51^st World Nursing Leadership & Healthcare Management Conference October 04-05, 2018 Moscow, Russia

Abstract Background: Nursing handover represents one of the basics of classical nursing practice. Recently, however, several authors have expressed dissatisfaction with the nursing handover process, arguing that much of the information transferred is either corrupted or lost during the handover, with obvious detrimental consequences for the quality of care. Hence, research and practice yearn for studies that enlighten our understanding of the ways to improve nursing handover. Two main theoretical approaches have been suggested for investigating nursing handover: standardization and resilience. Standardization calls for consistency in the processes and contents of nursing handover. In comparison, resilience is a more proactive approach, which focuses on nurses' anticipation of changes, constant attention, course corrections, reassessment, monitoring and feedback. This research focuses on the latter approach. Research aims: The main aim of the current study was to understand the process of nursing handover from the perspective of the nurses participating in the handover. More specifically, our aim was twofold: First, to identify the goals of handover from the perspective of the participating nurses; and second, to identify the cognitive, emotional and behavioral strategies nurses use when receiving and handing over shifts, which allow them to manage the information in the best manner for the benefit of the patient's care and safety. Methods: This research employed qualitative methods. Fourteen nurses, males and females, who worked at Rambam Medical Center in Haifa, Israel, participated in the study. Sampling strategy assured that participants would represent nurses from different clinical fields, seniority, roles and clinical experience. Research participants were interviewed individually through semi-constructed in-depth interviews. All interviews were recorded and later transcribed. Data analysis was done through content analysis. Findings: Content analysis revealed three major themes. The first referred to the goals of nursing handover. This theme focused on the declared versus the actual goals of the handover prevalent in the ward. While all the participants emphasized the importance of the declared goals, they at the same time described how these goals were informally shaped to create goals "in practice", which had better, conform to the nursing handover. The second theme referred to the ward's personal and interpersonal factors influencing the nursing handover. This theme related to personal factors such as the nurses' seniority and reputation, interpersonal factors such as trust among staff, and handover characteristics such as work load and interruptions. These factors were often involved in the handover process, turning the handover goals into attainable ones. The third theme referred to the strategies which the nurses develop and operate to bridge the gap between declared and actual goals, and thus to better respond to the goals of the nursing handover, as they perceive it. This theme is divided into two subthemes: (1) handing over strategies and (2) receiving strategies. Discussion: The findings of the present research are pioneering in terms of identifying the handover strategies, which nurses develop to strike a balance between efficiency and workload, on the one hand, and maintaining the quality and safety of care, on the other hand. Nine forecasting strategies were mapped. Nurse Handover strategies focused on recalling strategies aimed at recalling what the nurses perceived as the crucial information for handover. Strategies for receiving shifts focused on identifying "red warning lights" that enable receiving nurses to optimize care and to mark those cases, which require further inquiry, to develop an improved care map. These strategies are discussed in line with theories that relate to practical and professional knowledge development. In line with this body of theories, it seems that these strategies, which were developed based on nurses' clinical knowledge, experience, clinical judgment, and intuition, enable nurses to develop the ability to foresee negative events. Nevertheless, like all heuristics, they are vulnerable to error. Conclusions and implications: The present research have important theoretical and practical implications. The research identified nine forecasting strategies that are employed by nurses during the handover were mapped. Future research should examine the effectiveness of these forecasting strategies in preventing errors, on the one hand, and on maintaining the quality of care, on the other hand, so that they could be recommended for comprehensive practice. Furthermore, similar research can be conducted in other medical centers and on larger populations of nurses to hear more voices and identify more strategies. Furthermore, the findings of the present research have important implications for nursing practice. First, they emphasize the importance of verbal, face-to-face nursing handover at the patient's bedside. Under these circumstances, nurses can compare the different sources of information (e.g., the information provided at the handover with personal impressions from the patient, along with written records), which allow them to turn on "red warning lights" in case of inadequacy. Second, the findings highlight the gap between the information nurses wish to receive and the information they wish to hand over. While the handing over nurses emphasized the importance of standardized pattern for delivering information, the receiving nurses were not interested in consistent and complete information; they wished only to receive the most crucial information. Hence, it is recommended to consider changing the pattern of nursing handover, so that it is less constructed, thus enabling the receiving nurses to pose questions to the conveying personnel. Third, the research findings imply that the lack of common mental models among nurses regarding the information that must be transferred during the handover creates a lack of trust and lowers the credibility of the conveyed information. Fourth, our research emphasizes the importance of nurses' practical knowledge and experience. Therefore, one needs to invest more in improving nurses' theoretical knowledge for their practice to be more evidence based.

Ilana Kan pursued her MA Degree at the University of Haifa (Israel). She is the Head Nurse of Orthopedic Outpatient Clinic and a Vice Head Nurse of Ambulatory Outpatient Clinic at Rambam Health Care Campus, Haifa, Israel.

Leadership for quality means making it possible for everyone, every day to do better job with greater satisfaction, learning from and with their colleagues in order to improve services. It is crucial that every organization will have a framework to support ongoing quality improvement and patient safety. Nurse involvement is essential to any significant healthcare improvement initiative. As nurse leader managers and organizers, we should support our staff in developing knowledge, skills and attitudes in quality improvement and safety, by providing the learning and development opportunities or activities suitable for their role. Quality and safety are rooted in the daily work of all staff at the facility. At Rambam outpatient clinics, we establish a framework for placing nursing on the frontlines of transforming healthcare. Our goal is to provide safe care and services based on scientific evidence practice to all patients. We take efforts to ensure that all clinical plans are based on individual patient preferences, needs and values. To achieve this goal we put focus on transformational leadership at all levels of nursing. We engage and empower nurses to act as leaders in ensuring high quality patient care. We train our nurses to be leaders who can create and implement programs, products, environments to meet the patient population needs. Our strategy is to provide organizational learning opportunities for individual leaders (head nurses of outpatient clinic) and leadership teams (clinical mentor) in order to create tools and programs for all levels of nursing. For example, a training program for better compliance of hand hygiene. We create appropriate assessment tools for ongoing analysis of the current state of knowledge amongst all medical teams, quality of fulfillment of medical records and applying core principles. Staff meetings, nurse research and poster presentations provide educational platforms and involve all outpatient clinic nurses in the leading process.

Miri Foox pursued her MA Degree at University of Haifa (Israel). She is the Director of the outpatient clinic of Rambam Health Care Campus. She worked as Head Nurse in Orthopedic Department during 1999-2014; Trauma coordinator (1996-1999) and as Deputy Head Nurse in General Surgery Department (1990-1996).

The head nurse manager provides leadership and is responsible for the management of the outpatient clinics and ensuring high quality patient care; provides guidance and direction to junior staff and is resposible for organizing, directing, coordinating and supervising activities for the care of patients. Other roles include the development of personnel, ensuring compliance with regulatory and professional standards, strategic planning and fostering of interdisciplinary collaborative relationships. The head nurse manager oversees formation and usage of the budget, implemention of standard care and standards of practice. This position allows for flexibility in determining priorities, programs and procedures within the framework of hospital healthcare mission, goals and objectives. We would like to present several examples of leadership and managment as follows. 1. assessment of patients: in order to ensure high quality care, treatment and follow up protocol. All out patient clinics started to use common settings for evaluation of different patient factors and conditions. In addition, every outpatient clinic performed unique assessments for its patients. For example: questionnaire for the assessment of violent behaviors in the gynecology clinic, a diabetic foot assesment for orthopedic clinic or depression assessment questionnaire for immunology clinic. 2. patient safety goals: In order to provide accurate and effective communication and collaboration, author started to use a standardized report format with adaptation for unique needs and goals for every outpatient clinic. 3. patient and family education: to better understand their medical condition and participate in their own care, we strive to inform and teach our patient a topic every month. For example, a new technology of cross linking for the ophthalmology clinic, new drug generation for patient with HCV, common allergen for allergy clinic. 4. quality improvement: Our aim is constantly to make real improvements that help patients. We investigate how processes can be more efficient, resources can be used more wise and physical risks can be reduced. Our quality program includes routine patient satisfaction surveys and questionnaires. For example, after analysis and validation of survey data we changed the appointment letter for outpatient clinics all over the country. 5. staff qualifications and education: As the coordinator of all out patient clinics at the hospital, the head nurse manager identifies the number and types of staff needed based on the hospital goals and recommendations. All the various out patient clinics work as a team in order to improve skills, knowledge, education and previous work experience. For example, training in BLS, ACLS and the use of sedation. In addition, providing skills for patient group direction or the breaking of bad news.

Nadirbekova G E has completed Semipalatinsk Medical School. After graduation from the medical school, she began to work as a Nurse in the department of septic surgery. She has been working as a Nurse then as a Chief Nurse of the operative units at the cardiac surgery departments from 1994 till 2010. She is currently a Nursing Director at the JSC "National Research Center for Cardiac Surgery" since 2010. She has many awards for her professional merits; for selfless and noble work; devotion and love of medicine in Kazakhstan and special merits in the matter of protecting the health of population of the Republic of Kazakhstan.

Aim: The aim of this paper is to illustrate experience and management system of nurses’ working in National Research Center for Cardiac Surgery and its changing from 2012. Materials & Methodology: To increase the effectiveness of nursing work at the base of the National Research Center for Cardiac Surgery the nursing project was established with following methods: Uniform work standards; Narrowed direction of nurses’ training; Sharing a clear teaching of manipulation; Continuous training; Feedback and Communication skills. In other words, there were several implementations like mobile application with information on nursing standards, psychologist consultation on personnel, constant assessment of knowledge and skills of nurses, testing and supervision of the implementation of procedures, daily training at the workplace. Results: As a result, of our methods of organizing nursing work, we have received competent and qualified members of a multidisciplinary team. The result of the satisfaction survey before the implementation of project in 2012 was 70% (540 people), and after the project in 2017 it was 91% (621 people), doctors’ satisfaction with the nurses’ work before the project was 67% (78 people), after the project it was 91.5% (82 people), nurses’ satisfaction with their work before the project was 57% (198 people), after the project it was 87% (230 people). From the analyzed results of the study, after the implementation of the project, several errors in work related to the human factor and lack of knowledge has decreased. Conclusions: The methods which are used to organize the work of the nursing service have helped to improve nursing processes and have contributed to the effective work of the multidisciplinary team and the reduction in the number of medical errors.