Design and implementation of a virtual world training simulation of ICU first hour handover processes

Nursing training for an Intensive Care Unit (ICU) is a resource intensive process. High demands are made on staff, students and physical resources. Interactive, 3D computer simulations, known as virtual worlds, are increasingly being used to supplement training regimes in the health sciences; especially in areas such as complex hospital ward processes. Such worlds have been found to be very useful in maximising the utilisation of training resources. Our aim is to design and develop a novel virtual world application for teaching and training Intensive Care nurses in the approach and method for shift handover, to provide an independent, but rigorous approach to teaching these important skills. In this paper we present a virtual world simulator for students to practice key steps in handing over the 24/7 care requirements of intensive care patients during the commencing first hour of a shift. We describe the modelling process to provide a convincing interactive simulation of the handover steps involved. The virtual world provides a practice tool for students to test their analytical skills with scenarios previously provided by simple physical simulations, and live on the job training. Additional educational benefits include facilitation of remote learning, high flexibility in study hours and the automatic recording of a reviewable log from the session. To the best of our knowledge, we believe this is a novel and original application of virtual worlds to an ICU handover process. The major outcome of the work was a virtual world environment for training nurses in the shift handover process, designed and developed for use by postgraduate nurses in training.

Handover : the collective narrative of nursing practice

This paper examines the practice of handover in a large metropolitan hospital. It shows that the handover is a significant site at which to examine how tensions and imperatives derived from the traditional institutional position and role of the nurse are played out in contradiction with emergent professionalism. It identifies handover dimensions and focuses discussion on how the collective narrative of the handover serves to construct patient identities as well as ensure solidarity and cohesion among nurses.

SSCRC Austin ICU Handover

Video presented as part of Melbourne Smart Services CRC Participants conferences. Video showing the results of our collaboration with the Smart Services CRC and Austin Health. We created an environment for nurses to learn ICU Handover processes. Handover processes in an ICU involve, briefing meetings with ward nurses, and then a bedside handover of patient care information to the nurse starting the next shift. This simulation will allow students to remotely practice their handover skills, thus freeing up expensive resources at teaching hospitals, and enabling them to be at a higher skill level when they commence live training. More information available at: www.bpmve.org.

Enhanced fast handover triggering mechanism for fast proxy mobile IPv6

Handover performance is critical to support real-time traffic applications in wireless network communications. The longer the handover delay is, the longer an Mobile Node (MN) is prevented from sending and receiving any data packet. In real-time network communication applications, such as VoIP and video-conference, a long handover delay is often unacceptable. In order to achieve better handover performance, Fast Proxy Mobile IPv6 (FPMIPv6) has been standardised as an improvement to the original Proxy Mobile IPv6 (PMIPv6) in the Internet Engineering Task Force (IETF). The FPMIPv6 adopts a link layer triggering mechanism to perform two modes of operation: predictive and reactive modes. Using the link layer triggering, the handover performance of the FPMIPv6 can be improved in the predictive mode. However, an unsuccessful predictive handover operation will lead to activation of a reactive handover. In the reactive mode, MNs still experience long handover delays and a large amount of packet loss, which significantly degrade the handover performance of the FPMIPv6. Addressing this problem, this thesis presents an Enhanced Triggering Mechanism (ETM) in the FPMIPv6 to form an enhanced FPMIPv6 (eFPMIPv6). The ETM reduces the most time consuming processes in the reactive handover: the failed Handover Initiate (HO-Initiate) delay and bidirectional tunnel establishment delay. Consequently, the overall handover performance of the FPMIPv6 is enhanced in the eFPMIPv6. To show the advantages of the proposed eFPMIPv6, a theoretical analysis is carried out to mathematically model the performance of PMIPv6, FPMIPv6 and eFPMIPv6. Extensive case studies are conducted to validate the effectiveness of the presented eFPMIPv6 mechanism. They are carried out under various scenarios with changes in network link delay, traffic load, number of hops and MN moving velocity. The case studies show that the proposed mechanism ETM reduces the reactive handover delay, and the presented eFPMIPv6 outperforms the PMIPv6 and FPMIPv6 in terms of the overall handover performance.

Towards an understanding of the information dynamics of the handover process in aged care settings: A prerequisite for the safe and effective use of ICT

Background Poor clinical handover has been associated with inaccurate clinical assessment and diagnosis, delays in diagnosis and test ordering, medication errors and decreased patient satisfaction in the acute care setting. Research on the handover process in the residential aged care sector is very limited. Purpose The aims of this study were to: (i) Develop an in-depth understanding of the handover process in aged care by mapping all the key activities and their information dynamics, (ii) Identify gaps in information exchange in the handover process and analyze implications for resident safety, (iii) Develop practical recommendations on how information communication technology (ICT) can improve the process and resident safety. Methods The study was undertaken at a large metropolitan facility in NSW with more than 300 residents and a staff including 55 registered nurses (RNs) and 146 assistants in nursing (AINs). A total of 3 focus groups, 12 interviews and 3 observation sessions were conducted over a period from July to October 2010. Process mapping was undertaken by translating the qualitative data via a five-category code book that was developed prior to the analysis. Results Three major sub-processes were identified and mapped. The three major stages are Handover process (HOP) I “Information gathering by RN”, HOP II “Preparation of preliminary handover sheet” and HOP III “Execution of handover meeting”. Inefficient processes were identified in relation to the handover including duplication of information, utilization of multiple communication modes and information sources, and lack of standardization. Conclusion By providing a robust process model of handover this study has made two critical contributions to research in aged care: (i) a means to identify important, possibly suboptimal practices; and (ii) valuable evidence to plan and improve ICT implementation in residential aged care. The mapping of this process enabled analysis of gaps in information flow and potential impacts on resident safety. In addition it offers the basis for further studies into a process that, despite its importance for securing resident safety and continuity of care, lacks research.

The cross layer RMPA handover: a reliable mobility pattern aware handover strategy for broadband wireless communication in a high-speed railway domain

Enhancing the handover process in broadband wireless communication deployment has traditionally motivated many research initiatives. In a high-speed railway domain, the challenge is even greater. Owing to the long distances covered, the mobile node gets involved in a compulsory sequence of handover processes. Consequently, poor performance during the execution of these handover processes significantly degrades the global end-to-end performance. This article proposes a new handover strategy for the railway domain: the RMPA handover, a Reliable Mobility Pattern Aware IEEE 802.16 handover strategy "customized" for a high-speed mobility scenario. The stringent high mobility feature is balanced with three other positive features in a high-speed context: mobility pattern awareness, different sources for location discovery techniques, and a previously known traffic data profile. To the best of the authors' knowledge, there is no IEEE 802.16 handover scheme that simultaneously covers the optimization of the handover process itself and the efficient timing of the handover process. Our strategy covers both areas of research while providing a cost-effective and standards-based solution. To schedule the handover process efficiently, the RMPA strategy makes use of a context aware handover policy; that is, a handover policy based on the mobile node mobility pattern, the time required to perform the handover, the neighboring network conditions, the data traffic profile, the received power signal, and current location and speed information of the train. Our proposal merges all these variables in a cross layer interaction in the handover policy engine. It also enhances the handover process itself by establishing the values for the set of handover configuration parameters and mechanisms of the handover process. RMPA is a cost-effective strategy because compatibility with standards-based equipment is guaranteed. The major contributions of the RMPA handover are in areas that have been left open to the handover designer's discretion. Our simulation analysis validates the RMPA handover decision rules and design choices. Our results supporting a high-demand video application in the uplink stream show a significant improvement in the end-to-end quality of service parameters, including end-to-end delay (22%) and jitter (80%), when compared with a policy based on signal-to-noise-ratio information.

Handover en LTE basado en distancia en plataforma de simulación

[ES]Mejorar el proceso de handover en el despliegue de comunicaciones inalámbricas de banda ancha tradicionalmente ha motivado muchas iniciativas de investigación. En el dominio de los ferrocarriles de alta velocidad, el reto es incluso mayor. Debido a las largas distancias que se cubren, el nodo móvil se ve envuelto en una secuencia obligatoria de procesos de handover. Consecuentemente, un rendimiento pobre en la ejecución de esos procesos de handover degrada significativamente el rendimiento global extremo a extremo. Este documento propone una nueva estrategia de handover para el dominio de los ferrocarriles: un algoritmo de decisión para LTE basado en distancia en lugar de en potencia. La decisión de realizar el handover se realiza cuando un eNB candidato se encuentra más cerca del UE que el eNB fuente. Adicionalmente, cabe la posibilidad de retrasar esa decisión mediante un umbral. Asimismo, se añade una nueva función al modelo de LTE de la plataforma de simulación empleada en la verificación de este modelo. Este mecanismo de decisión introduce un retardo menor en los procesos de handover y, en consecuencia, la calidad extremo-a-extremo aumenta.

From projects into operations: lessons for data handover

Data from civil engineering projects can inform the operation of built infrastructure. This paper captures lessons for such data handover, from projects into operations, through interviews with leading clients and their supply chain. Clients are found to value receiving accurate and complete data. They recognise opportunities to use high quality information in decision-making about capital and operational expenditure; as well as in ensuring compliance with regulatory requirements. Providing this value to clients is a motivation for information management in projects. However, data handover is difficult as key people leave before project completion; and different data formats and structures are used in project delivery and operations. Lessons learnt from leading practice include defining data requirements at the outset, getting operations teams involved early, shaping the evolution of interoperable systems and standards, developing handover processes to check data rather than documentation, and fostering skills to use and update project data in operations

Challenging the handover : recommendations for research and practice

Communicating nursing care during the patient's total hospital stay is a difficult task to achieve within the context of high patient turnover, a lack of overlap time between shifts, and time constraints. Clear and accurate communication is pivotal to delivering high quality care and should be the gold standard in any clinical setting. Handover is a commonly used communication medium that requires review and critique. This study was conducted in five acute care settings at a major teaching hospital. Using a grounded theory approach, it explored the use of three types of handover techniques (verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semi-structured interviews with nurses and participant field observations. Textual data were managed using NUD-IST. Transcripts were critically reviewed and major themes identified from the three types of handovers that illustrated their strengths and weaknesses. The findings of this study revealed that handover is more than just a forum for communicating patient care. It is also used as a place where nurses can debrief, clarify information and update knowledge. Overall, each type of handover had particular strengths and limitations; however, no one type of handover was appraised as being more effective. Achieving the multiple goals of handover presents researchers and clinicians with a challenging task. It is necessary to explore more creative ways of conducting the handover of patient care, so that an important aspect of nursing practice does not get classified as just another ritual.

Discourses of anxiety in nursing practice : a psychoanalytic case study of the change-of-shift handover ritual

This paper reports on the findings of a study that considered how anxiety might function to organise nurses' practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change-of-shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, yet allowed some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety.

Nursing handover : it's time for a change

Nursing handover is a common part of nursing practice that is fundamental to safe patient care. Despite this, the literature provides little direction on the best way to conduct handover. This project aimed to examine nurses' perceptions of handover and to determine the strengths and limitations of the handover process. A staff survey was distributed to nurses in all inpatient wards at a metropolitan tertiary hospital. A total of 176 nurses responded to the staff survey. The findings revealed conflicting opinions about the effectiveness of the handover process; although a number of nurses were positive about current handover practice, indicating they were provided with sufficient information about patients and given opportunity to clarify patient care information, other nurses identified aspects of handover that could be improved. These included: the subjectivity of handover information, the time taken to conduct handover, repetition of information that could be found in the patients' care plans, and handing over of information by a nurse who has not cared for the patient. Some attention needs to given to addressing the perceived weaknesses associated with the handover process.

Examining communication and team performance during clinical handover in a complex environment : the private sector post-anaesthetic care unit

* Threats to patient safety during clinical handover have been identified as an ongoing problem in health care delivery.

* In complex handover situations, organisational, cultural, behavioural and environmental factors associated with team performance can affect patient safety by undermining the stability of team functioning and the effectiveness of interprofessional communication.

* We present a practical framework for promoting systematic, comprehensive measurement of the factors involved in clinical handover.

* The framework can be used to develop viable solutions to the problems of clinical handover.

* The framework was devised and used in a recent project examining interprofessional communication and team performance during clinical handover in post-anaesthetic care units.

* The framework combines five key concepts: clinical governance, clinician engagement, ecological validity, safety culture and team climate, and sustainability.

* We believe that use of this framework will help overcome the limitations of previous research that has not taken into account the complex and multifaceted influences on clinical handover and interprofessional communication.

Communication at the bedside to enhance patient care : a survey of nurses’ experience and perspective of handover

Strategies to support continuity of care and improve patient safety during clinical handover have been developed. The aims of this study were to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross-sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part-time compared with full-time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation-Background-Assessment-Recommendation, active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care