Introduction
The handover process involves the efficient transfer of clinical information to delegate professional responsibility and accountability for patient care to another individual or professional group [1]. This process is one of the top five priorities for improving patient safety worldwide [2]. Handover, especially at the end of shifts, occurs at least 2–3 times daily and is an integral part of nursing practice. With the increasing emphasis interprofessional patient care, the frequency of handovers has also increased [3].
Inefficient handover leads to incomplete information transfer, resulting in repeated assessments, treatment delays, medication errors, avoidable readmissions, increased complications and patient mortality, and additional financial burdens on the healthcare system [4‐6]. The United State Safety Committee has reported that poor handover is the primary cause of 65% of adverse events and 90% of root causes of errors [7]. Many nurses suffer from omissions, inaccuracies, and irrelevant information during handovers [5]. Essential information is omitted in 43.17% of handovers and nursing documentation [8], and approximately 22% of adverse events related to nursing care are associated with poor handovers [9]. Literature reviews have shown that nurses often struggle with handover execution due to a lack of self-efficacy and communication skills [4, 10, 11].
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Self-efficacy is the extent of an individual’s belief in their ability to complete a task or achieve a goal [12]. Self-efficacy increases confidence and motivation to communicate with others [13] and important factor in improving the quality of patient care [14]. Low self-efficacy among nurses leads to delays in intervention and negatively impacts patient care [15, 16]. Also, the World Health Organization (WHO) has identified communication failure as the primary cause of adverse events in healthcare [17] and stated that precise and skilled communication should be a high priority in handover [18].
To improve self-efficacy in handovers, nursing managers should create a positive organizational climate for relationships among nurses so that they feel satisfied with their communication with colleagues. They should also provide opportunities, such as education programs or systems, for nurses to develop their communication skills [19]. The ISBAR describes a structured form of handover and facilitates intra and interprofessional communication within healthcare providers has been endorsed by the WHO [20, 21]. (Table 1).
Table 1
The ISBAR handover framework
Introduction – identify yourself, your role and the patient Situation – state the patient’s main problem Background – give the relevant clinical history Assessment – give the relevant observations and assessment of the patient’s condition Recommendation – state the course of action or response that you are recommending |
The clinical supervision model (CSM) is one of the clinical education models for nurses designed to reduce the gap between theory and practice [22]. This model is a structured program in which nurses receive guidance and support from a trained supervisor, who provides feedback on their performance [23]. In cases where cutting corners’ and ‘gaps in care’ are regular occurrences in daily nursing practice; however, this often goes unnoticed and subsequently continues [24], the CSM provides an opportunity for reflection on current practice and the development and improvement of future practice [25]. The CSM aids learning through emotional, educational, and organizational support [26] and it’s recommended to enhance the quality of patient care in healthcare settings [27]. Education and support to enhance self-efficacy and communication skills in nurses are identified as two influential factors in improving effective handover. Therefore, the present study was conducted with the aim of examining the impact of the clinical supervision model on nurses’ self-efficacy and communication skills in the handover process within medical and surgical wards.
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Methods
This experimental two-group study with a pre- and post-test design was conducted in 2024 in the selected hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. This study was single-blinded by a statistical analyst.
Participants
Participants included all nurses working in the medical and surgical departments of selected hospital. Inclusion criteria were willingness to participate in the study, holding a bachelor’s degree, being a nurse responsible for direct patient care, and not using the ISBAR framework prior to the study. Exclusion criteria were discontinuation of collaboration with the study department and unwillingness to continue participation in the study.
Sample size
The sample size was estimated based on a similar study [4] with the following parameters: S1 = 15.11, S2 = 12.10, µ1 = 60.94, µ2 = 51.54, α = 0.05, and β = 0.2, assuming a 15% attrition rate, resulting in an estimated sample size of 80 nurses.
The researcher first visited the hospital, which had two medical departments (medical 1 and medical 2) and two surgical departments (Women’s Surgery and Men’s Surgery). Using a random number table, one medical department and one surgical department were selected as the intervention group, while the other medical and surgical departments were designated as the control group. From medical 1, medical 2, and Women’s Surgery departments, each with 20 nurses, all were included in the study (census sampling). From the Men’s Surgery department, which had 30 nurses, 20 were randomly selected using the random number table. Thus, the number of samples in each control and intervention group was 40 (Fig. 1).
Fig. 1
Consort flowchart
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Study tools
Data were collected using a demographic questionnaire, ISBAR Communication Checklist and Communication Clarity, Visual Analog Scale (VAS), Sherer Self-Efficacy Scale (GSES) and Manchester Clinical Supervision Scale (MCSS).
The demographic questionnaire included individual information (age, gender, marital status) and professional details (work experience, average number of shifts per month, and average number of patients under care).
ISBAR communication checklist
This checklist includes 12 items rated on a 3-point Likert scale (0 = Not Implemented, 1 = Incomplete, 2 = Acceptable), with a total score range from 0 to 24. This scale is used to evaluate nurses’ performance in implementing the ISBAR framework during handovers [4, 28]. The checklist was translated into Persian, and its content and face validity were assessed with the consultation of 10 nursing faculty experts specializing in handover and shift reports. The Content Validity Index (CVI), Content Validity Ratio (CVR), and face validity were 1, 1, and above 1.5, respectively. External reliability was assessed using test-retest method and its intraclass correlation coefficient (ICC) was 0.803 (95% CI: 0.628–0.901, p < 0.001). Internal reliability, measured by Cronbach’s alpha, was 0.739.
The communication clarity checklist
This checklist consists of 7 items, rated on a 5-point Likert scale, with a total score range of 7 to 35. The goal of this scale is to assess participants’ ability to identify important information and convey it accurately and understandably. Higher scores indicate greater clarity in their handovers [18]. The checklist was translated into Persian, and its content and face validity were assessed with the consultation of 10 nursing faculty experts specializing in handover and shift reports. The Content Validity Index (CVI), Content Validity Ratio (CVR), and face validity excluding item 8 which was removed, for the remaining items were 0.94, 1, and above 1.5, respectively. External reliability was assessed using test-retest method and its intraclass correlation coefficient (ICC) was 0.941 (95% CI: 0.880–0.972, p < 0.001). Internal reliability, measured by Cronbach’s alpha, was 0.871. Communication Clarity assesses the clarity of communication, complementing the ISBAR checklist in evaluating the effectiveness of communication skills.
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The visual analog scale (VAS)
This scale was used to assess participants’ self-efficacy in performing handovers. Participants were asked to indicate on a scale from 0 to 100 how confident they felt about their ability to perform handovers (0 = not confident at all, 100 = very confident). The VAS is a reliable and valid method for measuring subjective feelings with minimal distortion and bias [4]. Its validity as a measure of self-efficacy has been confirmed by Turner et al. (2008) [29].
The sherer self-efficacy scale (GSES) questionnaire
This questionnaire consists of 17 items, rated on a 5-point Likert scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree), with a total score range from 17 to 85. The questionnaire was originally developed and psychometrically validated by Sherer and colleagues [30]. The validity and reliability of the Persian version of the questionnaire have been confirmed in Iran [31].
The manchester clinical supervision scale (MCSS)
This scale was used to assess the effectiveness of the clinical supervision model. The MCSS was created in 1995 at the University of Manchester, England [32]. This questionnaire consists of 32 items covering 7 subscales: Trust and Relationships, Supervisor’s Advice and Support, Care and Improved Skills, Importance and Value of Clinical Supervision, Finding Time, Personal Issues, and Feedback. Each item is rated on a 5-point Likert scale: Strongly Disagree (1 point), Disagree (2 points), Neutral (3 points), Agree (4 points), and Strongly Agree (5 points). Scores for each subscale are summed, with higher scores indicating better clinical supervision performance in that area. The validity and reliability of the Persian version of the questionnaire have been confirmed by Khani et al. (2009), and the effectiveness score was reported as 122 and more [33].
Procedure
Initially, the researcher approached nurses during their free time, explained the importance of handover and the negative impacts of incomplete handover, and outlined the study procedure. Informed consent was obtained from the participants, and they were provided with the Sherer General Self-Efficacy Scale (GSES) and the Visual Analog Scale (VAS) to assess their self-efficacy in handovers. Additionally, the ISBAR scores and communication clarity were assessed using the checklist by observing their handover performance in both the intervention and control groups.
Intervention group
In the intervention group, handover based on the ISBAR framework were implemented through clinical supervision model, which included three phases as follows [34]:
Phase 1
In this phase, the nurse educator organized individual meeting outside the regular shift times for the nurses to avoid any stress related to their clinical duties. During this meeting, the importance of handover, the consequences of incomplete handover for both nurses and patients, and criteria for effective handover were discussed. The CSM, its benefits, stages, and the roles of the supervisor and nurses were also explained. Questions were answered, ambiguities were addressed. The ISBAR-based handover checklist was then distributed, and each item was discussed. Nurses were asked to apply the ISBAR framework to two clinical cases and provide feedback on the checklist items. The nurses were reminded that in future supervision sessions, they were expected to use the checklist items during patient handovers.
Phase 2
One week after the first phase, the observer attended the medical and surgical wards to conduct clinical supervision sessions while the supervised nurses were completing their shifts and handing over patients to the next shift nurse at the bedside. In this study, a nurse educator with years of experience in supervision and teaching was selected for the role. She was competent in communication skills, providing feedback, and nursing handovers. The clinical supervision sessions were held at the bedside, and the nurses’ performance was assessed using ISBAR communication and Communication Clarity checklists, also at the bedside. These sessions, conducted over 3 months, occurred 6 times (two morning shifts, two afternoon shifts, and two night shifts per participant) at two-week intervals. During these sessions, nurses brought the ISBAR checklist, followed its items, received feedback from the supervisor if errors were made, and discussed any issues with the supervisor. The nurses’ communication skills scores were calculated according to the checklist in each session. Each clinical supervision session lasted between 40 and 60 min and was conducted individually.
Phase 3
In this phase, the Manchester scale was used at this stage to determine the effectiveness of implementing the clinical supervision model.
Control group
For the control group, the nurse educator organized individual meeting outside the regular shift times for the nurses to avoid any stress related to their clinical duties. During this meeting the study objectives and the number of supervision sessions were discussed, and it was mentioned that their handover performance would be evaluated based on the ISBAR communication checklist and communication clarity during the sessions. However, they were not provided with the checklist. The control group also underwent 6 supervision sessions, held at two-week intervals over a period of 3 months. During these sessions, the nurses’ performance using ISBAR communication and Communication Clarity checklists at the bedside during handovers was assessed and recorded by the supervisor. Although feedback on erroneous performance was not provided, any questions from the nurses regarding handovers were addressed.
At the end of the study, the general self-efficacy scores and Visual Analog Scale (VAS) scores for both the control and intervention groups were obtained through self-reports by the nurses.
Data analysis
Data were analyzed using SPSS version 16 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to describe the data. The normality of quantitative variables was assessed using the Kolmogorov-Smirnov test. To compare qualitative variables between the two groups, the chi-square test was used. To compare means between groups and within groups, independent t-tests, multivariate analysis of covariance (MANCOVA), and paired t-tests were employed. Additionally, repeated measures analysis of variance (ANOVA) was used to compare mean scores at six time points. A significance level of < 0.05 was set.
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Results
There were no significant differences between the intervention and control groups regarding demographic characteristics (p > 0.05). Since the p-value for gender was close to 0.05, it could have been a confounding factor; therefore, it was considered as such in the analyses (Table 2).
Table 2
The baseline characteristics of the nurses in the intervention and control groups
Variable | Intervention group | Control group | t/ X2 | P Value a | |
|---|---|---|---|---|---|
Mean ± SD or N (%) | Mean ± SD or N (%) | ||||
Gender | Male | 10(25%) | 4(10%) | 3.117 | 0.077 |
Female | 30(75%) | 36(90%) | |||
Marital status | Single | 9(22.5%) | 8(20%) | 0.075 | 0.785 |
Married | 31(77.5%) | 32(80%) | |||
Age (Year) | 32.23 ± 8.56 | 32.05 ± 6.57 | 0.103 | 0.919 | |
Experience of work (Year) | 7.38 ± 6.49 | 7.93 ± 5.92 | 0.396 | 0.693 | |
Mean shift (Number per month) | 26.48 ± 1.99 | 26.43 ± 1.38 | 0.131 | 0.896 | |
General self-efficacy score before intervention | 65.60 ± 7.98 | 66.73 ± 8.25 | 0.620 | 0.537 | |
Handover self-efficacy score before intervention | 73.00 ± 10.61 | 73.88 ± 14.78 | 0.304 | 0.762 | |
ISBAR score before intervention | 9.10 ± 3.26 | 9.33 ± 2.99 | 0.322 | 0.748 | |
Communication Clarity score before intervention | 15.25 ± 4.21 | 15.58 ± 4.29 | 0.342 | 0.733 | |
The independent t-test revealed no significant difference in baseline ISBAR scores between the two groups. Repeated measures analysis showed that changes in ISBAR scores depended on the type of group, with the mean ISBAR scores significantly increasing over time in the intervention group (p < 0.001), while there was no significant change in the control group (p = 0.780). Multivariate analysis of covariance was used to compare scores between the two groups at six time points, accounting for gender and baseline ISBAR scores as confounders. The results indicated significant differences in mean ISBAR scores between the two groups across all measurement points (p < 0.001) (Table 3).
Table 3
ISBAR score a of interventions and control group during clinical supervision sessions
Session | Intervention group | Control group | t/f | P Value b |
|---|---|---|---|---|
Mean ± SD | Mean ± SD | |||
Before Intervention | 9.10 ± 3.26 | 9.33 ± 2.99 | 0.322 | 0.748 |
First | 14.70 ± 3.23 | 9.55 ± 3.03 | 92.459 | < 0.001 |
Second | 16.80 ± 3.24 | 9.38 ± 3.49 | 186.340 | < 0.001 |
Third | 17.98 ± 3.27 | 9.12 ± 3.01 | 268.497 | < 0.001 |
Forth | 20.77 ± 2.22 | 9.40 ± 3.31 | 672.282 | < 0.001 |
Fifth | 22.48 ± 1.65 | 9.58 ± 3.32 | 846.578 | < 0.001 |
Sixth | 23.30 ± 1.14 | 9.63 ± 3.16 | 1207.521 | < 0.001 |
P value –Time c | < 0.001 | 0.780 | ||
P value – Interaction c | < 0.001 | |||
P value – Intervention c | < 0.001 | |||
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The independent t-test indicated no significant difference between the two groups in baseline communication clarity scores. Repeated measures analysis revealed that changes in communication clarity scores were dependent on the group type. Specifically, the mean scores for communication clarity significantly improved over time in the intervention group (p < 0.001), while no such improvement was observed in the control group (p = 0.882). A multivariate analysis of covariance was used to compare scores between the two groups across six time points, considering gender and baseline communication clarity scores as confounders. The results demonstrated significant differences in mean communication clarity scores between the two groups across all measurement points (p < 0.001) (Table 4).
Table 4
Communication clarity score a of interventions and control group during clinical supervision sessions
Session | Intervention group | Control group | t/f | P Value b |
|---|---|---|---|---|
Mean ± SD | Mean ± SD | |||
Before Intervention | 15.25 ± 4.21 | 15.58 ± 4.29 | 0.342 | 0.733 |
First | 18.80 ± 4.46 | 15.80 ± 3.61 | 24.310 | < 0.001 |
Second | 21.72 ± 4.86 | 15.63 ± 4.67 | 78.143 | < 0.001 |
Third | 23.80 ± 4.36 | 15.50 ± 4.05 | 154.542 | < 0.001 |
Forth | 26.83 ± 3.69 | 15.77 ± 4.33 | 343.275 | < 0.001 |
Fifth | 30.02 ± 3.68 | 15.80 ± 4.13 | 495.164 | < 0.001 |
Sixth | 31.80 ± 3.04 | 16.03 ± 4.67 | 591.561 | < 0.001 |
P value –Time c | < 0.001 | 0.882 | ||
P value – Interaction c | < 0.001 | |||
P value – Intervention c | < 0.001 | |||
Finally, a pairwise comparison of the scores for both ISBAR and clarity communication of the intervention group sessions, using the LSD test, revealed a significant increase in scores for each supervision session compared to the other sessions (p < 0.001).
The independent t-test revealed no significant difference between the two groups in baseline general self-efficacy scores (p = 0.537). The multivariate analysis of covariance indicated that the mean general self-efficacy scores in the intervention group were significantly higher at the end of the intervention (considering gender and baseline self-efficacy scores as confounders) (p < 0.001). The paired t-test showed a significant difference in the mean scores of the intervention group before and after the clinical supervision sessions (p < 0.001), whereas no significant difference was observed in the control group before and after the intervention (p = 0.872) (Table 5).
Table 5
Difference in pre-post general self-efficacy score a between the intervention and control groups
Group | Before intervention | After intervention | P Value b |
|---|---|---|---|
Mean ± SD | Mean ± SD | ||
Intervention group | 65.60 ± 7.98 | 72.05 ± 6.80 | < 0.001 |
Control group | 66.73 ± 8.25 | 66.63 ± 9.45 | 0.872 |
P Value c | 0.537 | 0.001 | |
t/f | 0.620 | 11.947 |
The independent t-test indicated no significant difference between the two groups in baseline scores for delivery and handover self-efficacy (p = 0.762). The multivariate analysis of covariance showed that the mean scores for delivery and handover self-efficacy in the intervention group were significantly higher at the end of the intervention (considering gender and baseline scores as confounders) (p < 0.001). The paired t-test revealed a significant difference in the mean scores of the intervention group before and after the clinical supervision sessions (p < 0.001). Likewise, the change in the mean scores in the control group was significantly different before and after the intervention (p = 0.012). However, the mean scores of the intervention group were higher than those of the control group (Table 6).
Table 6
Difference in pre-post-handover self-efficacy score a between the intervention and control groups
Group | Before intervention | After intervention | P Value b |
|---|---|---|---|
Mean ± SD | Mean ± SD | ||
Intervention group | 73.00 ± 10.61 | 95.63 ± 6.72 | < 0.001 |
Control group | 73.88 ± 14.78 | 78.12 ± 13.76 | 0.012 |
P Value c | 0.762 | < 0.001 | |
t/f | 0.304 | 36.885 |
The mean total score for the Manchester Clinical Supervision Scale (MCSS) was 128.98, indicating an excellent effectiveness of the Clinical Supervision Model (CSM) from the perspective of the nurses (Table 7).
Table 7
Manchester Clinical Supervision Scale: subscales and total scores
Subscale | Possible score range | Actual score range | Mean ± SD a |
|---|---|---|---|
Trust and rapport | 6–30 | 16–30 | 24.95 ± 3.38 |
Supervisor advice and support | 5–25 | 16–25 | 21.23 ± 2.33 |
Improved care and skill | 7–35 | 20–33 | 27.48 ± 2.56 |
Importance and value | 4–20 | 12–20 | 17.65 ± 2.03 |
Finding time | 4–20 | 10–20 | 15.80 ± 2.59 |
Personal issues | 3–15 | 4–14 | 8.93 ± 2.85 |
Reflection | 3–15 | 11–15 | 12.95 ± 1.38 |
Total score | 32–160 | 111–152 | 128.98 ± 10.24 |
Discussion
This study aimed to assess the impact of the Clinical Supervision Model (CSM) on the handover process among nurses in medical and surgical wards, based on the ISBAR framework, to enhance communication skills and self-efficacy, which are essential components of patient care. The results of our study demonstrated the significant impact of the CSM on improving nurses’ communication skills and self-efficacy in the handover process. The CSM plays a crucial role in enhancing skills by providing appropriate feedback and creating a supportive learning environment. In the CSM, the supervisor identifies individual needs through observing performance, plans for improvements, and fosters a supportive and motivating environment that encourages active participation in skill development [35]. The effective supervision, through support and providing opportunities to identify strengths and weaknesses, reduces anxiety in supervisees and fosters a better sense of overall performance and ability, consequently having a positive effect on self-efficacy [36]. Supervisors can also significantly enhance self-efficacy by providing feedback on positive behaviors [37].
The pre-intervention ISBAR scores revealed that despite the incorporation of the ISBAR framework into continuing education programs and the hospital’s requirement for its implementation, including the design of handover documents consistent with this framework, nurses still did not adhere to it during handover, resulting in incomplete information transfer. Furthermore, the mean score of communication clarity before the intervention indicated that the quality of communication during handover was inadequate, highlighting the need for effective communication techniques to convey important issues concisely and clearly.
The results of present study demonstrate that the CSM significantly improved nurses’ performance in handover. This improvement underscores the model’s effectiveness in addressing the gaps identified in pre-intervention practices and enhancing both the adherence to the ISBAR framework and the overall quality of communication during the handover process. The clinical supervision provided not only facilitated adherence to structured communication frameworks but also enhanced nurses’ self-efficacy and communication skills, contributing to more effective and safe patient care transitions.
In the first phase of the CSM, a session was held with nurses to discuss not only the importance of handover but also the CSM, its benefits, stages, and the roles of supervisors and supervisees. Rothwell et al. (2021) identified a significant barrier to effective clinical supervision as a lack of understanding of the role and purpose of supervision. In such conditions, supervisees reported anxiety and sometimes perceived supervision as an intrusion into their work, leading to a negative association with the term “clinical supervision” and consequently decreased participation [38].
In the first phase, the ISBAR checklist and communication clarity were also agreed upon for use in implementing the model. Terry et al. (2020) demonstrated that a mutually agreed-upon program between the supervisor and supervisee can serve as a basis for periodic reviews, feedback, and a key indicator of successful clinical supervision [39]. Similarly, Thyness et al. (2022) highlighted that students viewed the use of checklists as a strength in executing clinical supervision due to its role in preventing confusion and increasing orderliness [40].
In the second stage, six clinical supervision sessions were conducted at two-week intervals over a period of three months. Continuous clinical supervision is essential for establishing a positive relationship between the supervisor and the supervisee, and for achieving success in clinical practice [41]. Studies have also highlighted the need for prolonged training in handovers and shift reports to improve communication clarity [18] and self-efficacy [42]. During the supervision sessions, the supervisor provided comprehensive support to the nurses in addressing issues related to handover execution, offered feedback based on their performance, and discussed any deficiencies. A notable advantage of the clinical supervision model is the shared dialogue between the supervisor and the supervisee and the feedback provided, as it facilitates agreement and collaboration, challenges individuals’ ideologies, and enhances both performance [43] and nurses’ self-confidence [44].
In the third stage of the clinical supervision model, the MCSS was used to examine the effectiveness of clinical supervision in the intervention group. The scores from the Manchester Scale indicated a high level of effectiveness of the clinical supervision. Snowden et al. also examined the effectiveness of the clinical supervision model among healthcare providers. Participants in their study assessed the model as effective and had a positive perception of its implementation [45].
In the present study, we assessed nurses’ communication skills using the ISBAR checklist and communication clarity. The communication skills scores, based on the ISBAR checklist, significantly improved in the intervention group following the implementation of the clinical supervision model. This finding is consistent with the results of the study by Fahim Yegane et al. (2017) [7]. The use of the standard ISBAR framework in handover prevents the omission of critical details and reduces the focus on irrelevant and unnecessary information [46]. Additionally, the communication clarity scores for nurses during handovers also improved in the present study. Uhm et al. (2019) found that using the ISBAR framework and providing feedback to final-year nursing students in real-world settings led to improvements in ISBAR communication and communication clarity [42]. These results align with our findings in the real-world nursing environment. Ikbal et al. (2019) conducted a study to determine the impact of clinical supervision on nurses’ performance, showing improvements in knowledge, attitudes, and skills [47]. Similarly, the study by Setiawan et al. demonstrated that implementing the clinical supervision model led to improvements in performance, including technical skills and knowledge [48]. In our study, which lasted for three months, the average scores for ISBAR and communication clarity showed a consistent upward trend over time, and self-efficacy also showed significant changes after three months. This reinforces the strength of the clinical supervision model in creating a supportive environment for addressing individual issues and ensuring adherence to training. Ultimately, improved communication skills can lead to enhanced patient safety, better quality of care, and increased inter professional collaboration.
Another finding of our study was the improvement in nurses’ self-efficacy in handover and general self-efficacy. Self-efficacy refers to self-confidence and a belief in one’s ability to perform tasks effectively, which implies ease, reduced anxiety, and a belief in the success of handovers [49]. Our results indicated a significant increase in handover self-efficacy following the implementation of the clinical supervision model. This finding is consistent with a study on nurses where self-efficacy and adherence to evidence-based handover practices improved after participation in a simulation-based program [50].
In our study, there was a significant difference in the mean general self-efficacy scores between the two groups. This finding aligns with the study by Lohani and Sharma (2023), which examined the impact of clinical supervision on self-awareness and self-efficacy among psychotherapists and counselors [36]. Additionally, Abrishami et al. (2024) found that training based on the ISBAR framework was effective in enhancing patient safety and nurse self-efficacy [16]. Self-efficacy is a crucial aspect of nursing practice and is associated with greater control, motivation, and resilience in challenging situations, such as the COVID-19 pandemic, which can impact patient outcomes and nurse job satisfaction [51]. Incorporating a long-term ISBAR-based handover training program into ongoing nursing education, rather than a single-session program, is essential for the continuous improvement of communication clarity, self-efficacy, safety, and quality of nursing care.
Conclusions
Communication deficiencies and lack of self-confidence are associated with poor information transfer during handovers, which threatens patient safety and care quality. The clinical supervision model offers a flexible opportunity for nurses to gain knowledge and extensively practice communication skills, while also providing emotional support that enhances their self-efficacy. Participants in the clinical supervision model reported high levels of satisfaction, adherence to the ISBAR framework, and improvements in communication clarity and self-efficacy. Therefore, the clinical supervision model is an effective method for training nurses in handovers and transitions.
Limitations
This study had several limitations. Firstly, it was conducted solely with nurses from a single hospital, which may limit the generalizability of the findings. Additionally, rather than randomizing individual participants, entire wards were randomly assigned. However, baseline variables did not differ between the intervention and control groups, and to ensure accuracy, baseline values of dependent variables were considered in statistical analyses. Also, we used a one observer according to the intervention protocol. We suggest that future studies utilize two observers and assess inter-observer reliability.
Implication
These findings underline the importance of clearly defining the roles and expectations of clinical supervision to increase engagement among supervisees. The successful implementation of the ISBAR checklist and the focus on communication clarity further supported the effective execution of the Clinical Supervision Model, enhancing the overall quality of handover practices.
Acknowledgements
The researchers would like to express their gratitude to the Vice Chancellor for Research of Isfahan University of Medical Sciences for the financial support of this study (project number: 3402282) and all participants.
Declarations
Ethics approval and consent to participate
This study was approved by the Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.NUREMA.REC.1402.100). All participants were informed about the study’s objectives and were assured that their personal information would remain confidential, participation was voluntary, and they could withdraw from the study at any time. All participants signed an informed consent form to participate in the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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