Exploring Practices During Nursing Handovers in Critical Care: An Anthropological Study

Area of Science:

• Medical Anthropology
• Nursing Science
• Critical Care

Background:

• Nursing handovers in intensive care units (ICUs) are crucial for patient safety and continuity of care.
• Handovers are key moments where nursing expertise can influence patient treatment trajectories.
• Power dynamics and visibility of nursing knowledge during handovers are underexplored.

Purpose of the Study:

• To explore how experienced ICU nurses influence clinical decision-making through handover practices.
• Investigate the role of nursing expertise in critical care decision-making during handovers.

Main Methods:

• Ethnographic study using participant observation and interviews in a Greek ICU.
• Data collected over two years (2012-2014, concluded 2020).
• Thematic analysis of fieldnotes using Atlas.ti.

Main Results:

• Nursing handovers act as "heterotopias" for nursing expertise, enabling influence on decision-making.
• Experienced nurses narrated patient trajectories, showcased expertise, mentored, verbalized decisions, and temporarily reversed hierarchies.
• Nurses' clinical reasoning became visible, influencing patient management.

Conclusions:

• Nursing handovers are strategic opportunities for nurses to redefine professional boundaries in the ICU.
• Handovers can strengthen team collaboration, support decision-making, and enhance patient care.
• Recognizing handovers as protected spaces for nursing expertise is vital for professional autonomy in critical care.