Author: Libba Reed McMillan, RN PhD
Title: Assistant Professor, Auburn University School of Nursing
Institution: Auburn University School of Nursing
Skills or Simulation Laboratories
- Demonstrate appropriate use of SBARR technique to communicate effectively with a physician/ health care provider.
- Evaluate performance of peer(s) in communicating utilizing the SBARR technique.
- Appreciate the importance of self- assessment of communication skills to ensuring quality and safety in nursing practice.
This strategy relates to quality and safety as it reduces the reliance upon memory, thus reducing the risk of harm to patients. It utilizes the standardized communication format of SBARR to communicate effectively with health care providers. SBARR is a modified and expanded version of SBAR, which adds Read-back as a means for improving communication in the healthcare setting. This strategy introduces the novice nursing student to the value of standardization as related to safety, as well as serving as a teaching tool via peer evaluation of the communication process.
Note: This exercise is NOT geared to measure critical thinking by the student of how to manage a complex health situation. Rather, the primary objective is to practice and apply theory of SBARR communication as a skill. This activity is adaptable by faculty to increasing complexity of exercise, or using a pre and post-test model at beginning of semester and end of semester or completion of nursing school.
- Roles: SBARR Exercise Leader
- Faculty/staff in lab to serve as the Physician/Health Care Provider (HCP)
- Student mentors/ staff to serve as playing the role of the patient
Instructions/ Pre-brief (15 minutes): Students will be given the theory content the previous day on “Communicating with Members of the Health Care Team”. This lecture includes SBARR technique and the importance of communication by health care providers to safety of the patient and in delivering quality nursing care. This theory content is part of Team STEPPS program by AHRQ. Click here for slideshow. Instructions by the exercise leader will be to give out pocket-sized SBARR cards for reference. The students will also be instructed that they will be given a simple “problem” with their patient, in which they will need to call the attending physician and/ or the health care provider. The students will be given peer- review evaluation forms. These will be used to evaluate their peers as to effective use of the SBARR technique in communicating with the physician/ HCP. The students are told that they have been called into the different patient rooms with the patient requesting to see them as soon as possible due to a complaint or concern. Each concern will necessitate contacting the HCP. It is NOT the role of the student to “diagnose” the problem. The primary objective is to communicate effectively with the HCP.
Scenario (1 hour): Students will arrive to lab/ simulation setting in 4 groups consisting of 4 students in each group. Students will randomly decide the order they will be in the primary role and communicate using SBARR. The other three students are to use the peer evaluation tool to evaluate the primary student’s performance. The “patient” will be in bed. The student will talk with the patient and the patient will communicate their concern regarding a particular problem (see scenario attachment) to the HCP (role played by faulty/staff member). After approximately 6 minutes, the groups will rotate to the next bed; where there will be a different student in the group serving in the primary role, and the other three students will peer evaluate their performance. This process continues through the 4 groups.
Debrief: (45 minutes). The SBARR exercise leader will conduct a debrief session consisting of the students completing the SELF ASSESSMENT EVALUATION OF SBARR COMMUNICATION tool.
Note: The student mentors will be briefed prior to the students entering the simulation setting. Playing the role of the patient, the student mentor will communicate his/her complaints/ concerns.
Ms Kim McIntyre, 40 years old, is complaining of extreme nausea. Has just vomited twice prior to the nurse arriving. Vomit has bright red blood in it. Stomach hurts very badly. Is allergic to aspirin and Sulfa drugs. History of liver disease. Vital signs are 120/80, 60 Pulse, 20 Respirations, and temperature of 102.5 orally.
If you would like a more complex scenario that incorporates oral medication communication to the HCP: Ms McIntyre current medications are: Ibuprophen 800 mg TID, Synthyroid 0.25 mg q day, Fish oil capsules TID
Margaret Miles, 88 year old patient, is complaining of severe ear pain in both ears. Is extremely hard of hearing. A week ago, she was placed on Erthromycin 500 mg QID. She has been taking Motrin for pain in the right ear. She has a history of gout, and high blood pressure. Vitals: blood pressure 110/64, Pulse 65, Respirations 16, Temp 100.2 orally.
If you would like a more complex scenario that incorporates oral medication communication to the HCP: Ms Miles is currently taking Tenormin 50 mg Qday, Digoxin 0.125 mg q day, Zyprexa 10 mg q day, and Zyloprim 600 mg q day.
Judy Riley, 60 year old patient, is complaining of severe chest pain. Has hurt the past 3 hours. Has a history of heart disease, and stroke. Is allergic to no medications. Has been taking Aspirin and vitamins for the past 2 months. Vitals: blood pressure 180/88, Pulse 80, Respirations, 20, Temperature 99.1 orally.
If you would like a more complex scenario that incorporates oral medication communication to the HCP:Multivitamin Q day, Baby aspirin q day, Antivert 25 mg QID, Crestor 5 mg Q day, Vasotec 20 mg BID, Nitroglycerin SL prn
Kathy Fairling, a 25 year old patient is complaining of a severe lower back pain, which is making it difficult to stay in bed. She has no pain medications ordered. She has a history of gall stones, and is 5 months pregnant with her third baby. Vital signs are blood pressure 190/84, Pulse 98, Respirations 22, Temperature 103.5 orally.
If you would like a more complex scenario that incorporates oral medication communication to the HCP:Prenatal vitamins 1 QD, Correctol 1-2 tabs prn
Students are listening for completeness of information:
- S (Situation): Peer introduced themselves to the physician, calling about ____ (patient’s name and room number), calling because____(brief statement regarding the problem, when it started, severity, etc).
- B(Background): Reason for admission, Complete vital isgns, LOC, pertinent assessment findings, other information, such as current medications, laboratory results, code status, etc.
- A(Assessment): Peer stated what was believed to be the problem, or identified some degree of concern or possibilities as to troubleshooting.
- R(Recommendation): Peer stated what they would like done, such as when to call physician back, requesting a consult, possibility of HCP coming to evaluate patient condition, transfer to another unit, etc
- R(Read-Back): Information/ orders were completely and accurately repeated to HCP.
2. Self-assessment tool: This is used during the debriefing period, where the student evaluates his/her performance of SBARR. There are also reflective questions that provide qualitative data to improve the exercise.
Faculty and staff find this exercise to be very easy to implement in the simulation setting, as it uses few resources. This exercise may also be enhanced throughout the semester by threading critical thinking into the scenarios to evaluate both communication and management of patient care. We received positive feedback from students, faculty and student mentors.