Bedside Shift Handover in Open-Box ICUs: Nursing Perspectives and Challenges from a Focus Group Study

Backgrounds: Patient handovers are critical moments in healthcare, particularly in intensive care units (ICUs), where communication failures can jeopardize patient safety. While structured communication tools such as SBAR (Situation, Background, Assessment, Recommendation) are widely promoted, their implementation in complex healthcare settings remains challenging due to contextual and organizational barriers. This study examines Portuguese ICU nurses' perceptions of bedside shift handovers and the application of structured communication tools in an open-architecture unit. Methods: This qualitative study employed thematic analysis to identify key themes. Twenty-four ICU nurses from a polyvalent ICU in Portugal participated, selected via convenience sampling with a minimum of two years of professional experience. Four online focus groups (OFGs) were conducted, each comprising six participants with diverse age and experience profiles. Sessions, lasting 50 to 70 minutes, were held via Google Meet, with informed consent obtained beforehand. A semi-structured discussion guide, developed from a comprehensive literature review, ensured thematic consistency and facilitated in-depth discussions. Interviews were recorded, transcribed verbatim, and analyzed using a deductive thematic analysis following Braun and Clarke’s methodology. To enhance credibility, the study adhered to COREQ guidelines and implemented investigator triangulation.. Results: Five main themes emerged: 1) Limited university training compels nurses to engage in self-directed learning and hinders the adoption of standardized methodologies.; 2) Although structured tools like SBAR are encouraged, they are often perceived as insufficient for complex ICU patients, leading to reliance on alternative non-validated approaches such as head-to-toe and ABCDE; 3) Bedside handovers enhance patient safety by enabling direct patient visualization and real-time clarifications; (4) Nurses express concerns regarding patient anxiety, frequent interruptions, and potential discomfort during bedside handovers.; (5) The open ICU layout compromises patient privacy and rest, particularly during morning shifts. Conclusions: Despite its benefits in improving patient safety and information accuracy, bedside shift handovers face persistent barriers, including inadequate formal training, resistance to change, and infrastructure constraints. Integrating clinical communication training into nursing education and optimizing ICU environments to protect patient privacy and comfort are essential. Addressing these factors is crucial to strengthening international nursing practice and ensuring the effectiveness of structured handover processes in critical care settings.