Development and validation of assessment tools for food allergy-related knowledge and management confidence.

Background: Given the life-threatening nature of food allergy (FA), it is important to assess the level of knowledge among families with food-allergic patients and their ability to cope with anaphylaxis. This study constructed a FA knowledge questionnaire (FAKQ) and confidence in FA management skills (CIFAMS) questionnaire to assess understanding and attitudes toward FA management in food-allergic families. Methods: Items from literature review and expert panel showing ≥80% content validity index and semantic equivalence were selected for translation into Chinese. These questionnaires underwent feasibility pilot testing followed by cross-sectional validation to assess their psychometric properties of internal consistency, test-retest reliability, and construct validity with a FA quality-of-life questionnaire and discriminant validity. Exploratory factor analysis was performed to confirm their factor structure. Results: A total of 155 subjects (104 patients and 51 parents) completed a 20-item FAKQ and 10-item CIFAMS. Both tools showed acceptable internal consistency in baseline and retest groups. FAKQ and CIFAMS correlated for all subjects (P = .002) and for adults (P = .002), and similarly between CIFAMS and parent-reported FA independent measure (P = .005). Total score of FAKQ was sensitive to within-group differences of patients hospitalized for FA (P < .001). FAKQ and CIFAMS items were factored into 4 and 2 domains, respectively. Subjects scored the lowest on FAKQ items about signs of allergic reaction and CIFAMS items on epinephrine autoinjector use. Conclusion: FAKQ and CIFAMS developed by our group are valid and reliable in assessing knowledge and confidence in FA management in patients and parents. These tools are crucial for formulating education programs and advocacy campaigns for FA.

Developing and validating a genre awareness questionnaire for writing scientific reports.

Current scholarship on language awareness focuses on learners' noticing of forms and functions of language. In writing scientific reports, learners need to be aware of the Introduction, Method, Results, and Discussion (IMRD) genres. While scholarship explores students' language awareness in writing genres for scientific reports, there is a limited quantitative instrument for researchers to measure students' language awareness in these four genres of writing scientific articles. This study investigates the structure of factors of Language Awareness of Genres in a Scientific Writing Questionnaire that measures students' awareness of IMRD genres for L2 bilingual secondary school students in Hong Kong (N = 234). Content validity and construct validity were used. The results show that this instrument is reliable for researchers and teachers to understand the effectiveness of specific genre-based interventions on genre awareness.

Nurses' perceptions of the ISBAR handover protocol and its relationship to the quality of handover: A case study of bilingual nurses.

Introduction: Poor communication at handover may cause harm to the patient. Despite numerous studies promoting ISBAR as a communication tool for structured handover, nurses have varied levels of understanding of the ISBAR tool; this may lead to different perceptions. This paper aims to explore the structural relationships between factors relating to handover communication among nurses. Method: A path analysis was conducted to analyse how 206 bilingual nurses' knowledge of the ISBAR affects the perceived quality of handover, using a validated Nursing Handover Perception Questionnaire. Results: Nurses' knowledge of the ISBAR was not a statistically significant factor affecting the perceived quality of handover. Rather, nurses' understanding of patients' care plans and receiving updated information about patients determine the perceived quality of handover. Discussion: Nurses' compliance with the ISBAR tool should be considered in order to further identify and develop effective communication skills. Nurses' understanding of patients' care plans and receiving updated patient information significantly corresponded to the perceived quality of handover.

Experience of Patients With Rheumatoid Arthritis: A Qualitative Study of a Nurse-Led Clinic.

Rheumatoid arthritis (RA) is an extremely prevalent chronic inflammatory rheumatic disease. This study explores the experiences of patients with RA under nurse-led care, the roles that nurses play, and the outcomes achieved when applying the patient-centered care (PCC) approach. A purposive sample of 12 participants who had been diagnosed with RA for at least 1 year were recruited from a nurse-led rheumatology clinic. They were also receiving treatment with disease-modifying antirheumatic drugs. All of the participants reported high levels of satisfaction with the care they received in the nurse-led clinic, along with high levels of medication adherence. The nurses were highly accessible to the participants, and they regularly communicated information regarding their symptoms, medication, and treatment management. These findings illustrate the importance of the holistic care that nurses provide to their patients, as the participants agreed that nurse-led services could have a wider outreach in hospitals and the community.

Role of patients' family members in end-of-life communication: an integrative review.

OBJECTIVES: To synthesise empirical findings on the role of family in end-of-life (EOL) communication and to identify the communicative practices that are essential for EOL decision-making in family-oriented cultures. SETTING: The EOL communication settings. PARTICIPANTS: This integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Relevant studies published between 1 January 1991 and 31 December 2021 were retrieved from four databases, including the PsycINFO, Embase, MEDLINE and Ovid nursing databases, using keywords with meanings of 'end-of-life', 'communication' and 'family'. Data were then extracted and coded into themes for analysis. The search strategy yielded 53 eligible studies; all 53 included studies underwent quality assessment. Quantitative studies were evaluated using the Quality Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist was used for qualitative research. PRIMARY AND SECONDARY OUTCOME MEASURES: Research evidence on EOL communication with a focus on family. RESULTS: Four themes emerged from these studies: (1) conflicts in family decision-making in EOL communication, (2) the significance of timing of EOL communication, (3) difficulty in identification of a 'key person' who is responsible for decisions regarding EOL care and (4) different cultural perspectives on EOL communication. CONCLUSIONS: The current review pointed towards the importance of family in EOL communication and illustrated that family participation likely leads to improved quality of life and death in patients. Future research should develop a family-oriented communication framework which is designed for the Chinese and Eastern contexts that targets on managing family expectations during prognosis disclosure and facilitating patients' fulfilment of familial roles while making EOL decision-making. Clinicians should also be aware of the significance of the role of family in EOL care and manage family members' expectations according to cultural contexts.

Using a simulation-based approach to promote structured and interactive nursing clinical handover: a pre- and post-evaluation pilot study in bilingual Hong Kong.

Effective clinical nursing handover involves the transfer of responsibility and accountability for patient care between nurses, leading to better patient safety and continuity of care. Nurses in bilingual contexts, such as Hong Kong - where nurses are trained in English but communicate in Cantonese - may find it challenging to deliver a safe clinical handover. This article reports a pilot study in which a simulation-based approach is being developed to enhance nursing handover with structured and interactive interactions, using handover protocols such as ISBAR (introduction, situation, background, assessment, recommendation and readback) and CARE-team (connect, ask, respond, empathise) protocols in a bilingual context. The study has a pre- and post-evaluation design involving a questionnaire survey before and after a 4-hour workshop. Fourteen selected bilingual nurses in Hong Kong were trained according to the ISBAR and CARE-team protocols, and their perceptions of complete and structured handovers were evaluated before and after training using the questionnaire. The nurses reported that they were more self-confident in their handover experiences, with a deeper understanding of ISBAR and CARE-team protocols after the simulation-based training intervention, leading to better (i.e., more structured and interactive) clinical handover between nurses. Overall, the staff perceived their handover communication to have improved using simulation-based training.

An exploratory study of communication training for Chinese medicine practitioners in Hong Kong to integrate patients' conventional medical history.

BACKGROUND: Despite Traditional Chinese medicine's (TCM) historical roles in Chinese society, few research has been investigated the nature of TCM practitioner-patient interactions. Improved communication skills among TCM practitioners will result higher-quality interactions and better clinical outcomes. METHODS: To investigate the changes in TCM practitioners' communication practices after communications training focused on promoting their awareness of integrating a patient's medical history from conventional medicine in TCM treatment, Eight registered Cantonese-speaking TCM practitioners in Hong Kong were randomly recruited from local clinics and randomised into control (n = 12) and experimental groups (n = 12), with a total of 24 consultations. The experimental group was given training focused on patient-centred communication, with an internationally recognised and communication framework validated in global consultation settings (i.e. the Calgary-Cambridge Guide) on how to take a patient's medical history from conventional medicine and communicate diagnosis and treatment plans. Consultations before and after training were audio-recorded and rated. The efficacy of the training was evaluated by comparing the two groups before training (pre-test), immediately after training (post-test) and after a 3-month delay (delayed post-test). Using validated scales, the primary outcomes were measured for the practitioners' clinical communication skills and the quality of interactions. RESULTS: The communication training significantly improved the TCM providers' patient-centred communication and communication proficiency. The results indicate that the team developed an effective communication model for integrating TCM and conventional medicine in Hong Kong. The framework helps trained TCM practitioners to integrate their patients' conventional medical history when delivering patient care. The findings shed light on how interpersonal relationships between TCM practitioners and patients can be constructed after communication training to better care for patients' psychological concerns in addition to their physical needs. CONCLUSION: Trained TCM practitioners can provide an integrated model that takes patients' conventional medical history into account when delivering a holistic patient-centred care. The findings can enhance our understanding of better ways to train the future TCM practitioners and to develop a continuing professional training for the current TCM practitioners to expand our understanding of TCM communication in acute clinical contexts and, thus offer a firm evidence-based foundation upon which to develop communication strategies that improve their clinical cpractices.

Promoting Patient Engagement in Medical Informed Consent - A Qualitative Study of Chinese Doctors' Communication Strategies.

Patient engagement is now widely endorsed as an essential ingredient for high-quality healthcare, yet there has been limited research on how patient engagement can be facilitated in medical informed consent (IC) communication. To address this gap, a fine-grained discourse analysis was conducted to identify communication strategies adopted by doctors to facilitate information delivery and ascertain patients' understanding, which translate into an increase in patient engagement. Data was collected from a public hospital in mainland China. Nonparticipating observations of 14 IC sessions were audio-recorded, followed by in-depth, semi-structured interviews with those observed patients. Four communication strategies emerged from the analysis: 1) seeking patients' understanding of their condition; 2) explaining medical information by reference to shared knowledge and practice; 3) recognizing and addressing patients' psychological concerns; 4) repeating critical information and checking patients' understanding through teach-back. The adoption of these strategies enables doctors to tailor the scope and delivery of information to accommodate and address patients' preferences, rather than defaulting to one-way information dumping. This study sheds light on the complexity of IC and further contributes to the ongoing endeavors to improve IC communication by raising the awareness of the role of patients in making mutually acceptable decisions. These identified strategies can be incorporated into medical communication training to facilitate delivery of healthcare that is sensitive to patients' needs and expectations.

An ethnographic discourse approach to explore GP-counsellor communication in primary health care settings in Hong Kong.

This study aims to explore the nature of GP-counsellor interaction during discussions of patients' mental health issues in primary care services. An ethnographic discourse analysis of audio-recorded GP-counsellor conversations and the participating counsellor's reflective accounts. Two participating GPs and one counsellor were recruited from a private medical clinic in Hong Kong. The GPs and the counsellor mainly discussed their patients' issues in terms of medication management, the counsellor's case conceptualization, the case management, knowledge transfer and acknowledging the partnership. During case discussions, both the GPs and the counsellor used a range of interactional strategies to clarify a patient's condition and treatment plans for mutual understanding. The GPs and the counsellor co-construct an insider discourse that covers a greater diversity of topics, including both medical and non-medical concerns. The research findings have implications for theory and practice, including the potential of ethnographic discourse analysis in understanding the features of participants' behavior and evaluating the effectiveness of communication in a particular setting, as well as the importance of exploring professionalized discourse during GP-counsellor communication in developing training programs aimed at enhancing staff awareness of effective IPC communication.

The active participation of elderly patients in traditional Chinese medicine consultations as means to creating a community of practice: A case study in Hong Kong.

Despite its historic role in Chinese society and its popularity with an elderly Chinese population, limited research has explored the discursive practices of Traditional Chinese Medicine (TCM). Our analysis of practitioner-patient interactions illustrated the reasons why TCM is widely welcomed by a specific patient group. This paper adopted the concept of Community of Practice (CoP) as a theoretical framework to document how patients interact with TCM practitioners to construct meaning through a process of participation and reification. This study aimed to explore how patients in a medical consultation context developed an understanding of their conditions and how they strategically used medical terminology to enact meaningful exchanges to realise their CoP. An inductive qualitative discourse analysis was conducted to for nine elderly patients (i.e., age > 65) in Hong Kong to demonstrate the role that a CoP played in a joint process of knowledge construction to promote a patient-centred practice and foster the active participation of the patients. TCM practitioners can develop specific communication skills to promote their patients' CoP, which will improve patient-centred care, empower patients to actively engage in their treatments and result in higher levels of patient satisfaction.

Views of Hospital Nurses and Nursing Students on Nursing Engagement-Bridging the Gap Through Communication Courses.

Background: Communicative engagement plays a significant role for effective nurse-patient communication. In the existing college nursing communication training within and outside China, there is a difference between what students are taught and what they can apply in their clinical placements. Aims: Using needs analysis, this mixed-methods study explored potential gaps between frontline hospital nurses' and college nursing students' perceptions of nurse-patient communicative engagement, and collated a list of effective engagement strategies for pedagogy. Methods: Surveys and interviews were conducted with key stakeholders, including 16 hospital nurses and 60 nursing students. A new scale named Nursing Engagement with Patients Scale (NEPS) was developed and validated to explore stakeholders' views on nursing engagement. Results: Differences between the views of nurses and students on engagement were identified. While frontline nurses affirmed the importance of engaging with patients while providing nursing care, nursing students were unsure about the concept and role of engagement, and how to enact it. A list of communication strategies that promote engagement was culled from the interviews with the experienced nurses. Implications: These can be used to inform nursing communication courses to bridge the gap between what nursing students are currently taught and what they will need in the workplace.

An Exploratory Study of Cantonese Learning Strategies Amongst Non-Chinese English-Speaking Ethnic Minority University Students in Hong Kong.

This study investigates the strategies for learning Cantonese that are adopted by non-Chinese English-speaking ethnic minority (EM) university students in Hong Kong. The aim is to identify the challenges these students face in applying their strategies to learn Cantonese and to explore their learning experiences when implementing them. Drawing on questionnaire surveys and semi-structured interviews with 30 EM students at a university in Hong Kong, this study identifies these learners' strategies, elicits their views on the use of these strategies and examines their learning experiences. The findings suggest that EM students are "medium strategy users," with social strategies being their most commonly used types of learning strategies, followed by compensation and metacognitive strategies. The more proficient Cantonese users tend to use metacognitive strategies that promote planning and are goal-oriented. Taken together, this study sheds light on the complex interplay of sociocultural variables in shaping EM university students' Cantonese learning experience in Hong Kong. It also highlights the importance of analysing EM students' linguistic repertoire and the local language ecology in understanding Cantonese learning in a multilingual context like Hong Kong.

The priorities, challenges, and scope of clinical communication teaching perceived by clinicians from different disciplines: a Hong Kong case study.

BACKGROUND: In the absence of a well-rounded syllabus that emphasises both interpersonal and medical dimensions in clinical communication, medical students in the early stages of their career may find it challenging to effectively communicate with patients, especially when dealing with perceived priorities and challenges across different disciplines. METHODS: To explore the priorities, challenges, and scope of clinical communication teaching as perceived by clinicians from different clinical disciplines, we recruited nine medical educators, all experienced frontline clinicians, from eight disciplines across seven hospitals and two medical schools in Hong Kong. They were interviewed on their clinical communication teaching in the Hong Kong context, specifically its priorities, challenges, and scope. We then performed interpretative phenomenological analysis of the interview data. RESULTS: The interview data revealed five themes related to the priorities, challenges, and scope of clinical communication teaching across a wide range of disciplines in the Hong Kong context, namely (1) empathising with patients; (2) using technology to teach both the medical and interpersonal dimensions of clinical communication; (3) shared decision-making with patients and their families: the influence of Chinese collectivism and cultural attitudes towards death; (4) interdisciplinary communication between medical departments; and (5) the role of language in clinician-patient communication. CONCLUSIONS: Coming from different clinical disciplines, the clinicians in this study approached the complex nature of clinical communication teaching in the Hong Kong context differently. The findings illustrate the need to teach clinical communication both specifically for a discipline as well as generically. This is particularly important in the intensive care unit, where clinicians from different departments frequently cooperate. This study also highlights how communication strategies, non-verbal social cues, and the understanding of clinical communication in the Hong Kong Chinese context operate differently from those in the West, because of differences in sociocultural factors such as family dynamics and hierarchical social structures. We recommend a dynamic teaching approach that uses role-playing tasks, scenario-based exercises, and similar activities to help medical students establish well-rounded clinical communication skills in preparation for their future clinical practice.

Navigating communication between conventional medicine and traditional Chinese medicine: a case study of cancer patients in Hong Kong.

BACKGROUND: Traditional Chinese medicine (TCM) is a growing phenomenon worldwide. Despite its historical role in Chinese society, however, few studies have explored the nature of communication among patients with cancer who receive TCM care in addition to conventional medicine. If TCM practitioners acquire adequate knowledge to understand the needs and communication issues for their patients with cancer, particularly those who are simultaneously receiving conventional medicine, this will lead to better quality of care and clinical outcomes, such as high patient satisfaction and treatment compliance. OBJECTIVES: To fill this knowledge gap, this study explored the nature of communication among patients with cancer in Hong Kong who receive TCM treatment in addition to conventional medicine. PARTICIPANTS: We conducted in-depth interviews with 20 patients, 5 oncologists and 5 TCM practitioners to elicit their views on TCM treatments. METHOD: We adopted a qualitative approach using an interpretative phenomenological analysis. RESULTS: Based on the themes that emerged from our interview transcripts, we outlined communication priorities when advising patients with cancer who are receiving both TCM and conventional medical care. We developed a framework to train TCM practitioners to better integrate their patients' conventional medical history when delivering patient care. CONCLUSIONS: Our study findings inform communication priorities when caring for patients who opt for TCM care in addition to conventional treatments. In addition, they provide useful information for developing future clinical research studies to explore integrated approaches between TCM and conventional medicine in treating patients with cancer.

Teaching end-of-life communication: priorities, challenges, scope-systematic review.

BACKGROUND: Without a well-rounded syllabus to teach end-of-life (EOL) communication, medical providers find it challenging to enhance their patients' quality of life at the final stage of life. AIM: The aim of this scoping review was to explore studies about the teaching of EOL communication and to detail how educators can approach the teaching of EOL communication. METHODS: A scoping review of both qualitative and quantitative studies was conducted according to the methodological framework of scoping review. The PsycINFO, PubMed, ERIC, CINAHL and EMBASE databases were searched for studies using the keywords 'teach', 'educat*', 'end of life', 'terminal care', 'communication' and 'palliative care'. Sixteen studies were appraised, and none was rejected on the grounds of quality. RESULTS: The search strategy yielded 22 278 entries and 16 studies were included. Two themes were identified from the priorities in teaching EOL communication: (1) challenges to teaching EOL communication and (2) methods of teaching EOL communication. To present a comprehensive overview of EOL communication teaching, we provide directions for priorities of topics and approaches when teaching EOL communication. CONCLUSIONS: The review detailed the complexity of teaching EOL communication, which indicates the need for a well-rounded syllabus that includes skills such as non-verbal social cues, communication strategies and understanding EOL communication in various cultural contexts to facilitate a well-rounded EOL communication experience for students' future practice.

Use of Questioning between Traditional Chinese Medicine Practitioners and Patients to Realize TCM Philosophy: Holism, Five Elements and Yin-Yang in the Context of Doctor-Patient Communication.

Adopting a broad discourse analytic approach, the present study investigates authentic interactions between Traditional Chinese Medicine (TCM) practitioners and patients in Hong Kong so as to identify specific characteristics of communication in this context, particularly how patients develop and internalize their understanding of illnesses in terms of 'balance' via the question-answer (Q-A) routine. Findings can improve our understanding of the role of doctor-patient negotiations and the effects of a practitioner's questioning style on the patients' ability to 'internalize' their understanding of their body conditions in the TCM context. While questioning is considered an important communication technique when soliciting patients' problems during consultations, its value in terms of understanding patients' concerns about issues other than their illnesses has not been explored. Based on consultations of 8 hours in length, our study finds that the use of questions not only can create a space wherein patients can discuss their illnesses and primary concerns, but also enable patients to gain a holistic understanding of their body conditions. This paper informs readers about the techniques that TCM practitioners can use to structure their conversations while delivering patient-centered care, including lexical, grammatical, and cultural resources.

Communication About Advance Directives and Advance Care Planning in an East Asian Cultural Context: A Systematic Review.

PROBLEM IDENTIFICATION: In East Asian cultural contexts, advance directive (AD) and advance care planning (ACP) discussions are generally challenging given patients' unawareness of decision-making rights. LITERATURE SEARCH: Selected databases were searched for articles published from January 2000 to December 2020. DATA EVALUATION: 21 studies were included and appraised with Critical Appraisal Skills Programme Systematic Review Checklist. SYNTHESIS: Five themes emerged. IMPLICATIONS FOR RESEARCH: Future research should focus on developing a culturally appropriate AD and ACP communication framework.

Reliability and validity of the Cancer Health Literacy Test - Chinese versions: CHLT-30-Chinese and CHLT-6-Chinese.

AIMS: The Cancer Health Literacy - 30 (CHLT-30) and Cancer Health Literacy - 6 (CHLT-6) are widely used instruments to measure cancer health literacy and to identify individuals with limited cancer health literacy, respectively. This study evaluated the psychometric performance of both instruments in Chinese cancer patient population. METHODS: The back-translation method was used in cross-cultural adaptation. Chinese versions, labeled as CHLT-30-Chinese and CHLT-6-Chinese, were administered to a diverse cross-sectional sample of 602 cancer patients. Of these, 30 patients retook the instruments over a 2-week interval to estimate test-retest reliability. Classical and modern psychometric methods were used to estimate the item and test properties. RESULTS: Model fit statistics confirmed the original measurement structures of CHLT-30-Chinese (one-factor model) and CHLT-6-Chinese (latent class model with limited and adequate cancer health literacy classes) providing construct validity evidence. The CHLT-30-Chinese showed high internal consistency (Cronbach's α = 0.83; McDonald's Ω = 0.93) and 2-week test-retest reliability (r = 0.78). The CHLT-6-Chinese separated limited and adequate cancer health literacy classes well (entropy = 0.77) with the estimated prevalence rates of 19% and 81%, respectively. The CHLT-6-Chinese was highly precise in assigning cancer patients into two categories: limited and adequate cancer health literacy classes with probability of 0.95 and 0.90, respectively. Invariant measurement properties of both instruments were supported between male and female patients as well as patients with and without high school diploma. CONCLUSIONS: The findings support the psychometric properties of the CHLT-30-Chinese for measuring cancer health literacy as a continuous trait and CHLT-6-Chinese for identifying patients with limited cancer health literacy with high precision. The two tools are recommended for use in both daily practice and clinical trials.

Clinical handover in a bilingual setting: interpretative phenomenological analysis to exploring translanguaging practices for effective communication among hospital staff.

OBJECTIVE: To explore the linguistic features of translanguaging in bilingual handover practices and elicit the views of hospital staff on factors that hinder or facilitate effective handover practice in a bilingual environment. METHODS: 78 hospital staff were recruited from hospital wards and emergency departments of two Hong Kong hospitals. They were interviewed to determine their perceptions of their handover communication in a bilingual context, and their responses were subjected to interpretative phenomenological analysis. RESULTS: Based on the staff interviews, three dimensions with potential applications to effective clinical handover are identified. A revised Identify, Situation, Background, Assessment and Recommendation protocol accounting for linguistic pluralism (i.e., the translanguaging process) is suggested to underpin the future research agenda around effective clinical communication in a bilingual context. CONCLUSIONS: Research on handover communication in multilingual contexts is limited. This study outlines linguistic pluralism at the handover stage and details the complexity of handover communication for staff in a bilingual context. It urges for more research with a specific focus on identifying avoidable linguistic issues that emerge from the clinical context and developing a suitable protocol to standardise staff's translanguaging processes to ensure a safe and efficient handover process in a bilingual environment.

Factors associated with nurses' perceptions, their communication skills and the quality of clinical handover in the Hong Kong context.

BACKGROUND: Clinical handover is a pivotal, high-risk communicative event because it involves the transfer of responsibility and accountability for patients and their care. Nurses' perceptions and their communication skills inevitably impact on their ability of clinical handover. Limited studies have explored nurses' handover practice in the Hong Kong context. This study aimed to identify factors associated with and specific impact paths between the quality, communication skills and nurses' perceptions on clinical handover. METHODS: A questionnaire survey was conducted immediately after the nurses' training in effective handover communication. A convenience sample of 206 bilingual nursing staff from a local hospital in Hong Kong participated in this paper-and-pencil survey adopted from the Nurses Handover Perceptions Questionnaire survey. RESULTS: The path analysis revealed that except the opportunity to ask questions and high perceptions of the ISBAR communication protocol, other factors were significantly correlated with improved quality of handover. In addition, nurses who had updated information were likely to ask more questions and obtain a better understanding of the patient care plan during handover. CONCLUSIONS: The quality of nursing handover depended on the degree of nurses' grasp of the patient care plan. The ISBAR communication protocol was considered helping nurses to improve their communication skills with other colleagues and indirectly enhance patient's safety. However, although ISBAR facilitated nurses to structure clearer handover communication, it was not the most important predictive factor for determining handover quality.