Correlation between the quality of nursing handover, job satisfaction, and group cohesion among psychiatric nurses

Patient safety is a serious global public health issue, as adverse events are common in health facilities, especially psychiatry [1‐3]. Psychiatric nurses care for psychiatric patients with mood disturbances and psychotic symptoms that may experience sudden, unexpected, and illogical agitation. Adverse psychiatric events, including violence, suicide, escape, falls, choking, and medication errors, have been widely reported [4, 5]. Several studies have shown that patient safety failures result from human factors concerning communication, teamwork, and mental health among healthcare professionals [ 4, 6, 7]. Promoting high-quality continuous care that can protect patients from harmful risks related to healthcare practices is a core component of patient safety. Among others, nursing handovers as a critical segment of patient safety deserve extensive attention [7, 8]. A nursing handover is a real-time process in which patient-specific information is passed between nurses to ensure the continuity and safety of patient care [9]. Nursing handovers are practiced daily in many ways in all institutional healthcare settings. Nursing handovers play a central role in achieving well-coordinated care, ensuring work continuity, delivering relevant clinical information to the follow-up care team, and sharing patient-related messages in an accurate and timely manner [10, 11]. Furthermore, an inadequate handover implies adverse events, delays, inappropriate treatment, or lack of care. To date, many studies have reported the benefits of nursing handover quality improvement projects aimed at enhancing patient safety in clinical practice [8, 10]. A systematic review suggested the effectiveness of using Situation, Background, Assessment, and Recommendation intervention as a handover tool and communication on patient safety [8]. Researchers have performed many primary studies in the field, mainly reporting findings from changes in nursing handover patterns. However, a previous survey found that interruptions are potentially a significant barrier to the delivery of effective handovers, and the mean interruption time was 0–4 min during a 15 min handover [12]. Liu et al. reported that the handover evaluation of nurses in general hospitals was 6.35 ± 0.74, indicating a higher level of quality of handover [13]. However, few quantitative studies have investigated the handover evaluation of psychiatric nurses and the analysis of the influencing factors.

Team is an important department of the healthcare system, which performs an active function in healthcare practices. Group cohesion is a phenomenon that determines how well a team holds together [14]. It has been defined as a subjective perception of bonding, working together toward common goals, mutual acceptance, and group affiliation [15]. Group cohesion is integral to cultivating a supportive work atmosphere and high-quality person-centered cultures of care in the modern healthcare setting [16, 17]. Studies have found that group cohesion was contributive to nurses in terms of occupational performance and job satisfaction [17‐19]. However, few studies revealed the association between group cohesion and quality of nursing handover among psychiatric nurses.

Job satisfaction is a multidimensional construct related to work engagement [20, 21]. Job satisfaction is also a predictor of psychological distress and other organization outcomes [22]. High job satisfaction is vital for nurses to ensure the high-efficiency delivery of service quality. Job satisfaction can strongly predict positive job performance such as being active at work, pursuing new goals, and developing good relationships. Conversely, workers with lower job satisfaction display high nurse turnover rates and poor quality patient care [23, 24].

Summarizing the findings of previous research, group cohesion was not only related to good psychosomatic experience but also a key indicator of professional performance for nurses. Nursing handovers are a form of professional performance that undoubtedly correlate with job satisfaction. Based on these facts, we hypothesized that job satisfaction could mediate the association between group cohesion and quality of psychiatric nursing handovers.

The purpose of this cross-sectional study was to achieve the following: (1) to investigate the status of psychiatric nursing handovers; (2) to examine the relationships between group cohesion, job satisfaction, and quality of psychiatric nursing handovers; and (3) to explore the mediating effect of job satisfaction on the relationship between group cohesion and psychiatric nursing handovers.

To the best of our knowledge, this is the first study to investigate the status of quality of handovers and explore the factors influencing the quality of handovers among Chinese psychiatric nurses. This is also the first study to examine job satisfaction’s mediation between group cohesion and the quality of psychiatric nursing handovers. The main findings were as follows: the score of quality of nursing handover was above the medium level, quality of nursing handover was associated with group cohesion and job satisfaction, and mediation analysis showed that job satisfaction was a partial mediator between group cohesion and the quality of nursing handover.

The quality of nursing handovers has become an international priority in both research and clinical fields for patient safety [33‐35]. The current research show that the score of quality of psychiatric nursing handover is (5.85 ± 1.14), indicating that the quality of nursing handover is good. However, the score of quality of nursing handovers is significantly lower than that of general hospital nurses [13], indicating that there is room for improvement for psychiatric nurses. Our study did not find a significant association between participants’ sociodemographic characteristics and handover quality score, which disagrees with previous findings. Liu revealed that the scores of nurses with a bachelor’s degree or greater were significantly higher than those of nurses with junior school or lower [13]. This may have occurred because the percentage of nurses with a bachelor’s degree or higher was 96.8%. The average item score of each dimension from high to low was as follows: quality of information, interaction and support, and efficiency. Adverse events, such as violence, suicide, escape, choking, and falls, occur frequently in psychiatric hospitals. Therefore, timely identification and delivery of risk assessment information are extremely important for the quality of information. The dimension of efficiency score was the lowest, suggesting that psychiatric nurses should control the content and timing of handovers. Prior research has revealed that delivering excessive information irrelevant to patient care can reduce work efficiency [36]. Relevant studies have also found that nurses cannot effectively cope with working confusion, resulting in low organizational support and high burnout, thereby affecting the level of the interaction and support dimension [13].

Group cohesion is a decisive factor affecting individual and organizational performance, and it is frequently emphasized in the field of social and organizational psychology [19, 30]. The score of group cohesion in this study was (5.75 ± 0.94), indicating good group identification. A possible explanation is that psychiatric nurses were prone to developing a team spirit in dealing with sudden, unexpected, and illogical agitation behaviors, which might cause more group cohesion. A significant positive correlation between group cohesion and the quality of nursing handovers was established in the present study. Relevant studies have revealed that individuals with high group cohesion usually display more cooperation, vigor, concentration, communication, and less burnout in daily work, whereas higher group cohesion is conducive to promoting nurses’ clinical communication skills and professional knowledge, thereby resulting in higher levels of quality of nursing handover [37]. These findings highlight the need to develop strategies for improving group cohesion among psychiatric nurses.

The total score for job satisfaction in the present study was slightly higher than Chen’s finding [38]. This may have occurred because the practice environment of psychiatric nurses has significantly improved due to the recent concern of the government and society. However, we also found that the global score of job satisfaction among psychiatric nurses was poor, that is, lower than the lowest index of job satisfaction. Related research has found that job satisfaction among Chinese nurses differs due to differences in welfare, promotion, social prejudice, working years, and region [22, 39]. Consistent with previous research showing that job satisfaction is not only an outcome of occupational stress but also benefits psychosomatic health and other organizational outcomes (e.g., absenteeism and performance) [22‐24], the results of this survey confirmed that job satisfaction was also the most important predictor of quality of nursing handovers. Job satisfaction explained 18.0% of the variance in nursing handover quality. Furthermore, prior surveys have confirmed the protective and positive effects of job satisfaction on nursing handover quality [40, 41]. Individuals with high job satisfaction and behaviors, such as being active in their job and maintaining good interpersonal relationships, were discovered. On the contrary, low job satisfaction was associated with the following behaviors: reduced work pace, absenteeism, resignation, and negative emotion, which caused low-quality nursing handovers.

The most unanticipated finding in the current study was the mediating effect of job satisfaction on the association between group cohesion and quality of nursing handovers among psychiatric nurses, which suggests that group cohesion not only directly influences the quality of nursing handovers but also indirectly the quality of nursing handovers via job satisfaction. Prior surveys have revealed an association between group cohesion and job satisfaction; in particular, group cohesion is beneficial to nurses, both in terms of job satisfaction [42]. Other studies have shown that nurses participate in power-sharing activities, foster a collaborative work environment, and demonstrate greater job satisfaction. High group cohesion may enhance job satisfaction, thereby improving the quality of nursing handovers. The indirect effect of group cohesion on the quality of nursing handovers through job satisfaction accounted for 45.8% of the total effect, indicating that job satisfaction might play a more important role in improving the quality of nursing handovers.

This study has some limitations. First, we could not define causality between group cohesion, job satisfaction, and quality of nursing handovers due to the cross-sectional research design. Second, all data were obtained from self-report questionnaires; thus, reporting bias cannot be avoided. Third, the limited sample size and inclusion of only a single psychiatric institution’s nurses in the survey can be considered as limitations. Further studies that recruit participants from wider areas are needed to verify the results of the current research. Moreover, further studies should be conducted to examine whether other personal and social factors (organizational support, work pressure, self-efficacy, and burnout) affect the quality of psychiatric nursing handovers.

The quality of psychiatric nursing handovers has enhanced the space. The findings of this study indicate that group cohesion and job satisfaction are positively related to the quality of psychiatric nursing handovers. The current study also showed job satisfaction mediation between group cohesion and the quality of psychiatric nursing handovers. These findings call for health managers to take various measures to strengthen group cohesion and promote job satisfaction, both of which are helpful for the quality of psychiatric nursing handovers. Specifically, health managers should commit to cultivating a comfortable supportive working environment and decreasing workloads, promoting a balance between demands and rewards, and increasing their income and job autonomy.