Nursing handovers represent an important and complex form of communication in healthcare organizations that involve the exchange of patient-related information between nurses. This qualitative descriptive study aimed to identify the intershift handover experiences among nurses working in small and medium-sized hospitals. Focus-group interviews were conducted with 30 nurses who directly participated in patient care in such hospitals in South Korea. The reporting of the study findings adhered to the Consolidated Criteria for Reporting Qualitative Research checklist. The data were analyzed using content analysis. Under the main theme of \"baton touch in a relay,\" 6 categories, 17 subcategories, and 45 codes (concepts) were derived. The six categories were \"procedural rituals for shifts,\" \"nonstandardized handover training,\" \"inconsistent handover style,\" \"stress due to handovers,\" \"coping strategies for handovers,\" and \"interruptions of handovers.\" Nurses in small and medium-sized hospitals strive to improve the quality of handovers by preparing individual-level coping strategies under difficult conditions. This indicates that standardized handover education strategies need to be developed for nurses that are suitable for the personnel systems of small and medium-sized hospitals.

WhatsApp is an instant messaging application that has grown in popularity over the last decade. The literature has focused on the use of WhatsApp in medical, surgical and nursing disciplines, with little work exploring pharmacists\' experiences of using WhatsApp to provide services.
The aim of this research was to explore pharmacists\' experiences of using WhatsApp to support delivery of out-of-hours pharmacy services.
A qualitative design was underpinned by a phenomenological philosophy. Focus groups and an extract of the WhatsApp transcript were thematically analysed using NVivo.
Over three hundred communication events (1580 messages) were analysed in the WhatsApp transcript. Message type was classified as follows; handover (26%, n = 410), procedural queries (26%, n = 410), laptop location (18%, n = 284), whole staff communication (24%, n = 379), clinical queries (5%, n = 79), and administrative communications (1%, n = 16). A total of five focus groups were conducted between October and November 2017 with 27 participants that included pharmacists with different levels of experience. The findings suggest that WhatsApp improved communication between junior and senior pharmacists, particularly during the global cyber crisis, and provided an opportunity to share best practice. Concerns were raised regarding the encroachment of work activities into personal time. Additionally, the tacit approval by senior pharmacists to group information sharing and solution development, despite the potential for non-active participation, highlighted the issue of collective complicity.
WhatsApp can be a useful platform to support the delivery of out-of-hours services through professional development, improving communication and supporting relationships. This paper demonstrates that service managers must consider multiple ethico-legal and social frameworks when developing or allowing the organic development of such communication methods within healthcare provider organisations.

Social network analysis quantifies and visualizes relationships between and among individuals or organizations. Applications in the health sector remain underutilized. This systematic review seeks to analyze what social network methods have been used to study professional communication and performance among healthcare providers.
Ten databases were searched from 1990 through April 2016, yielding 5970 articles screened for inclusion by two independent reviewers who extracted data and critically appraised each study. Inclusion criteria were study of health care worker professional communication, network methods used, and patient outcomes measured. The search identified 10 systematic reviews. The final set of articles had their citations prospectively and retrospectively screened. We used narrative synthesis to summarize the findings.
The six articles meeting our inclusion criteria described unique health sectors: one at primary healthcare level and five at tertiary level; five conducted in the USA, one in Australia. Four studies looked at multidisciplinary healthcare workers, while two focused on nurses. Two studies used mixed methods, four quantitative methods only, and one involved an experimental design. Four administered network surveys, one coded observations, and one used an existing survey to extract network data. Density and centrality were the most common network metrics although one study did not calculate any network properties and only visualized the network. Four studies involved tests of significance, and two used modeling methods. Social network analysis software preferences were evenly split between ORA and UCINET. All articles meeting our criteria were published in the past 5 years, suggesting that this remains in clinical care a nascent but emergent research area. There was marked diversity across all six studies in terms of research questions, health sector area, patient outcomes, and network analysis methods.
Network methods are underutilized for the purposes of understanding professional communication and performance among healthcare providers. The paucity of articles meeting our search criteria, lack of studies in middle- and low-income contexts, limited number in non-tertiary settings, and few longitudinal, experimental designs, or network interventions present clear research gaps.
PROSPERO CRD42015019328.

Primary care in remote communities in northern Canada is delivered primarily by nurses who receive clinical support from physicians in regional centres and the patient transportation system. To improve continuity, quality and access to care in remote northern communities, it is important to understand the perspectives of front-line providers and the complex challenges they face.
To design and implement a survey of primary care providers to identify issues relating to inter-professional communication, clinical support and patient evacuation.
In collaboration with the territorial government and regional health authority partners, we developed a 21-item self-administered questionnaire survey, which could be completed online. The survey was sent to 218 physicians and nurses who were employed in the Northwest Territories (NWT) at the time of the survey and were involved in sending patients out of the community and/or receiving patients. The survey also contained an open-ended question at the end seeking comments regarding primary health care.
The overall low response rate of 39% among nurses and 19% among physicians threatens the validity of the quantitative results. The majority of providers were satisfied with their ability to communicate with other providers in a timely manner, their freedom to make clinical decisions and their overall experience practicing in the NWT. The patient transfer system appears to work from both the sender and receiver perspectives. However, a common theme reported by nurses was that physicians providing clinical advice, especially short-term locums, were not familiar with the local situation, whilst physicians at the receiving end remarked that the clinical information provided to them often lacked clarity.
Important lessons were learnt from the pilot study, especially in better engagement of providers in planning and dissemination. The questionnaire design and the online method of delivery were acceptable. Although important issues were identified, a larger definitive survey is needed to investigate them in the future.

BACKGROUND: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital.
METHODS: A qualitative study with data collected through semi-structured focus groups and individual interviews.
RESULTS: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients.
CONCLUSIONS: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.

Improved life-sustaining technology in the neonatal intensive care has resulted in an increased probability of survival for extremely premature babies. In the neonatal intensive care, the condition of a baby can deteriorate rapidly. Nurses and parents are together for long periods at the bedside and so form close and trusting relationships. Neonatal nurses as the constant caregivers may be presented with contradictory demands in attempting to meet the baby\'s needs and being a patient and family advocate. This article aims to explore the issues arising for neonatal nurses when holding information about changes to a condition of a baby that they are unable to share with parents. Data were collected via interviews with 24 neonatal nurses in New South Wales, Australia. A qualitative approach was used to analyse the data. The theme \'keeping secrets\' was identified and comprised of three sub-themes \'coping with potentially catastrophic news\', \'fear of inadvertent disclosure\' and \'a burden that could damage trust\'. Keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the parent\'s right to know information. The neonatal nurses experienced guilt and shame when they were felt forced by circumstances to keep secrets or withhold information from the parents of extremely premature babies.

OBJECTIVE: Clinical documentation is central to the medical record and so to a range of healthcare and business processes. As electronic health record adoption expands, computerized provider documentation (CPD) is increasingly the primary means of capturing clinical documentation. Previous CPD studies have focused on particular stakeholder groups and sites, often limiting their scope and conclusions. To address this, we studied multiple stakeholder groups from multiple sites across the USA.
METHODS: We conducted 14 focus groups at five Department of Veterans Affairs facilities with 129 participants (54 physicians or practitioners, 34 nurses, and 37 administrators). Investigators qualitatively analyzed resultant transcripts, developed categories linked to the data, and identified emergent themes.
RESULTS: Five major themes related to CPD emerged: communication and coordination; control and limitations in expressivity; information availability and reasoning support; workflow alteration and disruption; and trust and confidence concerns. The results highlight that documentation intertwines tightly with clinical and administrative workflow. Perceptions differed between the three stakeholder groups but remained consistent within groups across facilities.
CONCLUSIONS: CPD has dramatically changed documentation processes, impacting clinical understanding, decision-making, and communication across multiple groups. The need for easy and rapid, yet structured and constrained, documentation often conflicts with the need for highly reliable and retrievable information to support clinical reasoning and workflows. Current CPD systems, while better than paper overall, often do not meet the needs of users, partly because they are based on an outdated \'paper-chart\' paradigm. These findings should inform those implementing CPD systems now and future plans for more effective CPD systems.