JMIR Publications

ABSTRACT

Background:

Shift handovers represent a critical moment for patient safety, where the effective transfer of information between nurses is essential. In this context, digital documentation systems such as IDEAS (Identification, Diagnosis, Evolution, Activities, Support) have been implemented to standardize and enhance the quality of clinical handovers.

Objective:

The main objective was to explore nurses’ perceptions in the hospital setting regarding information transfer during shift changes. Specific objectives included identifying the perceived strengths and weaknesses of the handover process, as well as the difficulties and improvement proposals reported by nurses.

Methods:

A qualitative study with a phenomenological approach was conducted. Semi-structured interviews were carried out with nurses from the Hospital Universitario Insular de Gran Canaria (HUIGC) who had experience using the IDEAS system, between June 2023 and September 2024, until data saturation was reached. After transcribing the interviews, an inductive thematic analysis was performed to identify emerging themes using both descriptive and interpretative approaches. Axial coding through co-occurrence analysis, analytical triangulation, and reflexivity strategies were incorporated to strengthen the credibility and consistency of the findings. Atlas-Ti software (version 25) was used for the analysis. The study was approved by the local ethics committee (code: 2023-244-1).

Results:

From the interviews (n = 15), six subthemes were identified and grouped into three main themes: Nurses (Difficulties and improvement proposals in information transfer, Strengths and weaknesses in shift change process), Patients (Electronic health records: Benefit for patient, Transfer of patient information), and Records (Form feedback, Information management). Participants valued the structured access to clinical information provided by the IDEAS system. However, they reported limitations such as poor data prioritization, editing difficulties, outdated information, and a lack of integration between nursing and medical records. Additionally, training deficiencies and variability in system use—particularly among less experienced professionals—were noted. Suggestions for improvement included redesigning the handover form, automating updates, incorporating brief clinical summaries, and providing ongoing training.

Conclusions:

While the IDEAS system represents an improvement over previous handover methods, its effectiveness remains constrained by technical, organizational, and cultural barriers. Optimizing the system requires clinically oriented redesigns, alongside training strategies and an institutional culture that promotes shared responsibility for documentation quality. These elements are essential for establishing a safer, more standardized, and patient-centered clinical handover model.