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Turkish Validation and Reliability Study of the 'HANDOFF-CEX' Patient Handover Scale

Yıl 2025, Cilt: 12 Sayı: 3, 359 - 367, 29.09.2025
https://doi.org/10.34087/cbusbed.1574256

Öz

Giriş: Hastaneler, 24 saat boyunca kesintisiz sağlık hizmeti sunan kuruluşlardır. Sağlık hizmetlerinin kesintisiz bir şekilde sunulabilmesi, hemşirelerin 24 saat boyunca çalışması ile mümkündür. Hemşireler arasında nöbet değişimi sırasında bilginin etkili bir şekilde aktarılması, hemşirelik bakımının devamlılığını sağlamak için kritik öneme sahiptir.
Yöntem: Bu çalışmanın amacı, hemşirelerin nöbet devir işlemlerinin kalitesini nesnel olarak değerlendirmek için "Handoff CEX" devir teslim ölçeğinin Türkçe versiyonunun geçerlilik ve güvenilirliğini değerlendirmektir. Dahiliye, cerrahi tıp ve yoğun bakım ünitelerinde görev yapan hemşireler tarafından toplamda 99 devir teslim anketi gerçekleştirilmiştir. Her bir devir teslim işlemi, bağımsız olarak iki gözlemci tarafından değerlendirilmiş ve toplamda 396 devir teslim değerlendirmesi yapılmıştır. Veriler SPSS 25.0 kullanılarak analiz edilmiş; sosyodemografik bilgiler, devir teslim süreçlerinin değerlendirilmesi, memnuniyet puanları, madde analizi, açıklayıcı faktör analizi ve Cronbach alfa kullanılarak güvenilirlik testine odaklanılmıştır.
Bulgular: Handoff CEX ölçeğinin Türkçe versiyonu, giden hemşire için 0.925 ve gelen hemşire için 0.914 Cronbach alfa değerleri ile yüksek güvenilirlik göstermiştir. İçerik geçerliliği, 0.96 CVI ile doğrulanmıştır. Faktör analizi, 0.745 ile 0.935 arasında değişen yüksek faktör yüklemeleri göstermiştir. Gözlemciler arası güvenilirlik için Kappa istatistikleri düşük çıkmış olup, gözlemci eğitiminde iyileştirmelere ihtiyaç olduğunu göstermektedir.
Sonuç: Türkçeye uyarlanan Handoff CEX ölçeği, hasta devir teslim süreçlerini değerlendirmek için geçerli ve güvenilir bir ölçüm aracıdır. Sağlık kurumlarında sürekli kullanımı, hemşirelerin iletişim becerilerinin ve hasta bakım kalitesinin uzun vadede gelişimine katkıda bulunacaktır.

Etik Beyan

Ethical Aspect of the Study Prior to the research, approval from Hasan Kalyoncu University Non-Interventional Research Ethics Committee (decision no: 2023/19) and institutional permission from the hospital where the research would be conducted (Number: 19) were obtained. In addition, permission was obtained via e-mail from the author of the original scale for the validity and reliability analyses. Written and verbal consent was also obtained from the nurses who agreed to participate in the study. The study adhered to the Declaration of Helsinki on Human Rights.

Destekleyen Kurum

none

Teşekkür

Acknowledgements The authors would like to thank all the nurses who participated in this study for their time and valuable contributions. We also extend our gratitude to the experts who provided insightful feedback during the scale adaptation process.

Kaynakça

  • 1. Do J, Shin S: Development of nursing handoff competency scale: a methodological study. BMC nursing 2024, 23(1):272.
  • 2. Vanderzwan KJ, Kilroy S, Daniels A, O’Rourke J: Nurse-to-nurse handoff with distractors and interruptions: An integrative review. Nurse Education in Practice 2023, 67:103550.
  • 3. Le A, Lee MA, Wilson J: Nursing handoff education: An integrative literature review. Nurse Education in Practice 2023, 68:103570.
  • 4. Calleja P, Adonteng-Kissi B, Romero B: Transition support for new graduate nurses to rural and remote practice: A scoping review. Nurse education today 2019, 76:8-20.
  • 5. Manias E, Geddes F, Watson B, Jones D, Della P: Perspectives of clinical handover processes: A multi‐site survey across different health professionals. Journal of clinical nursing 2016, 25(1-2):80-91.
  • 6. O'Connell B, Penney W: Challenging the handover ritual: recommendations for research and practice. Collegian 2001, 8(3):14-18.
  • 7. Ismuntania K, Nursalam FR, Nurlela Mufida I, Maulina Iriyanti Z, Muzaffar SD, Fitri Apriani AS: Bedside Handover using Patient Family Centered Care on Patient Safety and Patient Satisfaction: A Systematic Review. Journal of Positive Psychology and Wellbeing 2023:534-546.
  • 8. Pothier D, Monteiro P, Mooktiar M, Shaw A: Pilot study to show the loss of important data in nursing handover. British Journal of Nursing 2005, 14(20):1090-1093.
  • 9. Meißner A, Hasselhorn HM, Estryn‐Behar M, Nézet O, Pokorski J, Gould D: Nurses’ perception of shift handovers in Europe–results from the European Nurses’ Early Exit Study. Journal of advanced nursing 2007, 57(5):535-542.
  • 10. Chaboyer W, Wallen K, Wallis M, McMurray AM: Whiteboards: one tool to improve patient flow. Medical Journal of Australia 2009, 190(S11):S137-S140.
  • 11. Cronn S, Trevino C, Jansen K: Use of Theory in Quality Innovations: Shift Change Protocol in the Emergency Department. Journal of Nursing Care Quality 2023, 38(2):114-119.
  • 12. Methangkool E, Tollinche L, Sparling J, Agarwala AV: Communication: is there a standard handover technique to transfer patient care? International anesthesiology clinics 2019, 57(3):35-47.
  • 13. Umberfield E, Ghaferi AA, Krein SL, Manojlovich M: Using incident reports to assess communication failures and patient outcomes. The Joint Commission Journal on Quality and Patient Safety 2019, 45(6):406-413.
  • 14. Desmedt M, Ulenaers D, Grosemans J, Hellings J, Bergs J: Clinical handover and handoff in healthcare: a systematic review of systematic reviews. International Journal for Quality in Health Care 2021, 33(1):mzaa170.
  • 15. Ernst KM, McComb SA, Ley C: Nurse‐to‐nurse shift handoffs on medical–surgical units: A process within the flow of nursing care. Journal of clinical nursing 2018, 27(5-6):e1189-e1201.
  • 16. Tuna R, Dallı B: Hemşirelerin Nöbet Devir Teslim Etkinliği ve İlişkili Değişkenler. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2018(4):432-437.
  • 17. Güngör S, Tosun B: Hemşirelerin hasta devir teslim süreci. Uluborlu Mesleki Bilimler Dergisi 2023, 6(2):118-126.
  • 18. Sunay M, Arıcıoğlu C, Yıldız GK: Hemşirelerin hasta devir teslim etkinliğinin tıbbi hatalara eğilim düzeylerine etkisi. Yüksek İhtisas Üniversitesi Sağlık Bilimleri Dergisi 2023, 4(3):76-83.
  • 19. Bujang MA, Omar ED, Baharum NA: A review on sample size determination for Cronbach’s alpha test: a simple guide for researchers. The Malaysian journal of medical sciences: MJMS 2018, 25(6):85.
  • 20. Ferrara P, Terzoni S, Davì S, Bisesti A, Destrebecq A: A tool for assessing the quality of nursing handovers: a validation study. British Journal of Nursing 2017, 26(15):882-888.
  • 21. Horwitz LI, Dombroski J, Murphy TE, Farnan JM, Johnson JK, Arora VM: Validation of a handoff assessment tool: the Handoff CEX. Journal of clinical nursing 2013, 22(9-10):1477-1486.
  • 22. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL: Best practices for developing and validating scales for health, social, and behavioral research: a primer. Frontiers in public health 2018, 6:149.
  • 23. Streiner DL, Norman GR, Cairney J: Health measurement scales: a practical guide to their development and use: Oxford university press; 2024.
  • 24. Son J: Back translation as a documentation tool. Translation & Interpreting: The International Journal of Translation and Interpreting Research 2018, 10(2):89-100.
  • 25. Morgado FF, Meireles JF, Neves CM, Amaral A, Ferreira ME: Scale development: ten main limitations and recommendations to improve future research practices. Psicologia: Reflexão e Crítica 2017, 30.
  • 26. Arafat S, Chowdhury HR, Qusar M, Hafez M: Cross cultural adaptation and psychometric validation of research instruments: A methodological review. Journal of Behavioral Health 2016, 5(3):129-136.
  • 27. Gjersing L, Caplehorn JR, Clausen T: Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC medical research methodology 2010, 10:1-10.
  • 28. Baluyot A, McNeill C, Wiers S: Improving Communication From Hospital to Skilled Nursing Facility Through Standardized Hand-Off: A Quality Improvement Project. Patient Safety 2022, 4(4):18-25.
  • 29. Almanasreh E, Moles R, Chen TF: Evaluation of methods used for estimating content validity. Research in social and administrative pharmacy 2019, 15(2):214-221.
  • 30. Davis LL: Instrument review: Getting the most from a panel of experts. Applied nursing research 1992, 5(4):194-197.
  • 31. de Raadt A, Warrens MJ, Bosker RJ, Kiers HA: A comparison of reliability coefficients for ordinal

Turkish Validation and Reliability Study of the 'HANDOFF-CEX' Patient Handover Scale

Yıl 2025, Cilt: 12 Sayı: 3, 359 - 367, 29.09.2025
https://doi.org/10.34087/cbusbed.1574256

Öz

Abstract
Aim: Hospitals operate continuously, providing healthcare services around the clock. The seamless delivery of health services relies on nurses working 24 hours a day. Ensuring the effective transfer of information between shifts is crucial for maintaining the continuity of nursing care.
Methods: This study aims to assess the validity and reliability of the Turkish version of the "Handoff CEX" handoff scale to gauge the quality of nurses' handoff practices objectively. A total of 99 handoff surveys were carried out by participating nurses in internal medicine, surgical medicine, and intensive care units. Each handoff was independently assessed by two observers, resulting in 396 handoff evaluations. Data were analyzed using SPSS 25.0, focusing on sociodemographic information, evaluations of handoff processes, satisfaction scores, item analyses, explanatory factor analysis, and reliability testing through Cronbach’s alpha.
Results: The Turkish version of the Handoff CEX scale showed high reliability with Cronbach’s alpha values of 0.925 for the outgoing nurse and 0.914 for the incoming nurse. Content validity was confirmed with a CVI of 0.96. Factor analysis indicated high factor loadings, with values ranging from 0.745 to 0.935. Kappa statistics for inter-rater reliability were low, indicating a need for further refinement in observer training.
Conclusion: The Handoff CEX scale adapted into Turkish is a valid and reliable measurement tool for evaluating patient handoff processes. Its continuous use in health institutions will contribute to the long-term development of nurses' communication skills and the quality of patient care.

Kaynakça

  • 1. Do J, Shin S: Development of nursing handoff competency scale: a methodological study. BMC nursing 2024, 23(1):272.
  • 2. Vanderzwan KJ, Kilroy S, Daniels A, O’Rourke J: Nurse-to-nurse handoff with distractors and interruptions: An integrative review. Nurse Education in Practice 2023, 67:103550.
  • 3. Le A, Lee MA, Wilson J: Nursing handoff education: An integrative literature review. Nurse Education in Practice 2023, 68:103570.
  • 4. Calleja P, Adonteng-Kissi B, Romero B: Transition support for new graduate nurses to rural and remote practice: A scoping review. Nurse education today 2019, 76:8-20.
  • 5. Manias E, Geddes F, Watson B, Jones D, Della P: Perspectives of clinical handover processes: A multi‐site survey across different health professionals. Journal of clinical nursing 2016, 25(1-2):80-91.
  • 6. O'Connell B, Penney W: Challenging the handover ritual: recommendations for research and practice. Collegian 2001, 8(3):14-18.
  • 7. Ismuntania K, Nursalam FR, Nurlela Mufida I, Maulina Iriyanti Z, Muzaffar SD, Fitri Apriani AS: Bedside Handover using Patient Family Centered Care on Patient Safety and Patient Satisfaction: A Systematic Review. Journal of Positive Psychology and Wellbeing 2023:534-546.
  • 8. Pothier D, Monteiro P, Mooktiar M, Shaw A: Pilot study to show the loss of important data in nursing handover. British Journal of Nursing 2005, 14(20):1090-1093.
  • 9. Meißner A, Hasselhorn HM, Estryn‐Behar M, Nézet O, Pokorski J, Gould D: Nurses’ perception of shift handovers in Europe–results from the European Nurses’ Early Exit Study. Journal of advanced nursing 2007, 57(5):535-542.
  • 10. Chaboyer W, Wallen K, Wallis M, McMurray AM: Whiteboards: one tool to improve patient flow. Medical Journal of Australia 2009, 190(S11):S137-S140.
  • 11. Cronn S, Trevino C, Jansen K: Use of Theory in Quality Innovations: Shift Change Protocol in the Emergency Department. Journal of Nursing Care Quality 2023, 38(2):114-119.
  • 12. Methangkool E, Tollinche L, Sparling J, Agarwala AV: Communication: is there a standard handover technique to transfer patient care? International anesthesiology clinics 2019, 57(3):35-47.
  • 13. Umberfield E, Ghaferi AA, Krein SL, Manojlovich M: Using incident reports to assess communication failures and patient outcomes. The Joint Commission Journal on Quality and Patient Safety 2019, 45(6):406-413.
  • 14. Desmedt M, Ulenaers D, Grosemans J, Hellings J, Bergs J: Clinical handover and handoff in healthcare: a systematic review of systematic reviews. International Journal for Quality in Health Care 2021, 33(1):mzaa170.
  • 15. Ernst KM, McComb SA, Ley C: Nurse‐to‐nurse shift handoffs on medical–surgical units: A process within the flow of nursing care. Journal of clinical nursing 2018, 27(5-6):e1189-e1201.
  • 16. Tuna R, Dallı B: Hemşirelerin Nöbet Devir Teslim Etkinliği ve İlişkili Değişkenler. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2018(4):432-437.
  • 17. Güngör S, Tosun B: Hemşirelerin hasta devir teslim süreci. Uluborlu Mesleki Bilimler Dergisi 2023, 6(2):118-126.
  • 18. Sunay M, Arıcıoğlu C, Yıldız GK: Hemşirelerin hasta devir teslim etkinliğinin tıbbi hatalara eğilim düzeylerine etkisi. Yüksek İhtisas Üniversitesi Sağlık Bilimleri Dergisi 2023, 4(3):76-83.
  • 19. Bujang MA, Omar ED, Baharum NA: A review on sample size determination for Cronbach’s alpha test: a simple guide for researchers. The Malaysian journal of medical sciences: MJMS 2018, 25(6):85.
  • 20. Ferrara P, Terzoni S, Davì S, Bisesti A, Destrebecq A: A tool for assessing the quality of nursing handovers: a validation study. British Journal of Nursing 2017, 26(15):882-888.
  • 21. Horwitz LI, Dombroski J, Murphy TE, Farnan JM, Johnson JK, Arora VM: Validation of a handoff assessment tool: the Handoff CEX. Journal of clinical nursing 2013, 22(9-10):1477-1486.
  • 22. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL: Best practices for developing and validating scales for health, social, and behavioral research: a primer. Frontiers in public health 2018, 6:149.
  • 23. Streiner DL, Norman GR, Cairney J: Health measurement scales: a practical guide to their development and use: Oxford university press; 2024.
  • 24. Son J: Back translation as a documentation tool. Translation & Interpreting: The International Journal of Translation and Interpreting Research 2018, 10(2):89-100.
  • 25. Morgado FF, Meireles JF, Neves CM, Amaral A, Ferreira ME: Scale development: ten main limitations and recommendations to improve future research practices. Psicologia: Reflexão e Crítica 2017, 30.
  • 26. Arafat S, Chowdhury HR, Qusar M, Hafez M: Cross cultural adaptation and psychometric validation of research instruments: A methodological review. Journal of Behavioral Health 2016, 5(3):129-136.
  • 27. Gjersing L, Caplehorn JR, Clausen T: Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC medical research methodology 2010, 10:1-10.
  • 28. Baluyot A, McNeill C, Wiers S: Improving Communication From Hospital to Skilled Nursing Facility Through Standardized Hand-Off: A Quality Improvement Project. Patient Safety 2022, 4(4):18-25.
  • 29. Almanasreh E, Moles R, Chen TF: Evaluation of methods used for estimating content validity. Research in social and administrative pharmacy 2019, 15(2):214-221.
  • 30. Davis LL: Instrument review: Getting the most from a panel of experts. Applied nursing research 1992, 5(4):194-197.
  • 31. de Raadt A, Warrens MJ, Bosker RJ, Kiers HA: A comparison of reliability coefficients for ordinal
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Hizmetleri ve Sistemleri (Diğer)
Bölüm Araştırma Makalesi
Yazarlar

Betül Tosun 0000-0002-4505-5887

Soner Berşe 0000-0001-9108-3216

Ezgi Dirgar 0000-0001-8214-7441

Nursemin Ünal 0000-0003-3141-7194

Nuran Tosun 0000-0003-1792-8908

Yayımlanma Tarihi 29 Eylül 2025
Gönderilme Tarihi 26 Ekim 2024
Kabul Tarihi 8 Ağustos 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 12 Sayı: 3

Kaynak Göster

APA Tosun, B., Berşe, S., Dirgar, E., … Ünal, N. (2025). Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 12(3), 359-367. https://doi.org/10.34087/cbusbed.1574256
AMA Tosun B, Berşe S, Dirgar E, Ünal N, Tosun N. Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale. CBU-SBED. Eylül 2025;12(3):359-367. doi:10.34087/cbusbed.1574256
Chicago Tosun, Betül, Soner Berşe, Ezgi Dirgar, Nursemin Ünal, ve Nuran Tosun. “Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 12, sy. 3 (Eylül 2025): 359-67. https://doi.org/10.34087/cbusbed.1574256.
EndNote Tosun B, Berşe S, Dirgar E, Ünal N, Tosun N (01 Eylül 2025) Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 12 3 359–367.
IEEE B. Tosun, S. Berşe, E. Dirgar, N. Ünal, ve N. Tosun, “Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale”, CBU-SBED, c. 12, sy. 3, ss. 359–367, 2025, doi: 10.34087/cbusbed.1574256.
ISNAD Tosun, Betül vd. “Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 12/3 (Eylül2025), 359-367. https://doi.org/10.34087/cbusbed.1574256.
JAMA Tosun B, Berşe S, Dirgar E, Ünal N, Tosun N. Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale. CBU-SBED. 2025;12:359–367.
MLA Tosun, Betül vd. “Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale”. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 12, sy. 3, 2025, ss. 359-67, doi:10.34087/cbusbed.1574256.
Vancouver Tosun B, Berşe S, Dirgar E, Ünal N, Tosun N. Turkish Validation and Reliability Study of the ’HANDOFF-CEX’ Patient Handover Scale. CBU-SBED. 2025;12(3):359-67.