Author: Jayme Nelson,
Title: Associate Professor
Institution: Luther College
Teamwork and Collaboration
Skills or Simulation Laboratories
- Discuss principles of effective communication
- Examine nursing roles in assuring coordination, integration, and continuity of care
- Describe impact of own communication style on others
- Communicate patient values, preferences and expressed needs to other members of health care team
- Communicate with team members, adapting own style of communicating to needs of the team and situation
- Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care
- Assert own position/perspective in discussions about patient care
- Choose communication styles that diminish the risks associated with authority gradients among team members
- Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists)
- Value continuous improvement of own communication and conflict resolution skills
- Value teamwork and the relationships upon which it is based
- Value different styles of communication used by patients, families and health care providers
- Develop a realistic patient scenario that would mandate a health care provider contact (consider some of your past clinical experiences). Consider a typical situation that would warrant this phone call – a change in patient status, patient desires pain medication, has a fever, is constipated, desires “heartburn medication,” change in VS status, etc.
- Develop a realistic written narrative about your “patient.” Make sure that you think through information that you will need to provide for I-SBARR. For example, what is your “patient’s” admitting diagnosis? When were they admitted? What medications are they currently taking? Are there relevant lab results or x-ray results that you need to “create?” What assessment findings are you concerned about? Write all of this information down. You will submit it to your course professor after your “make a case” assignment.
- Schedule your “Make a Case” presentation with your course professor within the assigned 2-week time period. The “Make a Case” assignment will take about 30 minutes to complete the entire experience (including evaluation).
- Arrive at scheduled time to simulation exam room. Don’t forget your “Patient Information!”
- You will position yourself in the Simulation exam room facing the camera at a simulated nursing desk. You will receive the following supplies: scrap paper, a cell phone (if you do not have one), blank physician order forms, and a pen.
- You may wear professional clothes and a simulation lab coat for this experience.
- Call the health care provider (phone number and patient’s provider name posted on white board in simulation exam room).
- Convey your patient concern to the health care provider using the I-SBARR technique.
- Receive patient orders and correctly transcribe orders on physician order sheet.
- After you’ve completed the phone call, meet your course professor in the nursing conference room to review your videotaped “make a case” presentation and offer feedback. Consider professionalism, confidence, tone, non-verbal communication, pronunciation, and preparedness.
SBAR is communication tool originally developed by Dr. Michael Leonard at Kaiser Permanente of Colorado. This tool provides a template for doctors and nurses to effectively communicate during telephone calls and patient handoffs. Two nurses (Ruth Zaflan, a clinical nurse specialist and Lynn Jansky, a nurse manager) in Hartford, Connecticut noted that many times staff did not introduce themselves. They have advocated the addition of an “I” to the SBARR format. I-SBARR communication has the following components:
• Include your name, your title and the unit that you are working on
• Patient’s name and Room Number
• The problem (situation) that you are calling about
• Patient’s Admission Diagnosis and Date of Admission
• Patient’s Allergies
• Patient’s Code Status
• Brief Relevant Assessment of your patient (Make sure you’ve assessed your patient prior to initiating a phone call!). Consider including the following assessment data if relevant: cardiac, respiratory (O2 therapy & respiratory effort), neurological, musculoskeletal, skin, I & O, IV’s, Psychosocial, Blood glucose results (and any needed interventions), Abnormal labs, relevant radiology reports
• Always have current set of VS, including pain and pulse ox
• What do you think would be helpful or needs to be done? Do you think your patient needs medications? A treatment of some sort? X-rays? EKG? Transfer to ICU? To be seen immediately by physician?
• Ask about any changes in orders.
R= Read Back
• Repeat and read back any orders that have been given.
• Clarify criteria for calling back, frequency of VS, glucose checks, etc.
• “Thank you” for responding
This project has been an ongoing project for the last several years. Students have highly evaluated it as an experience that helps structure effective communication with a health care provider about a patient care need. Students typically struggle with organization of all relevant background information, and often forget to have current medication record handy or current assessment data readily available. Initially the project was completed in tandem with an ongoing simulation. Student feedback was positive. Students at the senior level appreciated the opportunity to create their own “patient case” for the health care provider contact. Many students had relevant clinical experiences that warranted provider contact that provided context for this assignment.