Exploration Of Effective Nursing Shift Handover In The Intensive Care Units In Saudi Arabia: Adaptation And Validation Of The Handover Evaluation Scale

Abstract

Background: Effective nursing shift handover in intensive care units (ICUs) is crucial for maintaining care quality and patient safety and reducing the risk of adverse events. In multicultural ICUs in Saudi Arabia, where nurses have diverse linguistic and cultural backgrounds, handover communication can be challenging. Although several handover evaluation tools exist, few reflect the unique demands of ICU practice or the multicultural dynamics that influence communication among nurses. Purpose: This dissertation aims to adapt the Handover Evaluation Scale (HES) and to assess its content validity, reliability, and dimensional structure for evaluating handover practices and factors influencing handover quality in Saudi Arabian ICUs. Method: An exploratory mixed-methods design was used. In the qualitative phase, semi-structured interviews were conducted with 24 ICU nurses recruited through purposive sampling. Data were analyzed using interpretive description to identify themes and items relevant to modifying the existing HES. Findings informed revisions to the instrument, which six expert ICU nurses with a master’s or doctoral degree in nursing evaluated for content validity. In the quantitative phase, 443 ICU nurses completed the modified HES in a cross-sectional study assessing its reliability and factor structure. Statistical analyses were performed using SPSS. Results: ICU nurses described handover as an integrated process involving informational and interactional components shaped by contextual factors such as, interpersonal, organizational, and environmental factors. These insights informed modification of the HES, including removal of irrelevant items and addition of a contextual factors section. Content validation showed strong expert agreement. Exploratory factor analysis supported a two-factor structure for the HES, comprising (a) information quality and engagement and (b) disruptive communication. It also supported a three-factor structure for the contextual factors scale, representing interpersonal and cognitive factors, organizational support, and operational interruptions. Reliability testing indicated acceptable internal consistency, although lower alpha values for subscales indicate the need for refinement. Conclusion: The modified HES represents an appropriate and reliable tool for assessing ICU nurses’ perceptions of handover within multicultural settings in Saudi Arabia. Refinement and psychometric testing are required to establish construct validity and enhance the tool’s applicability. Keywords: Shift handover, intensive care unit, Handover Evaluation Scale, exploratory factor analysis, reliability, multicultural