Enhancing Nurses' Handoff Practices Through Simulation‐Based I‐PASS Training: An Evidence‐Based Study

ABSTRACT

Aim

To evaluate whether simulation‐based I‐PASS handoff training improves ICU nurses' knowledge, perceptions of handoff communication and safety attitudes.

Background

Effective handoff communication is crucial for ensuring patient safety and reducing errors. However, simulation‐based training (SBT) with structured protocols, such as I‐PASS, is rarely used in Egyptian nursing education, highlighting a gap.

Design

A quasi‐experimental design was employed.

Methods

A convenience sample of 57 ICU nurses was studied from June to December 2023. Data were collected using the I‐PASS Handoff Knowledge Questionnaire, Perception of Handoff Communication Tool and Patient Safety Questionnaire. Nurses completed baseline assessments, participated in two simulation‐based I‐PASS scenarios and repeated assessments post‐intervention. Statistical analyses examined the training's impact and its relationships with participants' socio‐demographic characteristics.

Results

Significant improvements were observed in I‐PASS knowledge, perceptions of handoff communication and safety attitudes (all p < 0.001). Nursing qualifications and place of residence have shown a significant correlation with perceptions of handoff communication and safety attitudes (p < 0.05).

Conclusion

Simulation‐based I‐PASS handoff training significantly enhances ICU nurses' knowledge, perceptions of handoff communication and safety attitudes. Targeted, context‐sensitive educational interventions are necessary to strengthen handoff practices and improve patient safety within the Egyptian healthcare system.

Relevance to Clinical Practice

Structured simulation‐based training, such as I‐PASS, can be effectively integrated into nursing education to standardise handoff communication and improve patient safety outcomes in intensive care settings.

Patient or Public Contribution

No patient or public contribution.

Key Points

• I‐Pass handoff SBT strengthen communication quality and safety culture in nursing Integrating I‐PASS in clinical training enhances nursing practice, safety outcomes, and care quality nurses' perception of structured handoff communication is positively correlated with improved knowledge and safety attitudes.

Abbreviations

ICU

intensive care unit

SBT

simulation‐based training

1. Introduction

Handoff communication between nurses is crucial to patient safety as it directly impacts the incidence of avoidable adverse events, which continue to be a significant problem for patient morbidity and mortality worldwide (Joint Commission ²⁰²⁴; Vega et al. ²⁰²⁴). Up to 67% of medical errors are due to poor communication during handoffs (Joint Commission ²⁰²⁴). This miscommunication, particularly during interfacility transfer of critically ill patients, can be a source of preventable harm. Evidence‐based communication frameworks, such as the I‐PASS handoff programme, help improve the quality of information exchange and reduce patient harm by standardising information transfer (Starmer et al. 2023; Vega et al. ²⁰²⁴). Implementation of the I‐PASS handoff programme has been associated with high compliance to key handoff elements (96%), significant reductions in communication errors (50%), medical errors (23%) and preventable adverse events (30%), as well as improved efficiency and workflow (Clarke et al. 2017; Starmer et al. ²⁰¹⁴). In addition, systematic training and real‐time monitoring of adherence increased handoff protocol compliance from 41.6% in 2019 to 70.5% in 2022, alongside improvements in safety culture perception scores from 38% in 2018 to 59% in 2022 (Joint Commission ²⁰²⁴; Vega et al. ²⁰²⁴). Building on this progress, simulation‐based training (SBT) further strengthens the I‐PASS handoff by offering active, experiential learning that enhances knowledge, clinical performance, and safety attitudes, even though this combined approach remains underutilised in resource‐limited and culturally diverse healthcare environments (Lim and Kang 2024; O'Toole et al. ²⁰¹⁸). Research gaps also exist regarding how nurses' I‐PASS knowledge influences their perceptions of handoff communication and safety attitudes, particularly within intensive care units, where time constraints and barriers to protocol implementation are prevalent (Blazin et al. 2020; O'Toole et al. ²⁰¹⁸; Omidia et al. ²⁰²³).

2. Literature Review

2.1. I‐PASS Handoff

I‐PASS is a structured, evidence‐based communication protocol that aims to improve the safety and quality of patient handoff by organising the exchange of key information into five components: Illness Severity, Patient Summary, Action List, Situation Awareness and Contingency Planning and Synthesis by Receiver (Blazin et al. 2020; Ghasemi et al. ²⁰²⁵; Starmer et al. ^{2017, 2023}; Vega et al. ²⁰²⁴). Illness severity categorises patients based on their condition and aids in prioritising care (Starmer et al. 2017, 2023). Patient summary provides a concise clinical summary to support informed decision‐making following a patient visit (Blazin et al. 2020), while the action list details the tasks to be accomplished, the time frame within which these need to be completed, and who is responsible (Starmer et al. 2017, 2023). Situation awareness involves predicting imminent changes for the patient and preparing for contingencies (Blazin et al. 2020). Finally, synthesis by the receiver involves active confirmation and clarification to prevent miscommunication (Starmer et al. 2017, 2023).

This structured approach has become a critical component in advancing patient safety and communication efficacy in healthcare transitions. I‐PASS handoff implementation can enhance communication clarity, reduce errors and promote shared understanding among healthcare providers (Ganatra 2025; McCarthy et al. ²⁰²⁵; Shekelle et al. ²⁰²⁵). It also cultivates a culture of safety and nurse confidence, decreasing interruptions and enhancing situational awareness during handoffs (Blazin et al. 2020; O'Toole et al. ²⁰¹⁸). Adaptations of I‐PASS across various clinical and institutional settings have demonstrated increased adherence to handoff protocols, improved quality of transmitted information and sustained reductions in handoff‐related errors, without increasing handoff duration, highlighting its broad applicability (Ghasemi et al. 2025; Merchant ²⁰²²; Shekelle et al. ²⁰²⁵).

2.1.1. Safety Attitudes

Safety attitudes refer to the beliefs, perceptions and feelings healthcare workers hold about safety practices, protocols and policies. Positive attitudes are essential for building a strong safety culture, which promotes following safety guidelines, open reporting of errors without fear of punishment, supportive management and effective communication. This culture enhances overall safety outcomes (Alanazi et al. 2022; Hussein et al. ²⁰²²). Safety attitudes serve as a bridge between the organisation's safety climate, its general environment, commitment to safety, and actual safety behaviours, helping to reduce unsafe acts, which are often influenced by management and institutional factors (Arzahan et al. 2022; Mistri et al. ²⁰²³). Positive safety attitudes are directly linked to fewer errors and improved patient safety, underscoring the importance of a supportive workplace environment. Outside healthcare, safety attitudes also impact productivity and accident rates. Negative attitudes can lead to careless behaviour and more accidents, while positive attitudes promote safer and more efficient workplaces. Programmes aimed at improving safety attitudes, such as safety training and involving employees in safety development, have proven effective in enhancing both safety and productivity (Alanazi et al. 2022; Camacho‐Rodriguez et al. ²⁰²²). Therefore, focusing on safety attitudes is crucial for designing successful safety interventions and achieving lasting improvements in workplace safety across various sectors.

2.1.2. Simulation‐Based Training (SBT)

Simulation‐based training replicates clinical scenarios within controlled, safe environments, enabling learners to develop vital clinical decision‐making, communication and teamwork skills (Al‐Elq ²⁰¹⁰; Decker et al. ²⁰²¹). It significantly improves nursing competencies through higher learner engagement, enhanced self‐efficacy and increased learning satisfaction (Hung et al. 2021). Numerous studies confirm the efficacy of SBT across diverse clinical topics, including patient safety and handoff communication. However, its integration remains limited, particularly in Egyptian nursing education and similar resource‐constrained healthcare settings (Eltaybani et al. 2020; Piryani et al. ²⁰¹⁹).

Simulation fosters experiential learning, where trainees practice clinical skills and critical thinking without risk to patients, receiving immediate feedback that boosts their confidence and competence (Abdalla Jarelnape and Idris Sagiron ²⁰²³; Koukourikos et al. ²⁰²¹). Evidence shows that simulation enhances clinical reasoning, critical thinking, communication, self‐confidence and readiness for real clinical tasks (Jallad 2025; Tonapa et al. ²⁰²³). Its benefits include improved clinical performance, safer patient care and increased preparedness for complex healthcare challenges (Huang 2024).

2.2. Theoretical Framework

This study is based on two interrelated theories that explain how the I‐PASS handoff SBT programme can improve nurses' knowledge, perceptions of handoff communication and safety attitudes. First, the Communication Theory in healthcare highlights a persistent gap between the theory and its practical application in healthcare. While communication is crucial for improving healthcare outcomes, theories are often oversimplified in practice, focusing solely on information exchange, which limits the effectiveness of communication. To address this, healthcare must better integrate complex communication theories with real‐world practice, thereby enriching education and professional training to achieve better health communication outcomes (Ruben 2016). Central to this theory is the implementation of standardised tools such as the I‐PASS protocol, which organises the clinical encounter. Dividing signals in this way reduces cognitive load and ensures the transmission of all key information during a handoff (Starmer et al. 2023; Sweller ²⁰¹¹).

Second, Kolb's Experiential Learning Theory posits that learning is a continuous process grounded in experience, involving a four‐stage cycle: concrete experience, reflective observation, abstract conceptualisation, and active experimentation. In nursing education, this theory is widely used to link theoretical knowledge with clinical practice through active engagement and reflection. SBT provides learners with concrete experiences, allowing them to practice skills in a controlled environment, reflect on their performance, conceptualise lessons learned, and experiment with improved techniques. This process enhances knowledge, critical thinking and clinical competence in nurses (Cheng et al. 2025; Kolb ²⁰¹⁴; Sant and Kashive ²⁰²²). SBT combines these frameworks by providing a reflective practice setting that refines the technical skills necessary for I‐PASS communication while promoting the attitudinal elements essential to a culture of patient safety and quality patient care. Simulation improves engagement, promotes realism, supports the right intent and language and increases vigilance among nurses to care for their patients safely (Hughes et al. 2019; O'Toole et al. ²⁰¹⁸).

Together, these theories provide a solid foundation for the study design. The study tested the following hypotheses:

Hypothesis 1

Utilising the I‐PASS SBT programme enhances nurses' knowledge regarding I‐PASS handoff communication.

Hypothesis 2

Utilising the I‐PASS SBT programme has a positive impact on nurses' perceptions of handoff communication.

Hypothesis 3

Utilising the I‐PASS SBT programme improves nurses' safety attitudes.

2.2.1. Study Methods

2.2.1.1. Study Design

This study employed a quantitative quasi‐experimental pretest/post‐test design to evaluate the impact of simulation‐based I‐PASS handoff training on intensive care unit (ICU) nurses' knowledge, perceptions of handoff communication and safety attitudes.

2.2.1.2. Setting and Sample

The study was conducted in the intensive care unit of a university hospital that serves a large segment of the city's population.

A convenience sample of 57 ICU nurses was included in the study. The inclusion criteria required nurses to provide their informed consent and be actively involved in direct patient care and handoff processes, along with at least 6 months of experience in the ICU, nurses were required to have completed the three phases of the I‐PASS handoff SBT programme, including pre‐training evaluation, implementation and post‐programme evaluation. Exclusion criteria included nurses who were supplementary staff, those not routinely engaged in clinical handoffs, or those who did not complete the programme.

2.2.1.3. Measures

Data was collected using structured forms, which included the following tools:

2.2.1.4. Demographic Data Sheet

The researchers developed this sheet to collect participant information, including age, marital status, gender, education level, years of experience and place of residence.

2.2.1.5. Tool I. I‐PASS Handoff Knowledge Questionnaire

This questionnaire was developed by the researchers based on Blazin et al. (2020), Heilman et al. (2016) and Starmer et al. (2017) studies. It was used to assess nurses' knowledge of the I‐PASS handoff process. It comprised 20 multiple‐choice questions (MCQs) and classified into six domains reflecting key I‐PASS components: Domain 1 (Definition and Purpose) includes three MCQs to assess understanding of I‐PASS and its objectives; Domain 2 (Illness Severity) was composed of six MCQs that focus on patient condition and acuity; Domain 3 (Patient Summary) contains three MCQs that summarise patient status; Domain 4 (Action List) includes three MCQs covering pending tasks; Domain 5 (Situational Awareness and Contingency Planning) consisted of three MCQs addressing potential complications and planning; and Domain 6 (Receiver Synthesis) comprises two MCQs evaluating comprehension verification. It was scored one point for each correct answer and zero points for each incorrect answer, yielding scores from 0 to 20, with zero being the lowest and 20 being the highest.

2.2.1.6. Tool II. Perception of Handoff Communication Tool

This tool was adapted from Myndresku (2022) based on the work of Sand‐Jecklin and Sherman (2013). It was translated into Arabic by the researchers. It was used to evaluate nurses' perceptions of the current handoff system in ICU units. It consisted of 17 items that assessed key aspects of handoff communication, including effectiveness in patient‐care transfer, adequacy of clinical information, accountability, professionalism, stress, educational opportunities and teamwork. Responses were recorded on a 5‐point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree), with total scores ranging from 17 to 85.

2.2.1.7. Tool III. Patient Safety Questionnaire III (APSQ III)

The original APSQ‐III was developed by Carruthers et al. (2009). It was expanded to include four nursing‐specific items, resulting in a total of 30 items. It was then translated into Arabic and adapted for nursing practice by Abu‐El‐Noor et al. (2019). It was used to measure nurses' attitudes towards patient safety across nine factors using a 5‐point Likert scale from 1 (strongly disagree) to 5 (strongly agree), with total scores ranging from 30 to 150. Higher scores indicate more positive attitudes, with negatively worded items reverse‐scored. The translated version demonstrated acceptable reliability, with a Cronbach's alpha of 0.718.

2.2.2. Data Collection

2.2.2.1. Preparatory Phase

It took place from June to August 2023.

During this period, a comprehensive review of both national and international literature was conducted, encompassing scientific journals, textbooks and online databases, to identify current evidence on the I‐PASS handoff communication framework and patients' safety attitudes, specifically in the ICU, which also informed the programme design. Ethical approval was obtained from the institutional review board prior to the commencement of the study.

2.2.2.2. Pilot Study

It was administered to six ICU nurses, representing 10% of the participants, who were later excluded from the main results during the primary analysis to prevent data contamination. A pilot study was conducted to assess the clarity, relevance, and feasibility of the instruments, as well as the simulation procedures, prior to actual implementation. The I‐PASS handoff knowledge questionnaire took approximately 15 min to complete, while the Perception of Handoff Communication questionnaire and APSQ III took around 12 min. Each simulation session took an average of 50 min, including briefing, simulation play, debriefing, and feedback. Following the pilot results, minor adjustments were made to optimise the content flow and enhance instruction clarity.

Assessment Phase: During baseline data collection, which took place in September 2023. The researchers met the head nurse of the ICU and described the study's purpose to gain their cooperation. After that, the study team met with the nurses, explained the study's aim, and obtained their consent to participate. Participants were encouraged to ask questions and request clarifications regarding the study and its tools.

2.2.2.3. Implementation Phase

Following the baseline assessment, the I‐PASS handoff training programme was designed and implemented from October to December 2023. The participants were divided into groups with four to six nurses in each group. The researchers arranged a suitable time for programme implementation, which began with an introductory session. This session was conducted to orient nurses to the principles, goals, and expectations of the SBT, as this approach was new to many nurses. The SBT programme consisted of two simulation scenarios reflecting common challenges encountered during ICU patient handoffs. The first scenario focused on the accurate and comprehensive transfer of patient information during shift changes, incorporating all five key I‐PASS components: illness severity, patient summary, action list, situation awareness and synthesis by the receiver. The second scenario was designed to address more complex situations involving critical patient deterioration, multidisciplinary team communication, and promoting teamwork and patient safety principles. The design of each training session consisted of four stages. Stage 1: The briefing aimed to orient participants to the simulation environment and learning objectives, including a presentation of the specific case history of the patient to provide context. It lasted approximately 5 min. Stage 2: The simulation practice lasted approximately 15 min, during which participants actively practiced handoff communication scenarios using the I‐PASS framework in a real‐to‐life and fast‐paced ICU environment. Stage 3: The debriefing lasted approximately 20 min, during which the participants examined their performance in a guided reflective discussion, considering questions directed at them, such as “What went well?”, “What worked well for the committee?”, “What difficulties did you encounter?” and “What would you do differently next time?”. This reflection enabled peer learning and critical thinking in communication performance. Stage 4: The feedback lasted approximately 10 min, during which the facilitators and peers delivered constructive feedback to reinforce positives, identify areas for improvement, and summari s e the key learning objectives of the session. A second simulation session was also conducted to reinforce and retain learned skills, 1 week after the initial training.

2.2.2.4. Evaluation Phase

After completing the programme, participants were asked to complete a pre‐administered questionnaire to assess the effectiveness of the training in knowledge acquisition, perceptions of handoff communication, and safety attitudes.

2.3. Ethical Considerations

The principles of the Declaration of Helsinki were strictly followed in this study. Before data collection, the research protocol was approved by the Ethics Committee of the Faculty of Nursing, Menofia University, with approval number 943. Voluntary participation was ensured, and informed consent was obtained from the participants. Every nurse received an informed consent letter that included the study purpose, procedure, risks, and benefits of participating in the study. After being approved to participate in the study, they signed the letter in advance. The participants were reassured that they could withdraw from the study at any time without any consequences, that their responses would be anonymous, and that all data would be handled confidentially.

2.4. Data Analysis

The IBM SPSS Statistics version 26 was used to analyse data. Negatively worded items were reversed before analysis to ensure consistent scoring. Random double‐checking methods confirmed the accuracy of data input. Descriptive statistics, including frequencies and percentages, of participants' sociodemographic characteristics. Means and standard deviations were calculated to describe nurses' knowledge, perceptions of handoff communication, and safety attitudes before and after the implementation of the I‐PASS SBT programme. Inferential analysis was performed using Student's t‐test at 5% significance level and a 95% confidence interval. An independent t‐test was used to compare the mean scores between the two groups, and an ANOVA was used to analyse differences among multiple groups. Pearson correlation test was used to measure the strength and direction of a linear relationship between study variables.

3. Results

Table 1 presents that 59.6% of the studied group were younger than 30 years, 71.9% were married, and 77.2% were female. Nurses with technical institute nursing qualifications constituted 50.9% of the study population, 59.6% had less than 5 years of nursing experience, and 56.1% resided in rural areas.

TABLE 1.

Sociodemographic characteristics of the study group and its relation to I‐PASS knowledge, perceptions of handoff communication and safety attitudes after SBT programme implementation.

Variable	Total, N (%)	I‐PASS knowledge	t (p)	Perception of handoff communication	t (p)	Safety attitudes	t (p)
Age
Less than 30 years	34 (59.6)	15.56 ± 2.2	0.677 (0.414)	74.12 ± 71	0.126 (0.724)	119.7 ± 7.5	0.746 (0.392)
30 years or more	23 (40.4)	15.09 ± 1.9		73.39 ± 8.2		121.8 ± 10.4
Marital status
Married	41 (71.9)	15.02 ± 2.2	4.064 (0.051)	73.46 ± 7.8	0.333 (0.566)	120.5 ± 8.9	0.005 (0.947)
Not married	16 (28.1)	16.25 ± 1.6		74.75 ± 6.8		120.7 ± 8.4
Gender
Female	44 (77.2)	15.36 ± 2.1	0.001 (0.975)	73.27 ± 6.9	1.039 (0.312)	120.6 ± 8.9	0.014 (0.907)
Male	13 (22.8)	15.38 ± 2.1		75.69 ± 9.2		120.3 ± 8.3
Nursing qualification
Technical institute	29 (50.9)	15.31 ± 2.1	F = 0.173 (0.841)	69.34 ± 6.9	F = 19.548 (< 0.001*)	117.2 ± 7.9	F = 5.184 (0.009*)
Bachelor	22 (38.6)	15.55 ± 2.3		77.27 ± 4.2		123.4 ± 7.6
Postgraduate	6 (10.5)	15.00 ± 1.4		82.83 ± 4.4		126.3 ± 11.2
Years of experience
Less than 5 years	34 (59.6)	15.85 ± 2.1	F = 2.316 (0.108)	73.82 ± 7.1	F = 0.025 (0.975)	119.9 ± 7.4	F = 0.557 (0.576)
5–10 years	16 (28.1)	14.69 ± 1.9		74.06 ± 7.6		120.7 ± 10.4
More than 10 years	7 (12.3)	14.57 ± 1.7		73.29 ± 10.4		123.7 ± 11.4
Resident
Urban	25 (43.9)	15.20 ± 1.9	0.278 (0.600)	77.36 ± 6.9	11.722 (0.001*)	123.4 ± 9.3	4.857 (0.032*)
Rural	32 (56.1)	15.50 ± 2.2		71.06 ± 6.8		118.4 ± 7.8

Note: t = independent t‐test, F = ANOVA test.

^*Statistically significant at (p ≤ 0.05).

No statistically significant relationships were identified between I‐PASS knowledge and participants' personal attributes following SBT programme implementation. However, nursing qualification was significantly associated with differences in perception of handoff communication (p < 0.001) and safety attitudes (p = 0.009), with higher educational levels corresponding to more positive perceptions and attitudes. In addition, place of residence showed a significant relationship with both perceptions of handoff communication (p = 0.001) and safety attitudes (p = 0.032), with urban participants demonstrating higher mean scores than rural participants.

Table 2 shows an increase in the mean scores of I‐PASS knowledges, perception of handoff communication quality and safety attitudes from the pre‐training phase (8.46, 69.79 and 106.25, respectively) compared to the post‐implementation phase (15.37, 73.82 and 120.56, respectively). The study group demonstrated statistically significant enhancements across all variables following the SBT programme (p < 0.001). Improvement in nurses' responses was evident, supported by large effect sizes (Cohen's d = 2.8456, 0.8828 and 0.9571, respectively) and a significant change within the study group, reflecting the positive impact of the intervention on study variables.

TABLE 2.

Differences between studied variables in different stages among the study group.

Variable	Before	After	t (p)	Effect size (d)
I‐PASS knowledge	8.46 ± 4.2	15.37 ± 2.1	18.821 (< 0.001*)	2.8456
Handoff communication quality	69.79 ± 9.1	73.82 ± 7.5	6.665 (< 0.001*)	0.8828
Safety attitudes	106.25 ± 16.7	120.56 ± 8.7	7.570 (< 0.001*)	0.9571

Note: t = paired sample t‐test, d = Cohen's test for effect size.

^*Statistically significant at (p ≤ 0.05).

Figure 1 demonstrates the significant increase in mean scores of I‐PASS knowledge, perception of handoff communication, and safety attitudes within the study group, reflecting the positive impact of the training programme.

FIGURE 1.

Mean changes in I‐PASS knowledge, handoff communication perception and safety attitudes across study stages. [Colour figure can be viewed at wileyonlinelibrary.com]

Table 3 illustrates that no statistically significant correlation was found between I‐PASS knowledge, perception of handoff communication, and safety attitudes prior to the implementation of the SBT programme. In comparison, I‐PASS knowledge has a positive correlation with the perception of handoff communication after the SBT programme implementation (r = 0.355). Moreover, the perception of handoff communication has a positive correlation with safety attitudes following implementation of the SBT programme (r = 0.452).

TABLE 3.

Correlation matrix between I‐PASS knowledge, perception of handoff communication, and safety attitudes pre‐ and post‐SBT programme implementation.

Variables	I‐PASS knowledge		Safety attitudes
	Pre	Post	Pre	Post
Perception of handoff communication	r = 0.010 p = 0.941	r = 0.355 p = 0.007*	r = 0.018 p = 0.932	r = 0.452 p = < 0.001**
Safety attitudes	r = 0.013 p = 0.925	r = 0.146 p = 0.277	—	—

Note: r = Pearson correlation test.

*Statistically significantly correlated at p ≤ 0.05. **Highly statistically significant correlated at p ≤ 0.001.

4. Discussion

The simulation‐based I‐PASS handoff training has shown a significant beneficial effect on nurses' knowledge, perceptions of handoff communication, and safety attitudes. This training approach provided a structured framework for key handoff components, enabling more effective information exchange and fostering a stronger culture of safety. The study tested three hypotheses: that implementing the I‐PASS SBT programme would enhance nurses' knowledge of handoff communication, positively influence their perceptions of handoff communication, and improve their safety attitudes.

Consistent with Hypothesis 1, substantial increases were observed in nurses' knowledge of I‐PASS handoff communication following the implementation of the programme. This improvement can be explained through established educational theory and empirical evidence. Firstly, the I‐PASS mnemonic, which stands for Illness Severity, Patient Summary, Action List, Situation Awareness, and Synthesis by Receiver, provides a structured, shared language that simplifies the complex process of clinical handoffs. This structure enables nurses to relay patient information chronologically with reduced omissions, which can substantially enhance knowledge retention and practical application in clinical exchanges (Ait Aiss et al. 2025; Starmer et al. ²⁰²³). Furthermore, high training adherence rates to I‐PASS handoff support its effectiveness in knowledge transfer within nursing units (Ait Aiss et al. 2025).

Secondly, SBT aligns with adult education principles by providing experiential learning that encourages active participation, practice, and immediate feedback. Simulation allows nurses to rehearse handoff in realistic contexts that mirror real‐life experience, ensuring that I‐PASS content becomes second nature. This contrasts with traditional didactic learning, which promotes lower levels of cognitive processing and skill transfer to clinical practice (Amaram‐Davila et al. ²⁰²⁵; Vega et al. ²⁰²³).

Thirdly, embedding I‐PASS into clinical workflows further reinforces knowledge through practice and feedback. Programmes that pair training with systematic evaluation and reinforcement, such as monitoring adherence and providing peer review, have demonstrated sustained improvements in knowledge and handoff quality (Blazin et al. 2020; Vega et al. ²⁰²⁴).

Lastly, the programme's emphasis on promoting safety attitudes complements knowledge gains by fostering a culture that values precise, structured handoffs. This is mainly achieved by encouraging nurses to consistently apply the I‐PASS components, reinforcing knowledge through a shared commitment to patient safety and error prevention (O'Toole et al. ²⁰²⁰).

Supporting Hypothesis 2, this study demonstrated significant improvements in nurses' perceptions of handoff communication quality and effectiveness, following the implementation of the programme. This improvement is supported by evidence showing that systematic tools such as I‐PASS enhance handoff communication by standardising and clarifying the exchange of information among clinical teams. In the same context, Ait Aiss et al. (2025) reported improved handoff quality across all nursing areas after the comprehensive adoption of I‐PASS at a cancer centre. Additionally, institutional safety culture survey results showed an increase in favourable handoff perceptions from 64% to 72%. This suggests that standardised training programmes can effectively alter clinicians' attitudes towards handoffs by reducing variability, enhancing clarity, and fostering trust in the communication process.

Furthermore, Huber et al. (2024) noted that I‐PASS addresses common deficiencies in traditional handovers by emphasising illness severity and synthesis by the receiver, thereby improving anticipatory guidance and reducing complications. Amaram‐Davila et al. (2025) reported near‐complete adoption of I‐PASS among inpatient palliative care teams, citing its accuracy and efficiency over other handover approaches. Similarly, Vega et al. (2023) also documented an increase in standardised handoffs from 23% to 90% without prolonging handoff duration. Starmer et al. (2023) confirmed improved inclusion of key elements and a 47% reduction in handoff‐related adverse events. Institutional support, peer feedback, and tailored documentation were highlighted as pivotal for sustaining quality communication (Blazin et al. 2020; Vega et al. ²⁰²⁴). Enhanced perceptions in emergency and paediatric settings further highlight increased clinician engagement (Chladek et al. 2021; Yanni et al. ²⁰²³), underscoring the role of I‐PASS in strengthening communication quality, trust, and adherence to safe handoff practices (Coffey et al. 2017).

Aligned with Hypothesis 3, the I‐PASS handoff SBT programme significantly enhanced nurses' safety attitudes, which are fundamental to sustaining care standards and preventing adverse events. Positive safety attitudes among nurses are known to foster safer clinical environments and better patient outcomes. The findings of increased safety attitudes are consistent with those of Ait Aiss et al. (2025), who reported that comprehensive I‐PASS implementation at a cancer centre not only improved handoff quality but also was associated with a rise in favourable perceptions of safety culture among nurses. Maintaining zero high‐harm events during the study period signals that strengthened safety attitudes directly translate into meaningful patient safety improvements. Such results underscore the importance of effective communication in promoting a culture of safety, where nurses feel accountable and empowered to prevent errors.

Amaram‐Davila et al. (2025) documented a near‐universal adoption of I‐PASS in palliative care, where clinicians endorsed the handover tool to enhance communication accuracy and efficiency. This acceptance reflects a cultural shift towards valuing structured, reliable handoffs, which are crucial for patient safety. Studies by Vega et al. (2023) and Starmer et al. (2023) have observed a corresponding increase in standardised handoffs and a reduction in handoff‐related adverse events, reinforcing the link between structured communication and improved safety vigilance. O'Toole et al. (2020) further identified a reduction in medical errors following the implementation of I‐PASS which contributed directly to patient safety.

Sustaining these safety attitudes depends on institutional support, continuous education, feedback systems, and context‐specific adaptations (Blazin et al. 2020; Vega et al. ²⁰²⁴). In paediatric emergency settings, I‐PASS has reduced information loss and enhanced confidence among nurses (Chladek et al. 2021; Yanni et al. ²⁰²³). Moreover, clinician awareness of safety benefits, as noted by Coffey et al. (2017) and Al Riyami et al. (2023), fosters engagement, confidence in early detection of deterioration, and enduring adherence to safe communication practices.

5. Conclusion

The findings indicate that the I‐PASS handoff SBT programme had a significant positive effect on nurses' knowledge, perception of handoff communication, and safety attitudes. The substantial post‐intervention increases across all measured parameters, in combination with large effect sizes, demonstrate that the training had a positive impact on nurses' outcomes. On the other hand, educational qualifications and residence also influenced outcomes, with respondents holding higher qualifications and living in large cities holding slightly more favorable perceptions of the programme and more positive safety attitudes. Additionally, post‐intervention analysis revealed strong correlations between perception of handoff communication and safety attitudes. An enhanced understanding of structured handoff practices leads to more effective communication and a stronger safety culture among nurses.

6. Practical Implications

The study's results have significant implications for nursing education, clinical practice and patient safety. I‐PASS handoff training should be incorporated into hospital orientation programmes and continuing education initiatives to ensure adequate communication, reduce information loss and enhance safety outcomes. Nurse managers are encouraged to integrate purposeful, structured tools such as I‐PASS into routine practices of patient transfers and handoff procedures to promote accuracy, consistency, and accountability.

Simulation‐based workshops can help nursing staff develop and strengthen their communication and teamwork skills. Moreover, incorporating standardised handoff modules into nursing curricula would prepare future nurses early in their professional development. Hospital administrators can implement regular assessments of knowledge and perception regarding I‐PASS, which can serve as an indicator of quality care and safety culture. Ultimately, Interprofessional training involving physicians, nurses, and allied health professionals can enable them to work collaboratively to prevent errors that can be avoided.

7. Limitation

This study has several limitations. Using self‐reported questionnaires may introduce social desirability bias, as respondents may wish to provide favourable rather than fully accurate responses. To minimise this bias, validated tools with established reliability were employed, and knowledge was assessed objectively through multiple‐choice questions. Further, anonymity and confidentiality were maintained to support data credibility. Conducting the study at a single site may limit generalisability to other institutions with different cultures, resources, or patient populations. Nevertheless, the selected hospital was a high‐volume facility within a larger system, suggesting that findings remain potentially relevant in comparable contexts. Future multicentre studies are recommended to enhance external validity. The SBT programme also required substantial institutional resources, including time, equipment, and dedicated space, which may constrain replication elsewhere. Leadership commitment, efficient resource allocation, and faculty development were essential to maintaining programme quality and sustainability despite these challenges.

Author Contributions

Study design: M.M.A., M.G.E. and D.F.E. Data collection and analysis: M.G.E., M.M.A. and D.F.E. Study supervision: M.M.A. and M.G.E. Manuscript writing: M.G.E., M.M.A., R.H. and D.F.E. Critical revisions for important intellectual content: M.G.E., M.M.A. and R.H.

Funding

The authors extend their appreciation to Prince Sattam bin Abdulaziz University for funding this research work through the project number (PSAU/2025/03/33419).

Ethics Statement

The principles of the Declaration of Helsinki were strictly followed in this study. Before data collection, the research protocol was approved by the Ethics Committee of the Faculty of Nursing, Menoufia University, with approval number 943. Voluntary participation was ensured, and informed consent was obtained from the participants. Every nurse received an informed consent letter that included the study purpose, procedure, risks and benefits of participating in the study. After being approved to participate in the study, they signed the letter in advance. The participants were reassured that they could withdraw from the study at any time without any consequences, that their responses would be anonymous, and that all data would be handled confidentially.

Consent

Informed consent was obtained from all individual participants included in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The datasets generated and analysed during the current study are not publicly available. However, they can be made available from the corresponding author upon reasonable request.