# Exploring Practices During Nursing Handovers in Critical Care: An Anthropological Study

## TL;DR

This study explores how ICU nurses use handover moments to assert their expertise and influence clinical decisions, challenging traditional hierarchies in critical care.

## Contribution

The paper introduces nursing handovers as 'heterotopias'—protected spaces where nurses can assert influence and visibility in clinical decision-making.

## Key findings

- Nursing handovers serve as strategic moments for nurses to navigate professional boundaries and influence patient management.
- Experienced nurses use handovers to mentor colleagues, consolidate clinical decisions, and temporarily reverse hierarchical dynamics.
- Face-to-face handovers support mentorship and informal learning, which are at risk due to digitalization and 'silent' reporting.

## Abstract

Nursing handovers in intensive care units (ICUs) are critical for ensuring continuity of care, patient safety and clinical decision‐making. Beyond information transfer, handovers are key moments in which nursing expertise can influence treatment trajectories. However, power relations, communication practices and the visibility of nursing knowledge during handovers remain underexplored, particularly through the lens of critical medical anthropology and the concept of heterotopia.

To explore how experienced ICU nurses participate in and influence clinical decision‐making through handover practices.

This ethnographic study, grounded in a critical medical anthropology approach, was conducted in a general ICU in Greece. Data collection involved overt participant observation and ad hoc ethnographic interviews with ICU nurses and physicians, as part of a larger PhD study. Nurses who participated in interviews subsequently consented to observation while working. Fieldwork spanned 2 years (2012–2014) and concluded in 2020. Multiple nursing handovers were observed, and thematic analysis was applied to fieldnotes using Atlas.ti.

Nursing handovers functioned as heterotopias of nursing expertise, offering moments of access to clinical decision‐making. Four sub‐themes emerged: (a) narrating the patient's illness trajectory; (b) showcasing expertise and mentoring less experienced colleagues; (c) verbalising and consolidating clinical decisions; and (d) temporarily reversing hierarchical power dynamics. Through these practices, experienced nurses rendered their clinical reasoning visible and exerted influence over patient management.

Nursing handovers represent strategic opportunities for nurses to navigate and renegotiate professional boundaries within the ICU. The findings highlight the potential of handovers to strengthen team collaboration, support clinical decision‐making and enhance patient care. Recognising handovers as protected spaces for nursing expertise is essential for promoting professional autonomy within critical care settings.

Protecting nursing handovers as spaces of professional dialogue can enhance communication, clinical reasoning and patient safety. Combining structured and narrative‐based handover training may empower nurses, preserve mentoring and role‐modelling functions and sustain professional visibility—particularly relevant in the post‐COVID‐19 era, where digital and hybrid communication models increasingly shape critical care practice.

What is known about the topic?
○Nursing handovers in intensive care units (ICUs) are critical for ensuring continuity of care, patient safety and clinical decision‐making.○Effective handovers contribute to better communication, reduce the risk of medical errors and support team cohesion.○However, power relations, communication patterns and the visibility of nursing expertise during handovers remain underexplored—particularly from an ethnographic and anthropological perspective that examines how culture and hierarchy shape these practices.
What this paper adds?
○This study conceptualises nursing handovers as heterotopias—protected spaces where nurses can assert their expertise and influence clinical decision‐making.○The ethnographic approach reveals how handovers provide moments of access to clinical decision‐making, enabling nurses to challenge traditional hierarchies and make their voices heard.○Findings highlight the enduring value of face‐to‐face handovers as spaces for mentorship, role modelling and informal learning—dimensions that risk being lost amid increasing digitalisation and ‘silent’ reporting.○The study underscores the potential of structured yet narrative‐based handover training to enhance team collaboration, strengthen clinical reasoning and improve patient outcomes.

What is known about the topic?
○Nursing handovers in intensive care units (ICUs) are critical for ensuring continuity of care, patient safety and clinical decision‐making.○Effective handovers contribute to better communication, reduce the risk of medical errors and support team cohesion.○However, power relations, communication patterns and the visibility of nursing expertise during handovers remain underexplored—particularly from an ethnographic and anthropological perspective that examines how culture and hierarchy shape these practices.

Nursing handovers in intensive care units (ICUs) are critical for ensuring continuity of care, patient safety and clinical decision‐making.

Effective handovers contribute to better communication, reduce the risk of medical errors and support team cohesion.

However, power relations, communication patterns and the visibility of nursing expertise during handovers remain underexplored—particularly from an ethnographic and anthropological perspective that examines how culture and hierarchy shape these practices.

What this paper adds?
○This study conceptualises nursing handovers as heterotopias—protected spaces where nurses can assert their expertise and influence clinical decision‐making.○The ethnographic approach reveals how handovers provide moments of access to clinical decision‐making, enabling nurses to challenge traditional hierarchies and make their voices heard.○Findings highlight the enduring value of face‐to‐face handovers as spaces for mentorship, role modelling and informal learning—dimensions that risk being lost amid increasing digitalisation and ‘silent’ reporting.○The study underscores the potential of structured yet narrative‐based handover training to enhance team collaboration, strengthen clinical reasoning and improve patient outcomes.

This study conceptualises nursing handovers as heterotopias—protected spaces where nurses can assert their expertise and influence clinical decision‐making.

The ethnographic approach reveals how handovers provide moments of access to clinical decision‐making, enabling nurses to challenge traditional hierarchies and make their voices heard.

Findings highlight the enduring value of face‐to‐face handovers as spaces for mentorship, role modelling and informal learning—dimensions that risk being lost amid increasing digitalisation and ‘silent’ reporting.

The study underscores the potential of structured yet narrative‐based handover training to enhance team collaboration, strengthen clinical reasoning and improve patient outcomes.