursing. To reduce potential bias in the interpretation of the data, the results adhered to the principles of representativeness and followed quality criterio: credibility (triangulation of data), transferability (detailed description of the participants’ perceptions and the context in which the study was conducted), dependability (detailed reporting of methodology) and confirmability the results were given to the participants so that they could corroborate that the findings reflected their experiences) set by the qualitative research guidance for clinical practice [ 35 ]. In addition, to reduce potential biases in the interpretation of the data, the researchers regularly discussed their impressions and analyses. Meetings were held to examine different perspectives and to ensure that the findings were as objective and representative as possible.[ 36 ] No further OFGs were necessary as data saturation was achieved. Ethical Aspects The study respected the ethical principles of the Declaration of Helsinki and was conducted within the framework of a project approved by the CEIPSA of the Universitat Rovira i Virgili (CEIPSA-2024-TD-0001). Participants received verbal and written information regarding the study and provided informed consent. To ensure confidentiality data protection and participant anonymity data were securely stored with password protection after initial coding and access was restricted to the research team to prevent identity disclosure These procedures complied with Spanish regulations under Organic Law 32018 of December 5 on Personal Data Protection and Digital Rights Guarantees as well as Portuguese regulations under Law No 582019 of August 8 which ensures the implementation of the General Data Protection Regulation GDPR in the Portuguese legal system. Results Of the total 24 participants, 81% were women, with a mean age of 38 ± 7.34 years and a mean work experience of 11 ± 7.0 years (Table 2). Participants joined the online focus groups (OFGs) remotely and actively engaged in spontaneous discussions without requiring additional guidance or clarifications from the moderator. The average duration of the interviews for the four focus groups was 54 minutes. Each interview session was conducted once, with no need for repetition, as data saturation was achieved within the initial sessions. Table 2 . Profile of focus group participants Group 1 Group 2 Group 3 Group 4 Sex 3 women 6 women 5 women 6 women 3 men 0 men 1 men 0 men Age (years) 25-30 31-35 36-40 >40 2 0 0 0 2 2 2 3 1 0 0 1 1 4 4 2 ICU experience 10 years 1 2 2 2 1 1 2 1 4 3 2 3 Regarding the nursing professionals’ perceptions of the study topic, the themes and subthemes which are described below (Table 3). Table 3. Themes and subthemes identified in the thematic analysis Themes Subthemes Training and development University education Self-education Resistance to change Handover methodologies Methodological limitations Personal strategies Bedside handover Patient benefits Professional inconveniences Infraestructure Privacity Rest Training and development Subtheme 1: Insufficient university training in on-call handover methodologies All four OFGs revealed a lack of university-level training on information handover between professionals, regardless of staff experience: " During university internshipsand in the basic training, we don’t have specific education that makes us capable of performing information handovers according to any methodology." (P05-A) "I think it's not a topic widely covered in nursing school nor when you start your professional career, because it’s not standardized. It’s such a broad topic that, in both academic and hospital settings, it’s not well-defined." (P15-C) Subtheme 2: Self-education as a way of learning Participants specifically indicated that the necessary training to perform an adequate shift handover is self-taught and acquired through professional experience: "Everyone has their way of transmitting information, training themselves, and learning certain techniques throughout their professional career, but during nursing school, I didn’t have any specific training on shift handovers." (P08-B) ‘During the internship, seeing the registered nurses you could have some background, but all by observation and self-taught.’ (P18-D) Subtheme 3: Resistance to change for the adoption of new methodologies Two OFGs mentioned that despite hospital-provided training to encourage the adoption of scientifically validated methodologies like ISBAR, implementation has been challenging: ‘We have been doing the handover for many years as we learned it from others, using the ABCDE methodology, and therefore it is more complicated now to change to another method’ (P14-C). "We tried to implement the SBAR methodology, but the lack of initial training in schools and the absence of formalization within the hospital meant it wasn’t incorporated into daily practice, and everyone adapted the methodology to their reality." (P15-C) Handover methodologies Subtheme 1: Standardised methodologies are insufficient to deal with the day-to-day management of critically ill patients. All participants expressed unanimous agreement that the SBAR methodology is inadequate for conveying information during handovers of critically ill patients: "I’m aware there are scientific methodologies like the SBAR system; however, I don’t think it’s practical for us because, with complex patients, information gets lost." (P05-A) ‘I had the opportunity to use the SBAR method in my daily life, but my feeling is that it falls short because there are points that are not touched with this method and I have to use the ABDCE or the cephalo-caudal method’ (P18-D). Subtheme 2: need to develop their own strategies to cope with existing constraints. Participants also noted the used different techniques to SBAR, such as head-to-toe/system-based/ABCDE approaches, to ensure comprehensive information transmission: "There’s no methodology I follow to the letter; I use a systems-based approach and focus on what concerns me most. It has to be brief; too much information leads to dispersion." (P04-A) "I use ABCDE because it provides a deeper patient assessment and allows me to address disease-specific issues." (P24-D) Bedside handover Subtheme 1: Bedside handovers enhance patient safety through direct visualization and real-time clarifications All participants acknowledged being familiar with the bedside handover methodology. However, only half of them reported using it, primarily for highly complex patients to improve patient safety and actively involve them in their care plan: "Another advantage is that you can structure it better, making it easier for your colleague to understand, especially with complex patients." (P05-A) "By discussing it in front of the patient, you can help the receiver interpret the information. Plus, if the patient has any questions, you can clarify them, or even involve them actively in their own care plan." (P19-D) Subtheme 2: Conducting bedside handovers may cause patient anxiety A common theme in all four focus groups was the discomfort bedside handovers can cause patients when they are unaware of their clinical history, potentially increasing anxiety and destabilizing their acute condition: "One disadvantage is that when the patient is conscious, discussing their illness—especially during the most acute phase—can provoke anxiety." (P14-C) "In some cases, we need to limit the information we share or step aside to discuss certain details... you notice it when they start closing their eyes, not wanting to hear about their condition." (P21-D) Subtheme 3: Bedside handover increased distraction due to interruptions In two OFGs, participants noted that conducting handovers in front of patients can lead to interruptions and cause discomfort among professionals: ‘One of the disadvantages is that there can be interruptions, especially by the patient.’ (P09-B) "I think it's more uncomfortable for us as professionals because the patients are awake, might ask questions, and you don’t always know if they’re aware of certain information." (P23-D) Infraestructure Subtheme 1: Unit infrastructure affects patient privacy, however, this is not an impediment to its implementation. Two of OFGs noted that despite recognizing the benefits of bedside handovers, implementing them is challenging due to open-box infrastructures and the resulting lack of privacy for conscious patients: "With our current infrastructure, unless there are individual rooms, I don’t think it can be implemented because of confidentiality issues and patient characteristics." (P04-A) ‘In terms of physical space. We have 3 rooms, of which in 2 of them there is enough physical space to maintain this privacy that allows us to do this in the physical space, but I think we have the other room we can't do it because of the proximity.’ (P15-C) The remaining groups believed it could be implemented but with certain conditions: ‘I think it can be implemented, as long as there is a briefing afterwards so that information is shared.’ (P07-B) "Even with open boxes, I think it’s possible, but we’d need to be careful about privacy issues." (P23-D) Subtheme 2: Unit infrastructure affects patient rest, specially in the morning shift Two OFGs indicated that the open layout of units, combined with bedside handovers, can disrupt patient rest, particularly during morning shifts: ‘The shifts do have an influence, because being an open unit, especially in the morning shift it can interrupt the patients' rest.’ (P04-A) "Yes, especially during morning shifts—it can be very confusing and wake the patient, especially since we usually do it around 8 a.m., followed by the physician’s rounds." (P17-C) Discussion Several authors have analyzed perceptions of intraprofessional communication at the bedside from the perspective of healthcare professionals working in intensive care units (ICUs) [ 7 , 15 ]. The authors describe the advantages and disadvantages of this methodology [ 36 ]. Other studies have explored aspects such as the infrastructure of these units as points of analysis [ 11 ]. The SBAR tool has also been studied, demonstrating excellent outcomes in high-complexity units such as ICUs [ 19 , 38 ] and has been recommended by international institutions [ 16 ]; however, the results of the present study differ from reality, highlighting the costly implementation of this methodology due to several factors: the difficulty in fostering a culture of change, an initial training deficit, acquired self-learning and variability of structuring during on-call duty. In relation to the first three factors, which are intimately linked, similar results were reported by Mashail et al. [ 38 ] and Moran-Pozo et al. [ 3 ], who noted knowledge gaps among nurses concerning the information handover process. These authors emphasize the need for university programs or continuous safety training. In this context, it is unsurprising that challenges arise in promoting a culture of change toward adopting validated methodologies; therefore, authors like Santos et al. [ 15 ] advocate for developing a common training program to enhance communication skills, particularly in high-risk communication environments like ICUs. The third factor concerns the limitations of the SBAR method in encompassing all necessary clinical and contextual information. This shortcoming has prompted the integration of complementary methods (e.g., ABCDE, head-to-toe assessments, or functional systems approaches), which allow the transmission of qualitative, subjective, and situational aspects not fully captured by the rigid SBAR structure. Although these methods may be a hindrance, Paredes et al. (20) highligthed in their systematic review that other unvalidated standardized models can also be useful for avoiding information transmission errors, provided that message structuring occurs. Regardless of the methodology employed, participants perceive bedside handovers as enhancing patient safety, particularly for highly complex patients. This assertion is supported by the review conducted by Ansashi et al. [ 39 ], who gathered nursing and patient perceptions, with both groups expressing a sense of safety during information transfer. However, this delivery method is not without barriers, as Jimmerson et al. [ 41 ] indicate the need to individualize each case and, if necessary, share information away from the patient to avoid uncomfortable situations or misinformation. In the present study, these barriers align with the findings of the aforementioned authors, particularly regarding the anxiety patients may experience—especially during the most critical moments of their illness—if they lack adequate information, which may worsen their baseline condition. Another barrier noted by these authors and others, such as Alves & Veiga-Branco [ 42 ] and Vanderzwan et al. [ 43 ], is the interruption of the message during handovers, whether by patients or other external factors related to unit infrastructure, in particular with the lack of privacy and noise [ 11 ]. This last element, related to infrastructure, is also one of the underlying problems, especially with regard to privacy and rest of patients, mainly in the morning shifts are the most affected in terms of sleep disruption during bed transfer. This issue has been comprehensively analyzed by Tobiano et al. [ 7 ], whose findings corroborate the present study’s results, emphasizing the privacy concerns associated with bedside handovers and advocating for a more adaptable approach to patient communication. In terms of limitations, one of them could be related to the methodology used online (GFO), as it may present technological limitations, such as unstable connectivity, technical failures or affect data quality. To overcome these potential problems, a telematic warning was given with the recommendation to use a headset and to connect from a stable network environment. Similarly, participants' audio and video quality was checked before the start of the sessions and the required personalised support was provided. These measures minimised technological interruptions, ensuring the smooth running of the session and the collection of high quality data. Another limitation could be, one of them could be interpretation bias on the part of the PI, as there was no co-facilitator to record participants' non-verbal communication. Nevertheless, the online platform used for the OFGs allowed the observation of participant gestures, which was supplemented by verbal discourse elements such as tone, pitch, and pauses for later transcription. Lastly, to address other inherent limitations of OFGs, such as limited participation or digital fatigue, the PI utilized the nominal group technique (NGT). This tool ensured equitable discussion and maintained active participation within the stipulated times. To promote conversational flow and counter participant fatigue, the PI varied tone and pitch, actively monitored signs of fatigue, and encouraged breaks when necessary, fostering a comfortable and sustained dialogue environment. Conclusions Findings indicate that participants experience a deficit in university-level training related to information handovers, which they subsequently compensate for through self-directed learning and on-the-job experience. This situation complicates the implementation of new standardized methodologies, such as the SBAR method, not only due to cultural resistance but also because it lacks the elements required to convey all necessary information for highly complex ICU patients. As a result, non-validated methodologies such as head-to-toe or systems-based approaches are used. Regarding the bedside shift report methodology, participants highlight benefits such as increased patient safety—through direct visualization of the patient—and the facilitation of real-time clarifications between professionals and patients. However, some drawbacks were identified, including the anxiety patients may experience due to inadequate information and interruptions during the process from patient questions or suggestions. Furthermore, the open infrastructure of ICUs poses a disadvantage in terms of patient privacy and rest, particularly during morning shifts. These findings underscore the need to incorporate handover competencies into health sciences curricula through educational programs that include clinical communication methodologies, especially in high-complexity contexts like ICUs. Establishing continuous training programs is essential to enable professionals to acquire and refine skills in using standardized tools, such as the SBAR method or bedside shift report methodology, given their significant impact on patient safety. To address identified challenges, it is advisable to implement clear protocols for staff and families to mitigate patient anxiety arising from misinformation. Simulation scenarios, such as role-playing, can serve as valuable complements, allowing students and professionals to practice and improve these communication skills. Lastly, the study highlights the importance of redesigning ICU spaces to enhance patient privacy through measures such as installing dividers or soundproofing systems, thereby promoting patient rest and overall care quality. Abbreviations AHRQ Agency for Healthcare Research and Quality ACSQHC Australian Commission on Safety and Quality in Health Care ABCDE Airway, Breathing, Circulation, Disability, Exposure CEIPSA Ethics Committee for Research in People and Applied Society COREQ Consolidated Criteria for Reporting Qualitative Research GDPR General Data Protection Regulation ICU Intensive Care Unit ISBAR Identify, Situation, Background, Assessment, Recommendation JCI Joint Commission International NGT Nominal Group Technique OFG Online Focus Group PI Principal Investigator PNSD National Plan for Patient Safety (Portugal) SBAR Situation, Background, Assessment, Recommendation WHO World Health Organization Declarations Acknowledgements The authors would like to thank all the advanced practice nurses who participated in the study. Their time and expertise made this study viable. We thank the Department of Nursing, Physiotherapy, and Medicine at the University of Almeria, the Research Group Health Sciences CTS-451 and Centro de Investigación en Salud (CEINSA) and the Research Group Health Sciences HIGIA CTS-500 at the University of Huelva. Author contributions All authors have participated in the development of this study. F.P.G conceived the study and participated in the data collection, data analysis and in writing the manuscript.A.J.F.G and A.S.N.R participated in the collection of participants, data collection, data analysis and writing the manuscript. F.S, G.M and E.L.P participated in the interpretation of the data and revision the manuscript. Funding This study has not received funding external funding. Data availability Data are available from the first author or corresponding author on reasonable request. Ethics approval and consent to participate This study respected the Helsinki declaration (World Medical Association, 2013) and was approved by the CEIPSA of the Universitat Rovira i Virgili (CEPSA-2024-TD-0001). The participants were informed about the aim of the study, the methodology used and their rights. They signed an informed consent form in accordance with the European Personal Data Protection Act that guaranteed confidentiality and anonymity without repercussions in case of withdrawal from the study. Consent for publication Not applicable. Conflict of interest All authors declare that they have no conflicts of interest. References Fletcher KA, Bedwell WL, Rosen M, Catchpole K, Lazzara E. (2014). Medical team handoffs: Current and future directions. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 58 (1), 654–658. https://doi.org/10.1177/1541931214581154 Desmedt M, Ulenaers D, Grosemans J, Hellings J, Bergs J. 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U.S. Department of Health and Human Services. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.pdf Ding Y, Wang G, Chen H, Kang J, Wu Z. Application effects of SBAR communication mode in ICU nursing physical restraint shift. Altern Ther Health Med. 2022;28(6):112–7. Paredes-Garza F, López-Mases P, Lázaro E, Marín-Maicas P. Impacto en la seguridad del paciente del pase de guardia a pie de cama en cuidados intensivos: Revisión sistemática. An Sist Sanit Navar. 2022;45(2):e0996. https://doi.org/10.23938/assn.0996 . Anshasi H, Almayasi ZA. Perceptions of patients and nurses about bedside nursing handover: A qualitative systematic review and meta-synthesis. Nurs Res Pract. 2024;2024(1):3208747. https://doi.org/10.1155/2024/3208747 . Browner WS, Newman TB, Cummings SR, Grady DG. Diseño de investigaciones clínicas. 5– ed. ed.). Wolters Kluwer; 2023. Kitzinger J. Introducing focus groups. BMJ. 1995;311(7000):299–302. https://doi.org/10.1136/bmj.311.7000.299 . Oliveira JCD, Penido CMF, Franco ACR, Santos TL, A. D, Silva BAW. Especificidades do grupo focal on-line: Uma revisão integrativa. Ciênc saúde coletiva. 2022;27:1813–26. https://doi.org/10.1590/1413-81232022275.11682021 . Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57. https://doi.org/10.1093/intqhc/mzm042 . Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, Fowler RA, Meyfroidt G, Nakagawa S, Pelosi P, Vincent JL, Vollman K, Zimmerman J. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017;37:270–6. https://doi.org/10.1016/j.jcrc.2016.07.015 . Parker C, Scott S, Geddes A. (2019). Snowball sampling. En P. Atkinson, S. Delamont, A. Cernat, J. W. Sakshaug, & R. A. Williams, editors, SAGE Research Methods Foundations. SAGE Publications. https://doi.org/10.4135/9781526421036831710 Benner P. From novice to expert. AJN: Am J Nurs. 1982;82(3):402–7. Porcel-Gálvez AM, Hörner Schlindwein-Meirelles B, Gil-García E, Morales-Asencio JM, Guerra-Martín MD. Opiniones y satisfacción de las enfermeras. Enfermería Clínica. 2016;26(6):374–80. https://doi.org/10.1016/j.enfcli.2016.09.006 . Krueger R, Casey M. Focus groups: A practical guide for applied research. 5th ed. Sage; 2015. Parker A, Tritter J. (2021). Focus groups. En Research Methods in the Social Sciences: An A–Z of Key Concepts. https://doi.org/10.1093/hepl/9780198850298.003.0030 Casey MA. Focus groups: A practical guide for applied research. Sage; 2000. Braun V, Clarke V. Thematic analysis revised. J Chem Inf Model. 2019;53(9):1689–99. Landis JR, Koch GG. (1977). The measurement of observer agreement for categorical data. biometrics, 159–174. https://doi.org/10.2307/2529310 Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract. 2018;24(1):120–4. https://doi.org/10.1080/13814788.2017.1375092 . Olmos-Vega FM, Stalmeijer RE, Varpio L, Kahlke R. A practical guide to reflexivity in qualitative research: AMEE Guide 149. Med Teach. 2023;45(3):241–51. https://doi.org/10.1080/0142159X.2022.2057287 . Cruchinho P, Teixeira G, Lucas P, Gaspar F. Influencing factors of nurses’ practice during the bedside handover: A qualitative evidence synthesis protocol. J Personalized Med. 2023;13(2):267. https://doi.org/10.3390/jpm13020267 . Correia AIC, Melo MEGA, De Sousa LMM, Zangão MOB. (2024). Comunicação eficaz na transição dos cuidados em unidades de cuidados intensivos. En Gestão em enfermagem baseada em evidências (pp. 24–38). https://doi.org/10.37885/240616904 Fahmy Hamed Mashail E, Fakhry F, S., Abd-ELAzeem Mostafa H. Effect of Nursing Handoff Educational Bundle on Nurse Interns' Handoff knowledge and Communication Competence. Egypt J Health Care. 2024;15(4):331–9. https://dx.doi.org/10.21608/ejhc.2024.387313 . Anshasi H, Almayasi ZA. Perceptions of patients and nurses about bedside nursing handover: A qualitative systematic review and meta-synthesis. Nurs Res Pract. 2024;2024(1):3208747. https://doi.org/10.1155/2024/3208747 . Jimmerson J, Wright P, Cowan PA, King-Jones T, Beverly CJ, Curran G. Bedside shift report: Nurses opinions based on their experiences. Nurs open. 2021;8(3):1393–405. https://doi.org/10.1002/nop2.755 . Alves CDGB, Veiga-Branco A. Comunicação eficaz na transição de cuidados de enfermagem no serviço de urgência. Millenium: J Educ Technol Health. 2024;14:1–9. http://hdl.handle.net/10198/30520 . Vanderzwan KJ, Kilroy S, Daniels A, O’Rourke J. Nurse-to-nurse handoff with distractors and interruptions: An integrative review. Nurse Educ Pract. 2023;67:103550. https://doi.org/10.1016/j.nepr.2023.103550 . Additional Declarations No competing interests reported. Supplementary Files COREQitems.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 Mar, 2025 Editor assigned by journal 05 Mar, 2025 Submission checks completed at journal 04 Mar, 2025 First submitted to journal 01 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-6136762","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":424350448,"identity":"fdaae7b2-a5f6-40fc-bbe9-6942248298fe","order_by":0,"name":"Francisco Paredes Garza","email":"data:image/png;base64,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","orcid":"","institution":"Critical Care Nurse. Hospital Universitario La Paz","correspondingAuthor":true,"prefix":"","firstName":"Francisco","middleName":"Paredes","lastName":"Garza","suffix":""},{"id":424350450,"identity":"e034b151-8df9-4d62-83ad-b267d06b602e","order_by":1,"name":"Aramid José Fajardo Gomes","email":"","orcid":"","institution":"RISE-Health, Nursing School of Porto","correspondingAuthor":false,"prefix":"","firstName":"Aramid","middleName":"José Fajardo","lastName":"Gomes","suffix":""},{"id":424350452,"identity":"7b9b9b35-70b8-4a18-9842-7adaee902558","order_by":2,"name":"Ana Sofia Noviais Rosinhas","email":"","orcid":"","institution":"RISE-Health, Nursing School of Porto","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Sofia Noviais","lastName":"Rosinhas","suffix":""},{"id":424350456,"identity":"3c4d62e6-08eb-49f1-bf5d-0ed86705194d","order_by":3,"name":"Francisco Sampaio","email":"","orcid":"","institution":"RISE-Health, Nursing School of Porto","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"","lastName":"Sampaio","suffix":""},{"id":424350457,"identity":"e7d2e593-53d6-41e3-a264-d6e5b2c0c797","order_by":4,"name":"Gerard Mora López","email":"","orcid":"","institution":"Universitat Rovira i Virgili. Tarragona","correspondingAuthor":false,"prefix":"","firstName":"Gerard","middleName":"Mora","lastName":"López","suffix":""},{"id":424350458,"identity":"cb53e6df-caea-49aa-95a0-13e02b1b9b1d","order_by":5,"name":"Esther Lázaro Pérez","email":"","orcid":"","institution":"Universidad Internacional de Valencia. Valencia","correspondingAuthor":false,"prefix":"","firstName":"Esther","middleName":"Lázaro","lastName":"Pérez","suffix":""}],"badges":[],"createdAt":"2025-03-01 23:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6136762/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6136762/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77912597,"identity":"96356bb9-f7f6-4df8-83f1-5ee94991b2ee","added_by":"auto","created_at":"2025-03-06 18:20:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1074936,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6136762/v1/ac86d500-dbca-4d46-b87f-18cbe7e5fd9f.pdf"},{"id":77912285,"identity":"9f4ffbe3-e412-42fc-ba01-3db1cfdfdd6f","added_by":"auto","created_at":"2025-03-06 18:12:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16994,"visible":true,"origin":"","legend":"","description":"","filename":"COREQitems.docx","url":"https://assets-eu.researchsquare.com/files/rs-6136762/v1/e529a90f3919487503534897.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eBedside Shift Handover in Open-Box ICUs: Nursing Perspectives and Challenges from a Focus Group Study\u003c/p\u003e","fulltext":[{"header":"Backgrounds","content":"\u003cp\u003eThe term \"handover\" refers to \"the communication of information related to a patient, their diagnosis, and treatment at the moment when the responsibility for the care of a patient is transferred from one healthcare provider to another\" [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Handover is one of the most common processes among healthcare professionals (HPs), taking place in various settings (in-hospital, out-of-hospital), locations (hallway, break room, bedside), and at different times of the day (morning/afternoon/night) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite being a routine procedure, it represents one of the highest-risk moments for patient safety due to significant variability and lack of standardization [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatient safety assessment is not only conducted through scientific instruments and methodologies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] but also through the perceptions of professionals and patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In line with this subjective perspective, the Agency for Healthcare Research and Quality [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] conducted a survey among HPs regarding their perceptions during shift changes, concluding that these transitions pose a safety concern due to substantial information loss. Several factors play a crucial role in patient safety during handovers, including the standardization of the process [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], working conditions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the location of the handover [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], unit infrastructure [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], lack of training or inexperience of professionals in the handover process [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and the presence of patients during the process [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most recent report from the Joint Commission International (JCI) indicates that 67% of communication errors occur during patient handoffs, the critical transition of care responsibility between healthcare providers. These errors have a significant impact on healthcare management, contributing to increased patient morbidity and mortality. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This issue is particularly significant in highly complex units such as intensive care units (ICUs), which exhibit characteristics conducive to transfer errors, including a high turnover of professionals, multiple interprofessional consultations, the complexity of patient care, and the advanced technology used in the unit. Additional external distracting factors include the volume of complex information and acoustic pollution (noise, parallel conversations, alarms), which hinder communication and may increase the likelihood of transmission errors [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInternational organizations such as the Australian Commission on Safety and Quality in Health Care [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] o European countries like Portugal through the National Plan for Patient Safety 2021\u0026ndash;2026 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], advocate for enhancing patient safety through effective communication among healthcare professionals and standardizing information transfer processes. One solution proposed by the American AHRQ [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] is the use of the bedside shift report methodology, which involves conducting handovers at the patient\u0026rsquo;s bedside using a structured communication tool, such as SBAR (Situation, Background, Assessment, Recommendation) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This methodology has proven effective in reducing adverse events through triple-checking involving the patient, enhancing patient empowerment during recovery, improving the quality of the information transmitted, and increasing satisfaction among professionals, patients, and families [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, it is not without drawbacks, as concerns have been raised regarding patient privacy and interruptions during communication [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is essential to understand the specific characteristics of different settings and the contextual factors that may hinder care practice through prior assessments\u0026mdash;such as surveys, audits, inspections, interviews, or observations [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These evaluations will facilitate addressing and improving deficiencies in the work environment if application or implementation is not feasible. Therefore, the primary objective of this study is to determine the perceptions of nursing professionals in a Portuguese ICU regarding the bedside shift report methodology in an open-architecture unit. A secondary objective is to explore their perceptions of the communication structuring tool used during handovers and the training received regarding such tools and/or methodologies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThe study adopted a qualitative design, with thematic analysis guiding the data interpretation process. Data collection was conducted through online focus groups (OFGs), allowing for an in-depth exploration of participants' attitudes, knowledge, and experiences in healthcare settings has been supported by Kitzinger [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This technique enables discussions on specific topics through group dialogues among participants using written, audio, and/or video formats on online platforms that facilitate synchronous interaction (with audio and video), thus allowing the phenomenon under investigation to emerge vividly within the group [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The COREQ checklist has been used to optimise the reporting of this qualitative study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and participants\u003c/h3\u003e\n\u003cp\u003eThe study included nursing staff from the multipurpose ICU of a public hospital in the Northern region of Portugal. This unit comprises 36 open-box beds divided into three units according to patient complexity levels [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]: two level II units (moderate complexity) and one level III unit (high complexity). The total staff consists of 96 nurses working shifts across both units.\u003c/p\u003e \u003cp\u003eFollowing initial contact with unit managers, a purposive sampling [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] strategy was employed, applying the following inclusion criteria to ensure participant relevance: 1) Active ICU nurses with at least two years of experience, based on Patricia Benner\u0026rsquo;s model [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], which classifies them as competent nurses\u0026mdash;those who perform actions confidently and make decisions grounded in previous experiences, and 2) Voluntary agreement to participate in the study. No exclusion criteria related to sex or age were applied to maintain both homogeneity and heterogeneity, thus promoting open discourse and avoiding potential group discussion barriers. The goal was to collect the broadest range of information possible rather than compare different groups. No participant declined participation.\u003c/p\u003e \u003cp\u003eThe research team held a preliminary meeting to define the organizational strategy for the OFGs, setting an initial sample size of 24 participants, in line with other qualitative studies of similar nature [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Accordingly, four groups were formed, each comprising six participants of varying ages and professional experience, as per Krueger \u0026amp; Casey\u0026rsquo;s [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Each OFG was moderated by the principal investigator (PI) of this paper, who held no contractual relationship with the participants and refrained from disclosing any preconceived opinions about the research topic.Meeting dates and times were shared one month in advance via an online document.\u003c/p\u003e \u003cp\u003ePrior to participant confirmation, following Krueger \u0026amp; Casey\u0026rsquo;s [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] recommendations, the researchers contacted participants by phone one month before the meetings to provide information on: the purpose and rationale of the study; the PI\u0026rsquo;s research interests, meeting schedules (allowing participants to select options convenient to their availability), and the possibility of receiving feedback, as financial compensation was not feasible.\u003c/p\u003e \u003cp\u003eThis process facilitated efficient planning and ensured consensus, eliminating the need for later adjustments. Upon confirming their participation, volunteers received an access link to Google Meet\u0026mdash;a platform enabling synchronous audio and video communication. Meetings were initially scheduled for 50 to 70 minutes to address all key topics and foster discussion [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Sessions were digitally recorded, with written consent from participants, for subsequent transcription and analysis.\u003c/p\u003e\n\u003ch3\u003eInstrument and Data Collection and Instrument\u003c/h3\u003e\n\u003cp\u003eData collection took place in October 2024 during four online sessions held in the morning and/or afternoon to accommodate participant availability. The PI facilitated all sessions.\u003c/p\u003e \u003cp\u003ePrior to data collection, the research team was composed of six members (two women and four men, including the PI) with backgrounds in various disciplines. The team, from Spain and Portugal, included three nurses with ICU experience and three senior researchers.Together, they developed a discussion guide (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), ensuring that the question were semi-structured, open-ended, clear, brief, concise and focused on specific concepts [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This guide was informed by previous research on perceptions of bedside shift reports in a tertiary hospital ICU with mixed infrastructure (including both open and closed boxes) and similar patient complexity levels [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e During the OFGs, group dynamics were observed and registered, focusing on aspects such as participant proactivity, non-verbal communication, and subtle elements (e.g., tone, pauses, pitch), which were further examined during the recordings\u0026rsquo; playback.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterview guide questions for focus groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Do you believe that nursing professionals have sufficient training to conduct an adequate information transfer during shift handovers?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Do you use any methodology or structure to carry out the information transfer during shift handovers?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. \u0026iquest;Are you familiar with the bedside handover methodology? What benefits or disadvantages do you perceive in this methodology?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Could the bedside handover methodology be implemented in the unit where you work?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Do you think that work shifts or unit infrastructure would influence the implementation of bedside handovers in your unit?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were manually analyzed following Braun and Clarke\u0026rsquo;s thematic analysis framework, employing a deductive approach to systematically identify and classify emerging themes. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The process began with the transcription of the interviews by the principal investigator, with support from the team to resolve potential linguistic ambiguities. Subsequently, each researcher independently read the transcripts to familiarize themselves with the content, followed by a detailed reading to systematically group data and code emerging themes. Through a triangulation process, a unique coding system was established to systematically capture relevant data, and a thematic map was developed, distinguishing between Level 1 codes (primary study themes) and Level 2 codes (subthemes derived from the primary ones). Discrepancies in coding were discussed until agreement was reached, when a value\u0026thinsp;\u0026gt;\u0026thinsp;0.61 on Cohen's Kappa coefficient was exceeded, [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This process ensured rigour and consistency in the interpretation of the data. Finally, the final themes were determined and compiled into a comprehensive report of the findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRigor\u003c/h3\u003e\n\u003cp\u003eThe researchers are experienced in qualitative methodology and in the field of ICU nursing. To reduce potential bias in the interpretation of the data, the results adhered to the principles of representativeness and followed quality criterio: credibility (triangulation of data), transferability (detailed description of the participants\u0026rsquo; perceptions and the context in which the study was conducted), dependability (detailed reporting of methodology) and confirmability the results were given to the participants so that they could corroborate that the findings reflected their experiences) set by the qualitative research guidance for clinical practice [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In addition, to reduce potential biases in the interpretation of the data, the researchers regularly discussed their impressions and analyses. Meetings were held to examine different perspectives and to ensure that the findings were as objective and representative as possible.[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eNo further OFGs were necessary as data saturation was achieved.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical Aspects\u003c/h2\u003e \u003cp\u003e The study respected the ethical principles of the Declaration of Helsinki and was conducted within the framework of a project approved by the CEIPSA of the Universitat Rovira i Virgili (CEIPSA-2024-TD-0001). Participants received verbal and written information regarding the study and provided informed consent.\u003c/p\u003e \u003cp\u003eTo ensure confidentiality data protection and participant anonymity data were securely stored with password protection after initial coding and access was restricted to the research team to prevent identity disclosure These procedures complied with Spanish regulations under Organic Law 32018 of December 5 on Personal Data Protection and Digital Rights Guarantees as well as Portuguese regulations under Law No 582019 of August 8 which ensures the implementation of the General Data Protection Regulation GDPR in the Portuguese legal system.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf the total 24 participants, 81% were women, with a mean age of 38 \u0026plusmn; 7.34 years and a mean work experience of 11 \u0026plusmn; 7.0 years (Table 2). Participants joined the online focus groups (OFGs) remotely and actively engaged in spontaneous discussions without requiring additional guidance or clarifications from the moderator. The average duration of the interviews for the four focus groups was 54 minutes. Each interview session was conducted once, with no need for repetition, as data saturation was achieved within the initial sessions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Profile of focus group participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5 women\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6 women\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 men\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u0026nbsp;\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 25-30 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;31-35 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 36-40 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt;40\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU experience\u003c/strong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026lt; 6 years \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;6-10 years \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eRegarding the nursing professionals\u0026rsquo; perceptions of the study topic, the themes and subthemes which are described below (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Themes and subthemes identified in the thematic analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubthemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTraining and development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUniversity education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eSelf-education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eResistance to change\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eHandover methodologies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eMethodological limitations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003ePersonal strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eBedside handover\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003ePatient benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eProfessional inconveniences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eInfraestructure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003ePrivacity\u003c/p\u003e\n \u003cp\u003eRest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eTraining and development\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 1: Insufficient university training in on-call handover methodologies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll four OFGs revealed a lack of university-level training on information handover between professionals, regardless of staff experience:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u003c/em\u003e \u003cem\u003eDuring university internshipsand in the basic training, we don\u0026rsquo;t have specific education that makes us capable of performing information handovers according to any methodology.\u0026quot;\u003c/em\u003e (P05-A)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I think it\u0026apos;s not a topic widely covered in nursing school nor when you start your professional career, because it\u0026rsquo;s not standardized. It\u0026rsquo;s such a broad topic that, in both academic and hospital settings, it\u0026rsquo;s not well-defined.\u0026quot;\u003c/em\u003e (P15-C)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 2: Self-education as a way of learning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants specifically indicated that the necessary training to perform an adequate shift handover is self-taught and acquired through professional experience:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Everyone has their way of transmitting information, training themselves, and learning certain techniques throughout their professional career, but during nursing school, I didn\u0026rsquo;t have any specific training on shift handovers.\u0026quot;\u003c/em\u003e (P08-B)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;During the internship, seeing the registered nurses you could have some background, but all by observation and self-taught.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(P18-D)\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Subtheme 3:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eResistance to change for the adoption of new methodologies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo OFGs mentioned that despite hospital-provided training to encourage the adoption of scientifically validated methodologies like ISBAR, implementation has been challenging:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;We have been doing the handover for many years as we learned it from others, using the ABCDE methodology, and therefore it is more complicated now to change to another method\u0026rsquo;\u0026nbsp;\u003c/em\u003e(P14-C).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;We tried to implement the SBAR methodology, but the lack of initial training in schools and the absence of formalization within the hospital meant it wasn\u0026rsquo;t incorporated into daily practice, and everyone adapted the methodology to their reality.\u0026quot;\u003c/em\u003e (P15-C)\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eHandover methodologies\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 1: Standardised methodologies are insufficient to deal with the day-to-day management of critically ill patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants expressed unanimous agreement that the SBAR methodology is inadequate for conveying information during handovers of critically ill patients:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I\u0026rsquo;m aware there are scientific methodologies like the SBAR system; however, I don\u0026rsquo;t think it\u0026rsquo;s practical for us because, with complex patients, information gets lost.\u0026quot;\u003c/em\u003e (P05-A)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I had the opportunity to use the SBAR method in my daily life, but my feeling is that it falls short because there are points that are not touched with this method and I have to use the ABDCE or the cephalo-caudal method\u0026rsquo;\u003c/em\u003e (P18-D).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 2:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eneed to develop their own strategies to cope with existing constraints.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants also noted the used different techniques to SBAR, such as head-to-toe/system-based/ABCDE approaches, to ensure comprehensive information transmission:\u003c/p\u003e\n\u003cp\u003e\u0026quot;There\u0026rsquo;s no methodology I follow to the letter; I use a systems-based approach and focus on what concerns me most. It has to be brief; too much information leads to dispersion.\u0026quot; (P04-A)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I use ABCDE because it provides a deeper patient assessment and allows me to address disease-specific issues.\u0026quot; (P24-D)\u003c/em\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eBedside handover\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 1: Bedside handovers enhance patient safety through direct visualization and real-time clarifications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants acknowledged being familiar with the bedside handover methodology. However, only half of them reported using it, primarily for highly complex patients to improve patient safety and actively involve them in their care plan:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Another advantage is that you can structure it better, making it easier for your colleague to understand, especially with complex patients.\u0026quot;\u003c/em\u003e (P05-A)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;By discussing it in front of the patient, you can help the receiver interpret the information. Plus, if the patient has any questions, you can clarify them, or even involve them actively in their own care plan.\u0026quot;\u003c/em\u003e (P19-D)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 2: Conducting bedside handovers may cause patient anxiety\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA common theme in all four focus groups was the discomfort bedside handovers can cause patients when they are unaware of their clinical history, potentially increasing anxiety and destabilizing their acute condition:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;One disadvantage is that when the patient is conscious, discussing their illness\u0026mdash;especially during the most acute phase\u0026mdash;can provoke anxiety.\u0026quot;\u003c/em\u003e (P14-C)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;In some cases, we need to limit the information we share or step aside to discuss certain details... you notice it when they start closing their eyes, not wanting to hear about their condition.\u0026quot;\u003c/em\u003e (P21-D)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 3: Bedside handover \u0026nbsp;increased distraction due to interruptions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn two OFGs, participants noted that conducting handovers in front of patients can lead to interruptions and cause discomfort among professionals:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;One of the disadvantages is that there can be interruptions, especially by the patient.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(P09-B)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I think it\u0026apos;s more uncomfortable for us as professionals because the patients are awake, might ask questions, and you don\u0026rsquo;t always know if they\u0026rsquo;re aware of certain information.\u0026quot;\u003c/em\u003e (P23-D)\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eInfraestructure\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 1: Unit infrastructure affects patient privacy, however, this is not an impediment to its implementation.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo of OFGs noted that despite recognizing the benefits of bedside handovers, implementing them is challenging due to open-box infrastructures and the resulting lack of privacy for conscious patients:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;With our current infrastructure, unless there are individual rooms, I don\u0026rsquo;t think it can be implemented because of confidentiality issues and patient characteristics.\u0026quot;\u003c/em\u003e (P04-A)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;In terms of physical space. We have 3 rooms, of which in 2 of them there is enough physical space to maintain this privacy that allows us to do this in the physical space, but I think we have the other room we can\u0026apos;t do it because of the proximity.\u0026rsquo;\u003c/em\u003e (P15-C)\u003c/p\u003e\n\u003cp\u003eThe remaining groups believed it could be implemented but with certain conditions:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;I think it can be implemented, as long as there is a briefing afterwards so that information is shared.\u0026rsquo;\u003c/em\u003e (P07-B)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Even with open boxes, I think it\u0026rsquo;s possible, but we\u0026rsquo;d need to be careful about privacy issues.\u0026quot;\u003c/em\u003e (P23-D)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme 2: Unit infrastructure affects patient rest, specially in the morning shift\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo OFGs indicated that the open layout of units, combined with bedside handovers, can disrupt patient rest, particularly during morning shifts:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;The shifts do have an influence, because being an open unit, especially in the morning shift it can interrupt the patients\u0026apos; rest.\u0026rsquo;\u0026nbsp;\u003c/em\u003e(P04-A)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Yes, especially during morning shifts\u0026mdash;it can be very confusing and wake the patient, especially since we usually do it around 8 a.m., followed by the physician\u0026rsquo;s rounds.\u0026quot;\u003c/em\u003e (P17-C)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSeveral authors have analyzed perceptions of intraprofessional communication at the bedside from the perspective of healthcare professionals working in intensive care units (ICUs) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The authors describe the advantages and disadvantages of this methodology [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Other studies have explored aspects such as the infrastructure of these units as points of analysis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The SBAR tool has also been studied, demonstrating excellent outcomes in high-complexity units such as ICUs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and has been recommended by international institutions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]; however, the results of the present study differ from reality, highlighting the costly implementation of this methodology due to several factors: the difficulty in fostering a culture of change, an initial training deficit, acquired self-learning and variability of structuring during on-call duty. In relation to the first three factors, which are intimately linked, similar results were reported by Mashail et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and Moran-Pozo et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], who noted knowledge gaps among nurses concerning the information handover process. These authors emphasize the need for university programs or continuous safety training. In this context, it is unsurprising that challenges arise in promoting a culture of change toward adopting validated methodologies; therefore, authors like Santos et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] advocate for developing a common training program to enhance communication skills, particularly in high-risk communication environments like ICUs. The third factor concerns the limitations of the SBAR method in encompassing all necessary clinical and contextual information. This shortcoming has prompted the integration of complementary methods (e.g., ABCDE, head-to-toe assessments, or functional systems approaches), which allow the transmission of qualitative, subjective, and situational aspects not fully captured by the rigid SBAR structure. Although these methods may be a hindrance, Paredes et al. (20) highligthed in their systematic review that other unvalidated standardized models can also be useful for avoiding information transmission errors, provided that message structuring occurs. Regardless of the methodology employed, participants perceive bedside handovers as enhancing patient safety, particularly for highly complex patients. This assertion is supported by the review conducted by Ansashi et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], who gathered nursing and patient perceptions, with both groups expressing a sense of safety during information transfer. However, this delivery method is not without barriers, as Jimmerson et al. [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] indicate the need to individualize each case and, if necessary, share information away from the patient to avoid uncomfortable situations or misinformation. In the present study, these barriers align with the findings of the aforementioned authors, particularly regarding the anxiety patients may experience\u0026mdash;especially during the most critical moments of their illness\u0026mdash;if they lack adequate information, which may worsen their baseline condition. Another barrier noted by these authors and others, such as Alves \u0026amp; Veiga-Branco [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] and Vanderzwan et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], is the interruption of the message during handovers, whether by patients or other external factors related to unit infrastructure, in particular with the lack of privacy and noise [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This last element, related to infrastructure, is also one of the underlying problems, especially with regard to privacy and rest of patients, mainly in the morning shifts are the most affected in terms of sleep disruption during bed transfer. This issue has been comprehensively analyzed by Tobiano et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], whose findings corroborate the present study\u0026rsquo;s results, emphasizing the privacy concerns associated with bedside handovers and advocating for a more adaptable approach to patient communication.\u003c/p\u003e \u003cp\u003eIn terms of limitations, one of them could be related to the methodology used online (GFO), as it may present technological limitations, such as unstable connectivity, technical failures or affect data quality. To overcome these potential problems, a telematic warning was given with the recommendation to use a headset and to connect from a stable network environment. Similarly, participants' audio and video quality was checked before the start of the sessions and the required personalised support was provided. These measures minimised technological interruptions, ensuring the smooth running of the session and the collection of high quality data.\u003c/p\u003e \u003cp\u003e Another limitation could be, one of them could be interpretation bias on the part of the PI, as there was no co-facilitator to record participants' non-verbal communication. Nevertheless, the online platform used for the OFGs allowed the observation of participant gestures, which was supplemented by verbal discourse elements such as tone, pitch, and pauses for later transcription. Lastly, to address other inherent limitations of OFGs, such as limited participation or digital fatigue, the PI utilized the nominal group technique (NGT). This tool ensured equitable discussion and maintained active participation within the stipulated times. To promote conversational flow and counter participant fatigue, the PI varied tone and pitch, actively monitored signs of fatigue, and encouraged breaks when necessary, fostering a comfortable and sustained dialogue environment.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFindings indicate that participants experience a deficit in university-level training related to information handovers, which they subsequently compensate for through self-directed learning and on-the-job experience. This situation complicates the implementation of new standardized methodologies, such as the SBAR method, not only due to cultural resistance but also because it lacks the elements required to convey all necessary information for highly complex ICU patients. As a result, non-validated methodologies such as head-to-toe or systems-based approaches are used. Regarding the bedside shift report methodology, participants highlight benefits such as increased patient safety\u0026mdash;through direct visualization of the patient\u0026mdash;and the facilitation of real-time clarifications between professionals and patients. However, some drawbacks were identified, including the anxiety patients may experience due to inadequate information and interruptions during the process from patient questions or suggestions. Furthermore, the open infrastructure of ICUs poses a disadvantage in terms of patient privacy and rest, particularly during morning shifts.\u003c/p\u003e \u003cp\u003eThese findings underscore the need to incorporate handover competencies into health sciences curricula through educational programs that include clinical communication methodologies, especially in high-complexity contexts like ICUs. Establishing continuous training programs is essential to enable professionals to acquire and refine skills in using standardized tools, such as the SBAR method or bedside shift report methodology, given their significant impact on patient safety. To address identified challenges, it is advisable to implement clear protocols for staff and families to mitigate patient anxiety arising from misinformation. Simulation scenarios, such as role-playing, can serve as valuable complements, allowing students and professionals to practice and improve these communication skills. Lastly, the study highlights the importance of redesigning ICU spaces to enhance patient privacy through measures such as installing dividers or soundproofing systems, thereby promoting patient rest and overall care quality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAHRQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAgency for Healthcare Research and Quality\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACSQHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAustralian Commission on Safety and Quality in Health Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eABCDE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAirway, Breathing, Circulation, Disability, Exposure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCEIPSA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthics Committee for Research in People and Applied Society\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOREQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConsolidated Criteria for Reporting Qualitative Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGDPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneral Data Protection Regulation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eISBAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIdentify, Situation, Background, Assessment, Recommendation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoint Commission International\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNGT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNominal Group Technique\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOFG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOnline Focus Group\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrincipal Investigator\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePNSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Plan for Patient Safety (Portugal)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSituation, Background, Assessment, Recommendation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the advanced practice nurses who participated in the study. Their time and expertise made this study viable. We thank the Department of Nursing, Physiotherapy, and Medicine at the University of Almeria, the Research Group Health Sciences CTS-451 and Centro de Investigaci\u0026oacute;n en Salud (CEINSA) and the Research Group Health Sciences HIGIA CTS-500 at the University of Huelva.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have participated in the development of this study. F.P.G conceived the study and participated in the data collection, data analysis and in writing the manuscript.A.J.F.G and A.S.N.R participated in the collection of participants, data collection, data analysis and writing the manuscript. F.S, G.M and E.L.P participated in the interpretation of the data and revision the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has not received funding external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the first author or corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study respected the Helsinki declaration (World Medical Association, 2013) and was approved \u0026nbsp;by the CEIPSA of the Universitat Rovira i Virgili (CEPSA-2024-TD-0001). The participants were informed about the aim of the study, the methodology used and their rights. They signed an informed consent form in accordance with the European Personal Data Protection Act that guaranteed confidentiality and anonymity without repercussions in case of withdrawal from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFletcher KA, Bedwell WL, Rosen M, Catchpole K, Lazzara E. (2014). 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Nurse Educ Pract. 2023;67:103550. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nepr.2023.103550\u003c/span\u003e\u003cspan address=\"10.1016/j.nepr.2023.103550\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"patient handoff, qualitative research, critical care, nursing","lastPublishedDoi":"10.21203/rs.3.rs-6136762/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6136762/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackgrounds: \u003c/strong\u003ePatient handovers are critical moments in healthcare, particularly in intensive care units (ICUs), where communication failures can jeopardize patient safety. While structured communication tools such as SBAR (Situation, Background, Assessment, Recommendation) are widely promoted, their implementation in complex healthcare settings remains challenging due to contextual and organizational barriers. This study examines Portuguese ICU nurses' perceptions of bedside shift handovers and the application of structured communication tools in an open-architecture unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis qualitative study employed thematic analysis to identify key themes. Twenty-four ICU nurses from a polyvalent ICU in Portugal participated, selected via convenience sampling with a minimum of two years of professional experience. Four online focus groups (OFGs) were conducted, each comprising six participants with diverse age and experience profiles. Sessions, lasting 50 to 70 minutes, were held via Google Meet, with informed consent obtained beforehand. A semi-structured discussion guide, developed from a comprehensive literature review, ensured thematic consistency and facilitated in-depth discussions. Interviews were recorded, transcribed verbatim, and analyzed using a deductive thematic analysis following Braun and Clarke’s methodology. To enhance credibility, the study adhered to COREQ guidelines and implemented investigator triangulation..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFive main themes emerged: 1) Limited university training compels nurses to engage in self-directed learning and hinders the adoption of standardized methodologies.; 2) Although structured tools like SBAR are encouraged, they are often perceived as insufficient for complex ICU patients, leading to reliance on alternative non-validated approaches such as head-to-toe and ABCDE; 3) Bedside handovers enhance patient safety by enabling direct patient visualization and real-time clarifications; (4) Nurses express concerns regarding patient anxiety, frequent interruptions, and potential discomfort during bedside handovers.; (5) The open ICU layout compromises patient privacy and rest, particularly during morning shifts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eDespite its benefits in improving patient safety and information accuracy, bedside shift handovers face persistent barriers, including inadequate formal training, resistance to change, and infrastructure constraints. Integrating clinical communication training into nursing education and optimizing ICU environments to protect patient privacy and comfort are essential. Addressing these factors is crucial to strengthening international nursing practice and ensuring the effectiveness of structured handover processes in critical care settings.\u003c/p\u003e","manuscriptTitle":"Bedside Shift Handover in Open-Box ICUs: Nursing Perspectives and Challenges from a Focus Group Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-06 18:12:03","doi":"10.21203/rs.3.rs-6136762/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-05T07:22:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-05T05:07:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-04T10:13:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-03-01T23:32:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea3e7a8b-4a2e-44d6-aa61-b2033056ca1e","owner":[],"postedDate":"March 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-25T18:53:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-06 18:12:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6136762","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6136762","identity":"rs-6136762","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}