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

Abstract

Background: 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. Aim: To explore how experienced ICU nurses participate in and influence clinical decision-making through handover practices. Study Design: 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. Findings: 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. Conclusions: 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. Relevance to Clinical Practice: 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.