‘This is our liver patient…’: use of narratives during resident and nurse handoff conversations

Abstract

Objective Handoffs are often framed as the co-construction of a shared understanding relying on narrative storytelling. We investigated how narratives are constructed and used during resident and nurse handoff conversations. Method We audio-recorded resident (n=149) and nurse (n=126) handoffs in an inpatient medicine unit. Qualitative analysis using grounded theory was conducted to identify and characterise the structure of resident and nursing handoff narratives. Results Handoff conversations among both residents and nurses used three types of narratives: narratives on creating clinical imagery, narratives on coordinating care continuity and narratives on integrating contextual aspects of care. Clinical imagery narratives were common during patient introductions: residents used a top-down approach relying on overarching patient clinical situations (eg, 'a liver patient'), whereas nurses used a bottom-up approach using patient-specific identifying information. Narratives on the coordination of care continuity for residents focused on managing internal and external coordination activities, whereas nurse narratives focused on internal coordination, emphasising their role as an interface between patients and their physicians. Both resident and nurse narratives on the contextual aspects of care had considerable focus on highlighting 'heads up' anticipatory information and personal patient information; such information was often not present in patient charts, but was important for…