Author: Jalelah Abdul-Raheem, Ph.D., RN
Title: Director of Nursing and Assistant Professor
Institution: Langston University
1. Acknowledge potential to contribute to effective team functioning. (Attitudes)
2. Communicate with team members regarding a patient situation. (Skill)
3. Identify and analyze research and evidence related to the area of concern in practice based on the patient situation. (Knowledge, Skill)
4. Discuss observations or identified problems in the clinical setting to the healthcare team. (Knowledge, Skill)
5. Participate effectively in appropriate data collection and other research activities. (Skills)
6. Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care. (Skills)
7. Differentiate clinical opinion from research and evidence summaries. (Knowledge)
8. Locate evidence reports related to clinical practice topics and guidelines. (Skills)
9. Value own role in preventing errors. (Attitude)
10. Communicate observations or concerns related to hazards and errors to patients, families and the health care team. (Skill)
New graduate nurses have problems with determining what information is necessary to give providers when they contact them. Nursing students should learn how to communicate with providers during their program to help avoid miscommunications that may take place as a new graduate nurse. Students have the opportunity to gather patient information during clinical experiences and become aware of how to inform providers about patient problems. The clinical presentation assignment was developed and implemented to guide students on how to communicate situations to providers and other pertinent disciplines in an efficient way as new graduate nurses.
Students are required to use the SBAR format to report a patient case . SBAR is the format used to communicate information to providers which include the situation, background, assessment, and recommendation regarding a particular patient situation. The SBAR format is reviewed in classroom prior to clinical rotations to allow students to learn how to appropriately use the format to facilitate communication with providers and nurses (Objective 4). Although students will not communicate directly with providers, they will be able to collaborate with assigned nurses and assist in interdisciplinary communication regarding their assigned patient (Objective 2). For instance, students will collaborate with their clinical instructor to identify data that supports the problem to advocate for their client and maintain consistent care across transitions with other disciplines. Students will have their clinical instructors present to guide them in identifying problems and addressing them utilizing the SBAR format appropriately to minimize miscommunication during the learning process (Objective 6). After the clinical day, students have the opportunity to create their SBAR and present current evidence to support recommendation to their instructor and peers to receive additional feedback (Objective 8). Nursing students who develop the skill of using SBAR efficiently will be able to minimize miscommunication errors with providers when addressing concerns as new graduate nurses. It is important for nursing students to experience the process of communicating with other disciplines including providers to reduce verbal and written miscommunication as a new graduate nurse. This assignment allows them to obtain that practice with their instructor instead of a provider as a student to help prepare them when they complete the program and enter into the profession.
Nursing students must also learn how to document in a clear, concise way. The utilization of SBAR when recording accurate information within the notes is necessary to paint a clear picture of the situation that has occurred during patient care. The clinical presentation of SBAR allows students to practice documentation of clinical findings to facilitate successful communication with handoffs to providers and across transitions in the care (Objective 6). Student identification of research that supports the recommendation related to area of concern must be collected using appropriate means (Objective 5). Utilization of the research helps students distinguish between their clinical opinion and evidence based practice (Objective 7). This knowledge will assist them in communicating with providers to help to determine a valid solution to the patient situation. This learning strategy allows students to receive feedback from their clinical instructors based on documentation of SBAR and the identification of relevant research and evidence regarding their assigned patient. Students will confidentially report findings to their clinical instructor and peers during post-conference sessions. Individual feedback will be given to the student via the clinical instructor after further review of documentation.
The clinical presentation is delivered during post conference to address team functioning and how communication can impact hazards and errors to patients, families, and the health care team. For instance, this is a safe environment where discussion regarding how students feel that can contribute to the team environment and minimize hazards and errors with effective communication are appropriate (Objective 10). Students have the opportunity to address attitudes related to their SBAR communication and research activities with peers and their clinical instructors.
The assignment guidelines provided to the students prior to the beginning of their clinical rotation. They are required to identify a research article based on their assigned patient in the clinical setting before caring for them the next clinical day (Objective 5). Students are then required to address a particular problem using the SBAR format and apply information found in their research article outlined in the recommendation section (Objective 3). The research article will be summarized by the student during their presentation after describing their SBAR findings. The student will present their results during post-conference after their clinical experience that day.
The assigned clinical instructor will schedule student presentations before their clinical experience to ensure enough time is allowed during post-conference for each student in the group to discuss findings. Clinical instructors provide 10 to 15 minutes per presentation and are not allowed to schedule more than two students each post-conference. The instructor gives feedback after the presentation and also allows peer feedback to enhance the learning experience. Clinical instructors can facilitate learning of communication with providers within a small group to help improve the quality of communication. The assignment allows students to take ownership in their future role as a nurse by effectively learning to team functioning and help prevent errors in care related to miscommunication (Objective 9).
The assignment was implemented in the January of 2017 with 4th-semester students in an Advanced Adult Health course was used to improve student communication and clinical reasoning skills with the use of current evidence. Initially, students were confused how to apply the format to the patient when assigned in the clinical setting. Many students were under the impression that SBAR format was also used to give hand-off reports to nurses. Since students misinterpreted the use of the SBAR format, clinical instructors spent the first week of post-conference explaining how to use SBAR properly. Students were required to collaborate with nurses and clinical instructors to gain a better understanding of SBAR format prior to working on their assignment (Objective 1 and 4). This additional time used to clarify the usage of the format helped students realizes the importance of accurate communication and how it can impact handoffs and transitions in care (Objective 6).
Students used the assignment rubric as a guide to collect pertinent information. The rubric ensured students received necessary pieces and allowed them the opportunity to earn the maximum number of points in areas addressed. They had a chance to fully engage in the learning experience with immediate feedback from the instructor and peer feedback post presentation (Objective 2). The SBAR presentations lead to post conference discussion questions such as the following from peers (Objective 10):
1. How did the nurse alert the provider based on the patient issue?
2. How receptive was the nurse to the student’s recommendation of the issue?
3. How to discuss an issue with a nurse based on student findings?
4. What happened to the patient and/or family if the issue was not addressed in a timely manner?
These questions gave the clinical instructor an opportunity to address ways to help facilitate communication among team members to help reduce errors on the patient’s behalf (Objective 9). Students began to grasp the concept of the nurse’s role in preventing errors via effective communication and the importance to interdisciplinary collaboration.
Students struggled with what nursing research articles were appropriate for their patient issue. The clinical instructors were very instrumental in guiding students to appropriate research and explaining how it contributes to evidence based practice (Objective 5). The students had a basic understanding of research based on the theoretical course taken during the previous semester but needed more assistance with application of content. The nurses and clinical instructor used hospital databases to show how nurse’s and other providers on the unit access research to support their interventions and recommendations (Objective 3 and 8). After successful understanding of research and data collection, students were then able to distinguish between clinical opinions and evidence based findings (Objective 7). Once students felt comfortable in their role and research selection, they verbalized the ability to advocate for their patients with communication and avoid errors.
Clinical instructors were satisfied with the ease of grading a clinical presentation at the scheduled time rather than returning to grade the assignment at a later date. Students and clinical instructors stated that the assignment gave students the chance to learn effective communication and develop clinical reasoning skills using current evidence. The clinical presentation is slowing being introduced to other clinical courses to maintain consistency and reinforce the importance of effective communication. The clinical instructors and faculty expressed satisfaction with the assignments and student results which led to the decision to incorporate the assignment in other clinical courses. All students who completed the assignment earned an 80% or higher and expressed satisfaction. Students also stated they gained a better understanding of how to communicate findings and the application of current evidence.