SBAR Nursing Example
SBAR (Situation, Background, Assessment, and Recommendation) is a communication tool that enables health professionals to effectively communicate by sharing information among team members, stimulates short reaction times, and prioritizes quality patient care.
The U.S. Navy established SBAR originally to relay information about nuclear submarines, but it was adopted by the healthcare system in the 1990s, and later on, used globally. Since then, SBAR was found to be a valuable method for organizing and presenting patient information.
Though work considerations and other communication gaps were noted by some nurses as barriers to SBAR in some research, the quality of communication with nurses about changes in the patient’s condition had improved since the implementation of SBAR.
It is critical to have effective communication in healthcare settings, not only between patients and nurses but also between medical professionals.
To reduce the risk of error and ensure that the patient is treated appropriately, patient information should be communicated precisely, fast, and effectively at all times.
Nurses must utilize the SBAR approach when interacting with patients, other nurses, and physicians in order to improve their nursing communication skills.
The SBAR approach can help to ensure that all pertinent information is transmitted and communicated in a clear and concise manner.
Importance of SBAR in Nursing
The SBAR approach is valuable as it provides nurses with a framework for promptly and efficiently communicating essential factors of critical circumstances.
It guarantees that other members of the healthcare team obtain all pertinent data in a concise and systematic way, along with clear instructions on how to respond.
SBAR is a dependable and proven communication tool that has been proven to lower undesirable occurrences in health facilities, enhance collaboration among healthcare workers, and ensure patient safety.
The SBAR approach can be used by members of the healthcare team in a variety of situations and places. It might start early treatment as a patient is admitted to a unit.
When transferring care to a different care provider, the approach might assist in conveying patient information. It can also be useful in emergency situations, such as notifying a physician of a life-threatening situation.
The SBAR approach is a tool that helps healthcare team members communicate more effectively, especially with regard to patient status. The SBAR approach is an effective instrument for anyone developing communication methods, particularly nurses.
It can be a good strategy to use when presenting new shift report briefings over the phone, at the nurses’ station, and even in front of patients.
Components of SBAR Nursing
As per the Joint Commission, the following are the components of SBAR and their corresponding descriptions:
- Situation. In this segment, the member of the healthcare team describes the situation or problem in basic, short terms. Take into account the crucial details including the role in the patient’s treatment, as well as the patient’s identity, area, and room number. Describe the scenario, along with the extent of the situation, how it transpired, and the complexity of the condition.
- Background. In this segment, a healthcare member provides pertinent background information on the patient, including their admission time and date, diagnosis, necessary details, test results, and code status. If a patient has several laboratory reports, the nurse or other health providers may provide information about the preceding test’s date and time, as well as any differences in the results.
- Assessment. Provide a professional evaluation or judgment based on the patient’s situation and background in this segment. This is where the nurses explain what they found out about the patient. This can encompass everything they see, hear, smell, and feel, among other things.
- Vital signs (Blood pressure, temperature, pain level, etc.)
- Diagnostic test results
- Significant Physical observations
- Changes in physical and mental state
- Concerns and complaints from patients
- Recommendation. In this segment, healthcare providers state directions to their colleagues in healthcare and convey what they require from them in an accurate and direct manner on how to proceed with the patient’s treatment.
- Drug requirements or adjustments
- Diagnostic tests to run or specimens to obtain
- Other possible procedures to be done
- Additional interventions
- Order to transfer or refer as applicable
How to Demonstrate SBAR Nursing?
Here are some pointers in demonstrating the SBAR approach to effectively communicate in any healthcare setting:
- Gather the ideas. It is a smart decision to assemble thoughts before using the SBAR technique to make sure that a healthcare provider is just conveying the most valuable information. Determine whatever background data is significant to the patient’s status. Consider generating a bullet point range of ideas to include if making a phone call to a physician or having time to prepare statements.
- Be brief and straightforward. SBAR’s main purpose is to enable patients and other healthcare providers to avoid receiving irrelevant data that could mislead or worry them. Others can ask for inquiries and more information after giving a recommendation.
- Collaborate to create a plan of action. Arriving with a proposal or solution often necessitates the opinion or expertise of another person to make an informed conclusion. In these cases, the final element of the correspondence may include a request for guidance on how to continue.
- Respond to requests for more information. After presenting the patient’s status and requirements to another member of the medical team, be prepared to answer further inquiries. It may be easier to discuss more specifics once the most important facts are presented.
What to Do Before Using SBAR Nursing
It is essential to understand what members of the healthcare team must do before consulting with the doctor. The physician will ask appropriate questions, and it is preferable if they can predict what inquiries and information he or she would ask.
- Examine the patient. Even if it is simply a brief, concentrated evaluation, the nurse should assess the patient.
- Check for any orders in place to deal with the problem currently having. If the patient is hypertensive with a blood pressure of 180/106, check the doctor’s orders for an antihypertensive before calling to get one.
- Make absolutely sure in contacting the appropriate doctor. Many patients have several physicians supervising their care, or the attending physician may request that the caregiver contact the resident if there are any problems. If it’s a surgical problem, the nurse will most likely contact the surgeon. Alternatively, if the patient cannot tolerate dialysis, a nephrologist must be consulted. Always receive a list of the physicians on the patient’s care team when getting a report on them.
- Be ready to provide a quick summary of the patient’s hospital stay. It is possible that the physician who answers the phone is not really the attending physician. It might be a resident or the physician on call. Do not expect that the physician is always familiar with the patient to discuss. Remember the patient’s admission diagnosis, when they were hospitalized, and any major operations, such as surgeries or diagnostics, that they’ve had.
- Inform the resource nurse about any concerns. This could be a newbie’s mentor or the charge Nurse.
- Examine the most relevant physician progress note and end-of-shift summary provided by the nurses who submitted the report.
- Any information related to the current event. What is the patient’s most recent intake and output, for example, if a healthcare member calls concerning potential fluid overload? What kind of fluids is being used? What is the patient’s hemoglobin or hematocrit level if there is blood in their stool?
- When speaking with the physician, keep the chart open to easily access information such as vital signs records, allergies, laboratory test results, current prescriptions, code status, and so on.
When to Use SBAR Nursing
SBAR should be used to guide and inform any patient information contact with other healthcare practitioners. The following are some examples of circumstances when SBAR can be enhanced:
- When a medical team is dealing with a patient’s problem.
- Doctors, nurses, physical therapists, and other healthcare professionals are invited to participate in the discussion.
- When a quick response team needs access to information about a situation during an emergency or a crisis.
- For in-person and over-the-phone consultations about a patient’s care.
- When expressing or escalating concern about a patient’s care.
- In between shifts or during a shift change, when passing communication to other healthcare providers.
- In crisis and health briefings.
Nevertheless, it is important to emphasize that SBAR cannot be implemented uniformly across the board. There are restrictions when using this strategy, as there are to any approach. These are some of them:
- When the user is inexperienced with SBAR and is at risk of misusing it.
- Whenever it relates to disclosing patient information, it falls under the jurisdiction of HIPAA.
- Whenever a healthcare practitioner is under duress and unable to provide a judgment.
Who Should Use SBAR
SBAR is recommended by the Agency for Healthcare Research and Quality (AHRQ) for the following:
- Communicating with administrators and physicians
- Nurses conversing with one another
- Nurses and technicians exchange information.
- Nurses interacting with physicians
- Nursing assistants and nurses
- Physicians exchanging information with one another
- Communication between a pharmacy and a nurse or a physician
- Residents and attending physicians exchange information.
While the AHRQ outlines a specific group of healthcare team members who can benefit from SBAR, it should be highlighted that the communication strategy can help any healthcare provider. It is a useful tool for conveying information in a straightforward and effective manner.
SBAR Nursing Example
The following are some SBAR examples of communication strategies that use SBAR as a guide:
SBAR Nursing Example 1
A nurse is providing the patient’s next nurse with a shift report. Mr. Bowley, a 56-year-old man, was brought in by paramedics following a vehicular accident with multiple minor abrasions and hematoma. The medical team has been keeping a close watch on him for indicators of a concussion. The nurse believes Mr. Bowley is ready to be discharged after many hours of observation.
SBAR Nursing Example 2
Raiya Kurstey, a 66-year-old female admitted to the Intensive Care Unit (ICU), is exhibiting signs of cardiac arrest. Her nurse must inform the on-call physician about the matter. In this case, they might employ the SBAR approach as described in the following:
|Situation||“Dr. Roberts, my name is Michelle Lim, a nurse from Riverview District Hospital. I want to speak with you about your patient, Raiya Kurstey, who is having breathing problems and episodes of chest pains.”|
|Background||“Ms. Kurstey had hip surgery yesterday night, and just an hour ago she started to complain of chest pain. Her oximeter can’t detect a continuous pulse and is producing fluctuating results; her breathing appears strained, and her blood pressure is 108 over 52.”|
|Assessment||“I suspect that Ms. Kurstey is undergoing a cardiac event or pulmonary embolism.”|
|Recommendation||“Would you mind visiting Ms. Kurstey’s room right away for a more comprehensive examination. Until then, I would like to place her on oxygen, do you concur?”|
SBAR Nursing Example 3
A room nurse is relaying patient information to a visiting consultant for a probable pneumonia case. They can use SBAR to convey the case’s most essential information:
|Situation||“An ambulance rushed Ms. Collins in at 7 p.m. this evening as she was feeling ill and had a sudden onset of shortness of breath. She is 78 years old, and she presented with possible pneumonia but is currently stable.”|
|Background||“Ms. Collins has no known history of significant findings, does not smoke, and currently taking drugs for elevated blood pressure only. Her figures were almost normal when she came in, though she was afebrile with a mildly increased white blood cell count. She recently came back from a family vacation, but we believe we have ruled out the likelihood of a pulmonary embolism.”|
|Assessment||“I am inclined to think that Ms. Collins has pneumonia since she has a cough, pain over her chest, and shortness of breath.”|
|Recommendation||“Could Ms. Collins undergo both chest x-ray and complete blood count again on then start the antibiotic treatment? Are these recommendations for Ms. Collins’ care plan reasonable plan of action to you?”|
SBAR Nursing Example 4
A nurse from the General Medicine floor has received an order for a patient to be given fluids by mouth as he has been admitted with vomiting and abdominal discomfort. The patient’s pain started in the periumbilical area and has now extended to the right lower quadrant of the abdomen. The ordering physician should be informed to discuss the patient’s current status and verify the fluid intake order.
|Situation||“Dr. King, I am Kelly, a nurse on the General Medicine floor, and I have an order for clear fluid intake for Ms. Hanes, who is in room 304 with abdominal pain. I’d want to provide you an update on her status and clarify orders with you.”|
|Background||“I note Ms. Hanes was taken to the Emergency Room for abdominal pain and vomiting. Her abdominal pain has worsened and is now extending to her right lower quadrant. She was prescribed oral fluids.”|
|Assessment||“Ms. Hanes appears to be in poor health since her abdominal discomfort has worsened and she has been vomiting up more since her admission.”|
|Recommendation||” I recommend deferring the oral fluid order for the time being and starting IV fluids instead. I am also thinking of ultrasound to rule out appendicitis, if it would be fine with you.”|
SBAR Nursing Example 5
A patient was admitted due to chronic back pain and underwent a spinal infusion. The patient notices erratic vital signs measurements and needs to discuss the patient’s condition with his physician and make some recommendations.
|Situation||“Hello, Dr. Willis, this is Cassie from Riverview District Hospital’s unit 6 West. I’m calling to inquire about Mr. Derrick Ross, a 62-year-old patient in room 221. He’s in a lot of discomfort in his back.”|
|Background||“He has had persistent back pain for three years and was hospitalized on July 9 due to an increase in back discomfort. On July 12, he had a spinal fusion, and he is now receiving pain medication every 8 hours, with the last dose administered at 1735. He is also reported to be morphine-allergic.”|
|Assessment||“Mr. Ross’ Blood pressure is 175/104, Heart rate is 112, and Respiratory Rate is 26. He had been sweating heavily and breathing shallowly earlier. While going to bed this evening, he had a difficulty walking and weak. “Mr. Ross verbalized that he is in far more pain now than he was before surgery while crying and screaming for the past 20 minutes. He is also anxious, and asking if there was something that go wrong with his surgery.”|
|Recommendation||“Would you consider adjusting Mr. Ross pain medication to every 4 hours? Do you want a STAT back x-ray to ensure everything is in good condition? I also believe that we need to keep an eye on his vital signs every hour until he stabilized.”|
SBAR Nursing Example 6
In the morning, a patient with cardiomyopathy was hospitalized. The patient’s respiratory state has worsened, and his blood pressure has increased as of 1:30 in the afternoon. The attending physician must be informed of the condition of the patient and must request that the patient’s prescriptions be changed as well as additional testing.
|Situation||Hello, Dr. Miller. I am Mark, the nurse on the Cardiac PCU floor who is currently taking care of Mr. Harrison in Room 308. Shortness of breath and hypertension have recently developed in the patient, which alarms me.|
|Background||He was admitted early this morning and diagnosed with cardiomegaly, he also has a history of coronary artery disease, hypertension, and mitral valve disease. Antihypertensive drug once a day and diuretics BID are the medications he is currently taking.|
|Assessment||Crackles have appeared in his lung fields, particularly in the right and left lower lobes. Even though he is on 2 Liters of Oxygen through a nasal cannula, his oxygen saturation has declined from 96 percent to 85 percent, and his current respiratory rate is 32. He becomes tremendously out of breath when he speaks or engages in any type of strenuous activity. He has pitting edema in his lower extremities with a blood pressure of 205/110 mm Hg and a heart rate of 115 bpm. I believe he is suffering from fluid volume overload, which could be aggravating the patient’s respiratory and cardiovascular concerns.|
|Recommendation||I believe that Mr. Harrison may necessitate prescription changes as well as additional diagnostic tests. What measures do you want me to undertake with this patient? Do you want me to arrange a prescription adjustment and/or diagnostic procedures, such as a chest x-ray, ABGs, cardiac enzymes, and ECG, to evaluate the patient’s condition even further?|
Patient safety is the most important consideration in patient care, and ineffective communication are the most frequent cause of adverse outcomes. During patient shift handover, health care providers make every effort to avoid communication mishaps.
SBAR is a structured communication method that has been effective in reducing undesirable occurrences in the hospital setting. SBAR is a communication tool for healthcare practitioners that has been endorsed by a number of medical associations and significant healthcare organizations.
The SBAR communication tool is simple to use and adapt to most clinical contexts; nevertheless, it can be tough in complex clinical cases, such as those involving patients hospitalized in Intensive Care Units.
Furthermore, maintaining the therapeutic use of the SBAR communication tool necessitates educational training and a shift in culture.
More research is needed to determine the impact of the SBAR communication tool on patient outcomes and the instrument’s validation in additional subspecialties and comparisons to other communication tools.
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