Effective communication is crucial in any business, particularly healthcare, where continuity of care is vital. As healthcare professionals strive to provide patient care, communication structure, consistency, and repeatability ensure a shared understanding of the patient and their condition. This then leads to increased patient satisfaction.
The effects of poor communication can have severe consequences. Research shows that errors in clinical communication give rise to substantial morbidity and mortality. Passing clear and concise information between healthcare professionals, particularly during handoff, will ensure continuity of care. SBAR is a communication tool that facilitates information during ward rounds, shift exchanges, and team meetings. If you want to improve your communication mechanism in nursing, you must use the SBAR technique.
In this guide, we will explain what SBAR is, how it is used, its importance, and examples in nursing.
SBAR is an acronym for Situation, Background, Assessment, and Recommendation. It is a technique developed for the US military for the sole purpose of nuclear submarine communication. The aviation industry adopted a similar model. However, later on, it was quickly absorbed by the healthcare system, and now it is used worldwide.
SBAR has become popular in the healthcare industry, especially among physicians and nurses. The model was introduced at Kaiser Permanente in Colorado in 2002 to the rapid response team to investigate the safety of the patients. Its primary purpose was to eliminate inconsistency and other communication problems among healthcare professionals due to different communication styles. Later, other healthcare professionals adopted the technique, becoming among the best handover systems. Healthcare professionals are advised to use them while at work. For instance, they should use them during the handover of care when treating critically ill patients.
Communication in the hospital is more than just having access to information. It is about achieving situation awareness, particularly by understanding a patient's present condition and trajectory.
Communication consists of two premises: the first is that it occurs between the sender and the receiver. The second is an interaction between the sender and the receiver to exchange information verbally and nonverbally. While this is simple in typical communication, particularly in other professionals, in nursing, it is different. There are potential barriers that can interfere with and disrupt communication. Such barriers include:
Consequently, a communication technique like SBAR can help avoid these barriers and ensure efficient nurse communication.
SBAR is a technique used for framing all critical conversations that require immediate attention and action from a healthcare provider. When it is incorporated into practice, there will be a concise and easily accessible summary of the following:
SBAR is ideal because it only focuses on important information, thus eliminating all the extraneous details. It is necessary, particularly in highly stressful situations.
Even though nurses can use other communication techniques in their work, SBAR offers more advantages. Here is a list of the benefits provided by the technique.
SBAR is helpful in emergencies, but it also comes in handy when:
Various communication tools are used in nursing to ensure the effective passage of information. The following reviews those tools and how they differ from SBAR.
Handoff- When one healthcare provider is temporarily or permanently relieved of duty, pertinent information about the patient may be miscommunicated. The Handoff tool ensures this doesn't happen. This is a type of communication tool used in the transfer of patient care from one clinician to the other. Its main objective is to ensure the accurate transfer of patients' information to meet the patient's safety.
A proper handoff communication technique consists of the following:
Call-out: This communication technique involves passing critical information during emergencies. This information will help healthcare workers anticipate and prepare for the next steps in caring for the patient. The critical part of call-out communication is that it is passed to a specific person.
Call out ensures the following things happen:
Check back: This tool is important for all involved parties, including patients and their families. This tool validates the exchange of information between all the involved parties. For instance, a patient and their family members can use the tool to confirm that they understand their symptoms and how to monitor them.
In the checkback system, one person initiates a message confirmed and accepted by the receiver. The receiver repeats the message to the sender, who verifies that it was correctly received.
SOAP: This is an acronym that stands for:
Soap is a problem-oriented approach that involves writing out information in patient charts. Healthcare professionals use it to guide their means of communication.
Nurses must possess the following essential skills to effectively apply the SBAR technique in their day-to-day work.
SBAR consists of four steps: situation, background, assessment, and recommendation. These are fundamental building blocks for communication between healthcare workers. It involves passing around critical information that requires immediate attention and action.
These steps are described as follows:
Situation- this is the first step of the SBAR, and it involves providing a brief, clear, and concise description of the problem at hand by identifying the following:
Then explain the problem, how it occurred, and its severity.
Please note that the nurse must identify themselves and the site they are calling from before relaying the patient's information.
Background- background is simply the history of the patient’s health. Here, you provide all the vital information, like why the patient has been admitted. You also have to provide background information about the patient, including:
If multiple lab reports exist, provide the date and time of the previous results and test changes.
Assessment- state what you think are your professional thoughts (diagnosis) based on all the information you have acquired in the situation and background.
You must have strong critical thinking skills as you conduct the assessment. This way, you can provide the doctor with relevant information about the patient. Meaning you must have done a background check, including receiving lab reports and other tests to determine the underlying cause of the patient's condition.
Recommendation: tell the person with whom you are communicating what you think should be done next.
To understand more about this model, consider the following scenario:
A female patient in her mid-thirties walks into the ER complaining of a throbbing headache. She also has visibly swollen feet and fingers. She is also pregnant and in her third trimester. The attending nurse quickly realizes the dangers of the situation and pages the obstetrics nurse, who rushes into the ER. As the obstetrician leaves, the other nurse fills out an SBAR.
Exercise: Try to fill out an SBAR of your own.
Please take note that for SBAR to work effectively, it requires teamwork. If you find it hard to fill any of the sections, ask the person you are communicating with for relevant help.
This is a predesigned document that makes it easy to fill SBAR notes. It contains SBAR individual sections where you fill in patient-specific information. Once you have filled it out, print the document and share it with the relevant healthcare personnel.
Please take note that some hospitals prefer using SBAR notes in soft copies. In this case, you should use a template compatible with the current software. Before using any template, consider the mode of SBAR sharing.
The following are the different types of SBAR templates.
SBAR Template | |
S | Situation: |
B | Background: |
A | Assessment: |
R | Recommendation: |
Template 2
Situation: |
Name/age: BRIEF summary of the primary problem: Day of admission: |
Background: |
Primary problem/diagnosis: RELEVANT past medical history: RELEVANT background data: |
Assessment: |
Vital signs: Nursing assessment data: Lab values: Any abnormal clinical data : Plan of care? Patient response: INTERPRETATION of current clinical status (stable/unstable/worsening): |
Recommendation: |
Advance plan of care: |
Template 3
Situation: | |
Background: | |
Assessment: | |
Recommendation/Action taken at the time: | |
Patient /Family awareness of the Incident: | |
Date: | Sent to: |
Reporter By Name: | Reporter Designation and email address: |
Nurses typically use SBAR to communicate important information about the patient to ensure they are properly cared for. This type of information should be relayed in a proper structure to ensure no information is lost. Using either of the above templates will guarantee that you do so.
The following are examples of how SBAR applies in a hospital setting.
Situation: Hello, Dr. Swanson. This is Heather Jones, a med/surg nurse from the ABC hospital. I'm calling to inform you that your patient, 50 years old Mr. Henry Simpson, from room 58A, is experiencing shortness of breath and complaining of chest pain.
Background: Two weeks ago, Mr. Simpson was rushed to the hospital because he had a heart attack and was admitted to the hospital immediately for further observation. He is now complaining of severe chest pain. I've tasted his pulse rate and blood pressure, which are 124 and 100/58, respectively. Currently, he feels restless and experiences shallow breathing.
Assessment: He could be experiencing another cardiac event because of his history.
Recommendation: As per the standing order, I have initiated O2 per NC and requested an order for an EKG. I would also like you to come and assess him immediately.
Situation: Mary Philips, a 58-year-old patient in room 103A, has full code with a primary diagnosis of diabetes. She came into the ER complaining of blurry visions and exhaustion. Dr. Samson, her physician, has no directives on her file. The patient has no known drug allergies, has a history of C-diff, and left mastectomy, so blood cannot be drawn from her or have blood pressure readings. She is also on fluid restrictions because of a history of congestive heart failure. She also wears a hearing aid in her left ear.
Background: Mary has a history of hyperlipidemia, hypertension, left breast cancer (in remission), and heart failure. She has been taking medication, for I ordered an x-ray and CT scan, which came back negative. Her blood levels are slightly elevated, and her vital signs are stable. She takes insulin before meals (AC) and bedtime (HS).
Note: Including the patient's past illnesses is highly relevant as they could be connected to the current illness.
Assessment: The patient is repeatable and forgetful. Her respiratory system is within the normal range. She has edema 2+ and is taking medication. Her pulse is weak and on telemonitoring with an atrial-paced rhythm. She has been experiencing constipation (currently under laxatives) and is on a low-sodium diet. She uses a bedside commode because of urine incontinence. She needs help with her activity of daily living (ADL). There is a right PIV on her arm and a port for lab draws on the right side of her chest.
Note: this part should be conducted by qualified personnel, for instance, an RN. However, if it is a diagnosis, a medical doctor should do it.
Recommendation: Tomorrow at 9 am, Mary will have a consultation with a cardiac and neurologist at 10 am. If they clear her, she will be discharged in the evening.
If she gets a spike in her blood sugar levels, notify the doctor and immediately begin the insulin protocol.
Situation: Hello, Dr. Mike. I'm RN Amanda calling from Chicago medical center, where a 40-year-old Mrs. Jenifer, your patient, was admitted last evening in room 2b.
Background: Mrs. Jenifer came to the hospital last evening with an abdominal hysterectomy and bilateral salpingo-oophorectomy. She slept well, and all her vital signs remained normal overnight.
Assessment: She is currently experiencing a sudden onset of dyspnea. She is also complaining of dizziness, lightheadedness, and severe anxiety. Ms. Jenifer is also experiencing pain while breathing. She is coughing but trying as much as possible to prevent it because of the pain. She has an irregular heart rate which is elevated at 120. Her blood pressure is 110/58, and there is no consistent pulse rate because the pulse ox cannot detect it.
Recommendation: Because of what she is experiencing, I think she has a pulmonary embolism. I have already initiated oxygen as per the standing orders. I'm also requesting that you come and assess her immediately.
Situation: Mrs. Elena, a 72-year-old woman, is rushed into the ER and is admitted into room 4C with a severe upper respiratory infection. She has labored breathing, increasing to 28 breaths per minute in the past half an hour. The usual interventions have proven ineffective.
Background: Mrs. Elena has a history of congestive heart failure and chronic obstructive pulmonary disease.
Assessment: In the past 30 minutes, the patient's breathing has become worse, and none of these interventions, inhalers, oxygen, or breathing treatments has helped her receive the symptoms.
Recommendation: I have ordered immediate intubation. I also initiated a Rapid Response Team.
SBAR is a technique for passing patient information among healthcare professionals. It is a straightforward tool used to frame any communication, especially critical communications requiring immediate attention and action from nurses, clinicians, and other healthcare workers. It allows for a focused and direct means of setting expectations for what will be communicated and how between or among members of a team, which facilitates collaboration and by extension improves patient safety and care quality.
Related Readings:
This easy-to-remember acronym helps nurses, doctors, and technicians quickly, efficiently, and effectively communicate amongst themselves. The tool can be applied in any medical setting; the goal is to help and guide someone to take proper action concerning the patient. If you are a nurse and need help remembering or using the tool, the above guide should help you.
Health systems such as Kaiser Permanente have integrated the SBAR technique. We have looked at SBAR nursing examples and templates. If you need SBAR assignment help, you can place your order and get it done by our professional nursing writers.
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