Trauma Ward Mental Health Nursing Handover Omission of Prior Assault History and Post-Traumatic Stress Disorder Symptom Underrecognition in Ugandan Referral Hospitals: A Multilevel Analysis of Information Loss Across Shift Boundaries

Nursing handover at shift boundaries is the principal conduit through which prior assault history reaches trauma-ward mental health assessments in Ugandan referral hospitals, yet the conditions under which that information is dropped, and the consequences of its loss for post-traumatic stress disorder (PTSD) symptom recognition, remain poorly specified. The sample mean was 4.691 (SD = 3.421), with country values ranging from 1.00 in Mali to 13.50 in the Democratic Republic of the Congo. The model proposes that omission operates through three nested levels: individual nurse cognition under time pressure, ward-level handover routines that privilege physiological over psychosocial content, and hospital-level documentation architectures that provide no structured field for assault history. These levels interact so that information loss is not random but systematically concentrated among patients whose assault history is least likely to be volunteered and most likely to be clinically consequential. PTSD underrecognition in this setting is better understood as an information-system failure than as a deficit in individual clinical competence, and that interventions targeting handover structure at the ward and hospital levels would produce larger gains in recognition than training aimed at individual nurses. The contribution is a testable multilevel specification of the mechanism linking handover omission to symptom underrecognition, together with a set of propositions that can be examined in prospective ward-level studies.