CARE Navigator Facilitator • St. Mary's Hospital • Decatur, Ill.
The author has disclosed that she has no significant relationship with or financial interest in any commercial companies that pertain to this educational activity.
There are many different approaches to hand-off communication, including shift report in a room, at the nurses' station, by phone, and at the bedside. Much of the literature indicates a need for a standardized communication method such as the Situation-Background-Assessment-Recommendation (SBAR) technique. This technique provides a framework for effective communication among members of the healthcare team and helps create an environment that allows individuals to speak up and express their concerns. This, in turn, reduces the risk of adverse events and ultimately fosters a culture of patient safety.
Improving the communication between caregivers can prevent negative patient outcomes and strengthen a teamwork approach to care. The SBAR technique provides common expectations such as what will be communicated, how it's structured, and what are the required elements. It allows communication to be focused on the problem and not the people. This is very important when staff members are communicating hand-off information at the change of shifts.
The SBAR technique also provides a way to hand-off relevant information in the presence of the patient, allowing active participation of the patient in his or her care. The patient is central to all information surrounding care activities. Patients can ask questions or add information to the discussion. Through this process, the patient sees the staff working as a team and is assured that all involved know and agree on the plan of care. Evidence suggests that better-informed patients are less anxious and more likely to follow medical advice.
Now, let's take a look at how following the steps in the SBAR acronym leads the speaker to convey information in a methodical and logical way so that the listener can easily follow.
Following the steps
ituation. The "S" component should take about 8 to 12 seconds. The nurse states what's happening now. If giving a shift report to the next caregiver, the nurse states the patient's name, why the patient is on the unit, and introduces the nurse coming on duty to the patient. For example: "Ms. J, this is Tina Jones, the registered nurse who will be caring for you today. Tina, Ms. J is here to have rehab after her right knee replacement." To be effective, you must be concise, clear, and to the point when giving the report, leaving irrelevant information out of the conversation.
Background. During the "B" component, the nurse gives the next caregiver brief background information specific to the patient's relevant history. This section sets the context for what's being discussed, which may include the patient's diagnosis, history of procedures done, and family situation. For example: "Ms. J had a right knee replacement on June 3rd by Dr. Smith. She has a history of hypertension, diabetes, and arthritis. She lives with her husband who's retired and able to care for her at home when discharged."
Assessment. During the "A" component, the nurse reports the current condition of the patient. For example: "Blood glucose levels have been stable, vital signs within normal limits, and the incision line is clean and dry with no drainage noted. The dressing was changed today. Ms. J is able to ambulate to the restroom with a contact guard of one and the use of a walker. Her pain has been reported as a 7 on a 0-to-10 scale and she was given two hydrocodone pills at 9 a.m. The hydrocodone appears to be helping her, especially when given before therapy."
Recommendation. During the "R" component, the nurse states what he or she thinks would be the desired response to the patient's care of the day. She may suggest that discharge planning be initiated by discussing needs with the patient, contacting the physician with discharge plans, and conveying to the rest of the care team what needs to be done before discharge. You don't need to read the entire patient profile or orders. For example: "Ms. J is scheduled for discharge this Friday and will need to speak to the discharge planner today."
Remember, not everything about the patient needs to be conveyed, just what's pertinent to the situation at that time. Also remember that effective communication takes two: Ask if there are any questions and remind team members and the patient that you'll be available should further clarification be needed.
Although nurses communicate all the time with their patients, it's sometimes difficult for them to conduct a report that includes the patient. One reason for this uneasiness has been identified as a fear of having to interrupt the patient if he or she monopolized the report episode. Staff nurses who feel comfortable communicating in the presence of and with patients can share their techniques to demonstrate best practices to the nurses who are unsure of the process.
Informing the patient of his or her role in the bedside report process is also important. To guide patient participation and minimize the disclosure of irrelevant information, remind your patient of the upcoming bedside report toward the end of the shift. To minimize interruptions by the patient during the report, use this time to address the patient's needs for pain relief, toileting, and other requests.
You should also discuss the bedside report process with the patient upon admission to the unit. The patient can choose whether the family or significant other can be present during the bedside report, and those wishes must be passed from nurse to nurse. One hospital made signs for each patient room that reminded the patients, as well as the nurses, about the reporting process. Preparing patients proved to be a vital part of this hospital's implementation process and successful bedside report.
As easy as S, B, A, R
As you continue to use the SBAR technique, you'll enjoy the benefits of effective communication with your coworkers at the bedside. These benefits include the oncoming nurse's ability to visualize patients immediately and prioritize care for the shift. Nurses can also demonstrate equipment use and share information related to individual patient needs. Accountability between shifts is promoted by immediate visualization of patient needs by both shifts. And staff -relationships are improved because communication between shifts is face to face, which builds teamwork and decreases blame. It's that effective!
Learn more about it
Anderson CD, Mangino RR. Nurse shift report: who says you can't talk in front of the patient? Nurse Adm Q. 2006;30(2):112–122.
Caruso EM. The evolution of nurse-to-nurse bedside report on a medical-surgical cardiology unit. Medsurg Nurs. 2007;16(1):17–22.
Manning ML. Improving clinical communication through structured conversation. Nurs Econ. 2006;24(5):268–271.
The Joint Commission. The SBAR technique: improves communication, enhances patient safety. Jt Comm Perspect. 2005;5(2):1–8.