Running head: UTILIZING SBAR TO IMPROVE COMMUNICATION AND TEAMWORK 1 Utilizing SBAR to Improve Communication and Teamwork Jenifer Coxson Dixie State University
UTILIZING SBAR TO IMPROVE 2 Utilizing Communication Techniques to Improve Teamwork Relationship-Based Care and Teamwork Health care does not occur in a vacuum, with each discipline acting alone and interventions occurring independently. Rather, there are many dynamic factors that are constantly interacting and influencing each other. Perhaps the most important dynamic elements of healthcare are the human providers. Each person, with their corresponding discipline, can have a great effect on the health of a patient. However, for optimal health care outcomes these different providers need to function as a team and work together. Unfortunately health care providers don t always function as a cohesive team, which results in poor service and patient care. One of the primary reasons for this disjointed approach to care is the lack of communication and cooperation among professionals (Smith, 2014). Furthermore, Koloroutis (2012) suggests that conflicts among caregivers could evolve into toxic patterns which could completely undermine effective care. Koloroutis (2012) continues on to say that health care teams exist to care for the patient, and are central to relationship-based care. Moreover, effective interdisciplinary collaboration and coordination are achieved through communication. Therefore, it can be determined that communication is essential for effective relationship-based care, and should be an utmost priority. Communication Project Description Communication happens every day, in nearly every situation. However, although communication is happening, it isn t always effective (Brindley & Reynolds, 2011). George Bernard Shaw, renowned playwright, journalist, and winner of the Nobel Prize, one said, The single biggest problem in communication is the illusion that it has taken place.
UTILIZING SBAR TO IMPROVE 3 Perhaps the best way to facilitate effective communication is the use of a standardized communication model. The Joint Commission, the organization that accredits health care programs for the United States, endorses the use of standardized communication models for communication between health care team members. The model that the Joint Commission uses for communication is SBAR, an acronym standing for Situation, Background, Assessment, and Recommendation (Labson, 2013). Ongoing education is a significant factor in the implementation of relationship-based care (Woolley, et al., 2012). In an effort to improve communication and foster teamwork among team members, it was determined that the nurses on the Medical/Surgical floor, the Ortho/Neuro floor, and the Pediatrics floor at Timpanogos Regional Hospital should all be instructed in the use of SBAR. This leadership and education task was assigned as a project for NURS 4040. The scope of the project was to include research regarding the history and effectiveness of SBAR, construction of a multimedia presentation, facilitation of multiple educational sessions for the presentation of materials, and reinforcement of teaching through a hands-on learning experience where simulation and practice were utilized. Project Implementation Research Regarding SBAR SBAR was originally developed by the United States Navy as a means of communication between nuclear submarines. It was then adopted by the aviation industry, before coming to health care. Kaiser Permanente of Colorado was the first health care to utilize this communication model, implementing it in their rapid response teams (Wikipedia, 2015). The use of SBAR in health care communications has proven effective. According to Guhde (2014), it has promoted discussion between disciplines, and led to improved clinical
UTILIZING SBAR TO IMPROVE 4 judgment and decision making. In addition to these finding, the use of SBAR has increased consistency in interdisciplinary collaboration and improved efficiency (Cornell, Gervis, Yates, & Vardaman, 2014). Multimedia Presentation A multimedia presentation was constructed, using multiple mediums for maximum learning avenues. The presentation consisted of a power point slide show which contained written information regarding the discussion. It also contained a video clip with visual and audio components. Finally, the presentation also had printed handouts for note taking and future reference. The presentation was centered on the four elements of SBAR, which are Situation, Background, Assessment, and Recommendation. A brief synopsis of each element is described below. Situation. This identifies what is happening right now. Health care providers should give a short, concise statement describing the situation at hand. Examples could include my patient is having difficulty breathing or the patient is complaining of chest pain. Background. This identifies how the patient arrived at this situation. A pertinent health history, along with a brief synopsis of recent treatment should be included here. Assessment. This identifies that patient s condition or status. When conveying information about patient assessment, health care providers should include current vital signs, mental status, and pain levels, as well as changes from baseline. Recommendation. At this point in the communication, the person initiating the communication conveys suggestions or recommendations for further treatment. This can include lab or diagnostic tests, medications, or simply a request for the provider to come and assess the patient personally.
UTILIZING SBAR TO IMPROVE 5 Educational Sessions Nine sessions of this training were offered on three different days to accommodate the large number of participants. To first get attention and create a positive atmosphere, music was playing as participants entered the classroom. The song In The Navy by the Village People was utilized for its upbeat nature, as well as a nod to the origins of SBAR. The participants were then given a pretest to assess current knowledge of communication needs, techniques, and the SBAR model. Following the pretest, the power point presentation was shared. This opened the opportunity for discussion between class members regarding the topics covered. Next a video clip was viewed, which reinforced the topics covered in the power point presentation. Simulation and Practice In a study by Chaharsoughi, Ahrari, & Alikhah (2014), it was found that role playing and simulation were more effective tools in teaching SBAR than traditional lecturing. Therefore, at the conclusion of the traditional lecture and power point presentation, students were led in a simulation activity. Each participant randomly selected a hypothetical patient situation that had been previously prepared, and presented it to the group. The other participants then identified appropriate communication responses, utilizing each element of SBAR. All participants were required to support their answers with rationales and explanations. Conclusion At the conclusion of the nine presentation sessions, feedback from the hospital administration was received regarding the teaching project. They expressed delight and satisfaction with the efforts that were made, as well as the quality of the materials presented. A follow up activity was also initiated. Hospital supervisors and charge nurses were tasked with performing random audits of interdisciplinary communications, to see if the teaching
UTILIZING SBAR TO IMPROVE 6 was effective, and the SBAR model was being utilized. The audit criteria was six audits per week, for three months. These audits are still ongoing. Additionally, health care team members for disciplines outside of nursing are being surveyed to assess whether teamwork and coworker relationships are improving. This is also ongoing.
UTILIZING SBAR TO IMPROVE 7 References Brindley, P.G., & Reynolds, S.F. (2011, April). Improving verbal communication in critical care medicine. Journal of Critical Care, 26(2), 155-159. Chaharsoughi, N.T., Ahrari, S., & Alikhah, S. (2014, June). Comparison the effect of teaching SBAR technique with role play lecturing on communication skill of nurses. Journal of Caring Science, 3(2), 141-147. Cornell, P., Gervis, M.T., Yates, L. & Vardaman, J.M. (2014, September/October). Impact of SBAR on nurse shift reports and staff rounding. Medsurg Nursing, 23(5), 334-342. Guhde, J.A. (2014, May/June). An evaluation tool to measure interdisciplinary critical incident verbal reports. Nursing Education Perspectives, 35(3), 180-184. Koloroutis, M. (2012). Relationship-based care, A model for transforming practice. Minneapolis, MN: Creative Health Care Management. Labson, M. (2013, November 19). SBAR A powerful tool to help improve communication! Retrieved from http://www.jointcommission.org/at_home_with_the_joint_commission/ sbar_%e2%80%93_a_powerful_tool_to_help_improve_communication/ SBAR. (2015, March 13). Retrieved from http://en.wikipedia.org/wiki/sbar Smith, K.E. (2014, April). Health care interprofessional education: Encouraging technology, teamwork, and team performance. The Journal of Continuing Education In Nursing, 45(4), 181-187. Woolley, J., Perkins, R., Laird, P., Palmer, J., Schitter, M.B., Tarter, K.,... Woolsey, M. (2012, May/June). Relationship-based care: Implementing a caring, healing environment. Medsurg Nursing 21(3), 179-182.