Teaching SBAR using Story: Online and in Clinical Learning

Submitter Information

Author: Vicky J.-H. Yeh, PhD, RN
Title:
Institution: University of North Carolina at Chapel Hill & Synensys®
Email: yeh.vicky@mayo.edu
Coauthors: Gwen Sherwood, PhD, RN, FAAN, ANEF (gwensher@email.unc.edu); Stephen Powell, MSc (spowell@synensysglobal.com); Cynthia Foronda, PhD, RN, CNE, CHSE, ANEF (c.foronda@miami.edu)

Competency Category(s)
Patient-Centered Care, Safety, Teamwork and Collaboration

Learner Level(s)
Advanced Practice Providers, Continuing Education, Graduate Students, Interprofessional, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development

Learner Setting(s)
Classroom, Clinical Setting, Skills or Simulation Laboratories

Strategy Type
Online or Web-based Modules

Learning Objectives

By the end of the course, students will be able to:
1. Describe the components of the Situation-Background-Assessment-Recommendation (SBAR) communication tool to facilitate communication among the healthcare team
2. Recognize and value own role in preventing errors.
3. Analyze a clinical story about a critical event (e.g., medication error, a significant change in vital signs, missed care, etc.) that must be reported to ensure the safety of the patient
4. Engage in deliberate practice to complete multiple story-guided SBAR reporting by applying to one’s own clinical practice
5. Demonstrate effective use of SBAR in reporting a critical incident to other members of the healthcare team by covering critical patient information in an SBAR format, evaluated by a story-specific rubric

Strategy Overview

Purpose: In this assignment, learners complete an online asynchronous SBAR reporting practice session using pre-recorded clinical stories followed by application to situations encountered in clinical practice. This strategy can be used with all educational levels, as part of a Transition to Practice orientation or as staff development. Deliberate practice (Ericsson, 1993) (practice -> reflection -> feedback -> repeat cycle) is a theoretical framework that leads learners through a series of practice activities to achieve a particular skill. Pre-licensure learners have few opportunities to practice critical team communication to achieve mastery. The practice sessions are also effective for post-licensure nurses to achieve competency in SBAR. This assignment utilizes deliberate practice to help learners develop confidence in team communication by providing multiple practice sessions.

Method: Before completing the online asynchronous SBAR practice session, learners are expected to review the SBAR Quick Review from the SBAR Toolkit (see supplemental materials) or other assigned readings or publicly accessible YouTube videos demonstrating how the SBAR communication tool can be applied in team communications.

The learners are to complete an independent online practice session (described below) as assigned. In this first practice session, learners listen to audio-recorded clinical story (an example story and the corresponding script is included in the supplemental materials describing a scenario from various viewpoints (patient, nurse, provider, etc.). The learner must identify a critical incident embedded in the story which necessitates a report to another provider to ensure the safety of the patient. Learners then complete the following steps:

1. Record a verbal report (audio only, simulating making a phone call) in an SBAR format of the critical incident to another member of the healthcare team (e.g., charge nurse, MD, etc.).
2. Complete an SBAR checklist (see supplemental materials) to self-assess the completeness of their SBAR report
3. Respond to 2 reflective questions on what they did well and what they thought could be improved
4. Record a second verbal report of the same scenario addressing areas for improvement
5. Listen to a pre-recorded exemplar SBAR report
6. Learners may repeat the exercise to engage in unlimited practice sessions

After successful completion of the first online practice session, learners then are to take what they learned to the real-world of the clinical setting. Each week, learners are asked to identify a situation in practice that requires sharing critical information with another provider. Following the same steps as the online practice sessions, the learners prepare an SBAR report on an assigned patient and present it as part of the clinical debriefing. Learners then work in pairs or small groups to practice giving SBAR reports and offer feedback to each other’s reports according to the SBAR checklist. Learners continue weekly practice sessions together until mastery learning is reached which is defined by achieving all 15 points of the checklist consistently.

Submitted Materials

Supplemental-Materials_Final.pdf
ISBAR-Nurse-to-Physician-Communication-Rubric.docx

Additional Materials

1. Steps of the Scenario-Based SBAR Reporting Practice Cycle
2. SBAR Toolkit
3. Audio Story Sample and Script
4. Learner Self-Assessment SBAR Communication Checklist
5. Self-Reflection Questions
6. Citations and Supporting Work
7. ISBAR Nurse-to-Physician Communication Rubric

Evaluation Description

To evaluate learning outcomes, the instructor, preceptor, or teaching assistant will listen to the learner’s 2nd recorded verbal SBAR report using a checklist and provide feedback to the learners via email or the course platform. Alternatively, if the learning group is large, a group class debriefing can be completed to review common SBAR errors. Students can also work in pairs; listen to their peers’ SBAR reports while checking off the items on the checklist. This provides an opportunity for students to provide/receive feedback and would engage them in metacognitive reflection about their own performance.

For the clinical setting, each learner submits a feedback report of what they did well and what still needs improvement.