The effect of a step-by-step handover educational package on nursing students’ outcomes: a pretest-posttest nonequivalent groups design

Based on the available evidence, many nurses are inefficient and inadequate when it comes to shift handover; however, teaching shift handover to nursing students in a clinical setting is often overlooked and underestimated. Studies suggest the existence of a standardized and structured framework for shift handover, so this study aimed to investigate the effect of a step-by-step intervention program using the ISBAR (Identification, Situation, Background, Assessment, and Recommendation) framework on self-awareness and shift handover performance. This quasi-experimental interventional study with a pretest-posttest nonequivalent groups design was conducted in 2023 at Alborz University of Medical Sciences. A total of 98 students were recruited for the study, comprising 51 individuals in the control group and 47 individuals in the intervention group, utilizing the convenience sampling method. The intervention (Microlearning, video-based learning, and peer role-playing) was presented step-by-step. Self-awareness at 4 time points, satisfaction at 3 time points, and performance at one time point were evaluated in the intervention group. The control group was presented with a written ISBAR instruction, and pre-test and post-test of self-awareness and performance were performed at the end of the study. Self-awareness of shift handover in the intervention group increased from 38.4 ± 3.4 at pretest to 44.0 ± 3.8, 46.7 ± 3.6, and 47.3 ± 3.6 after Steps 1, 2, and 3 (all Bonferroni-adjusted P < 0.001). At post-test, the intervention group had higher self-awareness than the control group (47.3 ± 3.6 vs. 41.5 ± 4.2; P < 0.001), higher satisfaction (9.3 ± 1.0 vs. 5.6 ± 1.7; P < 0.001), and higher handover performance (24.3 ± 3.1 vs. 16.2 ± 3.7; P < 0.001). The control group also showed an increase in self-awareness from pretest (39.5 ± 3.9), but the change was smaller (mean change 2.0 vs. 8.9 points; P < 0.001). Differences remained significant after adjustment for baseline score and semester. The stepwise ISBAR-based handover education package was associated with higher self-awareness, satisfaction, and handover performance among nursing students compared with usual education, with similar findings across the 5th and 7th semesters. Because the study used a quasi-experimental design with group-level allocation and did not fully account for clustering, the findings should be interpreted with caution. The educational package was evaluated as a whole; therefore, separate or cumulative effects of microlearning, video-based learning, and peer role-playing cannot be determined. Larger randomized studies with appropriate adjustment for clustering are needed to confirm these findings and assess their longer-term sustainability.