Adjunct Faculty William F. Connell School of Nursing Boston College Chestnut Hill, Massachusetts
The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
In this issue, Dr Elizabeth Henneman and Dr Suzette Cardin remind us that how we indentify ourselves as nurses and as professionals is a topic we should discuss. Patients and families are introduced to many professional and technical staff as they navigate health care environment. It is often a frightening and confusing time.
It is always disheartening to me to hear that a patient isn’t really sure who his/her providers are. It is important to know our patients and to make sure they know who we are. Our full name and titles provide them with essential information.
This is increasingly important as patients move through our hospitals and care sites quickly; often our expedited care leave patients wondering: who was that person?
Make sure you use many strategies to identify yourself. Wear you name badge in a visible place. Engage with patients and share your name and credentials as you explain what you will be doing for them. Be present and share your identify as you share your talents and compassion. As you engage with patients in this manner you also become a role model for students and new practitioners!
We have many incentives that encourage us to identify ourselves. White boards are available in all patients’ room as one of our communication innovations. Write your full name followed by RN. Encourage all members of the care team to do the same.
During handoffs and telephone communications remember to state your name and role in the patients care, using techniques that promote enhanced identification. Recently, the use of SBAR to communicate during handoffs and reporting of urgent events has now been expanded to include identity. The original SBAR (ie, situation, background, assessment, recommendation) is a tool developed by Michael Leonard, MD, along with colleagues at Kaiser Permanente of Colorado, that is designed to streamline the way doctors and nurses communicate during telephone calls and patient handoffs.1
Original used in military settings, SBAR has been used with great success in healthcare. However, nursing leaders at Hartford (Connecticut) Hospital still noticed many accidents that resulted from a lack of communication during patient handoffs. They suggested adding the “I” and introduced an education program to institute the addition of “identity” or “introduction” and required all licensed employees involved with direct patient care to follow the new communication protocol daily.
“We decided to add ‘I’ [in front of SBAR] because we thought it was very important that the clinicians start off with an introduction if they didn’t actively know the person they were speaking with [during a patient handoff or over the phone],” says Ruth Brunner Zafian, MSN, MA, APRN-BC, clinical nurse specialist in cardiovascular services at the Hartford Hospital. Others agreed and thought it was important that all personnel start with an introduction… during any patient handoff but especially over the phone.1
ISBAR is now the preferred acronym for this procedure in many clinical sites and is a wonderful model for all of our interactions with patients and staff!
ISBAR IN ACTION
* Introduce yourself and your role in the patient’s care1
* Confirm who you are speaking with
* State the unit you are calling from when speaking with a physician or other providers over the phone
* Specify the patient’s name and current condition or situation
* Explain what has happened to trigger this conversation
* State the admission date of the patient, his/her diagnosis, and pertinent medical history (also date of surgery or procedure if pertinent)
* Give a brief synopsis of what’s been done so far (eg, laboratory test, O2, electrocardiography, medications)
* Give a summary of the patient’s condition or situation
* Explain what you think the problem is or say, “I’m not sure what the problem is, but the patient is deteriorating,” then be as specific as you can
* Expand upon your statement with specific signs and symptoms
* Explain what you would like to see done (eg, laboratory tests, treatments, or “I need you to see the patient now”)
* State any new treatments or changes ordered (eg, monitoring and frequency or when to renotify the physician if there is no improvement in the patient)
Repeat back all orders, times, and dates to confirm the immediate plan.
Kathleen Ahern Gould, PhD, RN
William F. Connell School of Nursing
Chestnut Hill, Massachusetts