This essay outlines justification of the importance of exchanging information skill for nurses. In addition, a critical discussion of the impact and issues about exchanging information is indicated. The essay focuses on SBAR as means of exchanging information on the delivery of high quality and safe care. Demonstration of the way I implement my knowledge on SBAR is discussed.
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Exchanging of information skill is important for nurses to develop as through this exchanging of information, patient outcomes depend on. Cohen et al. (2012) defined exchanging information is a way of information transmission. This is how healthcare system works transferring information from one to another claimed by Ardoin and Broussard (2011). Handoff is other known as exchanging of information is use as way of providing accurate information about patient’s care, treatment, and conditions. Riesenbergh et al. (2010) view handoff an integral part of nursing practice and regarded as high risk process due to being source of errors by Freitag and Carroll (2011).
Exchanging information has many barriers. Ardoin and Broussard (2011) point out lack of consistency and poor communication resulting in inadequate handoffs. The inadequacy of handoff triggers errors leading to ineffective care delivery and compromised patient safety (Freitag and Carroll 2011). Equally, Cohen et al. (2012) claim that, communication failure endangered patient safety and undermine quality of care. Hughes (2008) elaborate patient safety is at risk due to lack of critical information, misinterpretation of information and unclear orders over the telephone drives. Solet et al. 2005 point of view, the increase number of handoffs is a factor causes changes of the meaning of information. Solet et al. 2005 further explain that, the lack of face to face conversations is a consequence of unclear message. Unclear messages ends up receiver to make assumptions about the intent and motivation of the person initiating the message (Solet et al. 2005).
Other factors drives failure in handoffs includes the lack of training and formal systems for patient handover impede the best practice to maintaining standards of clinical care (Bosh et al. (2012); Manser and Foster (2011); Williams et al. (2007). In contrast, Honenhaus (2006) view hierarchical relationship between doctors and nurses together with atmosphere of anxiety and frustration negates transfer of information. Furthermore, Honenhaus (2006) highlight, nurses lack of standardised methods in handoff of patient information causes confusion which leads to medical errors. Honenhaus (2006) clarified that; the cause of compromise patient safety is not necessarily being individual’s fault but inadequate or faulty systems.
The problematic exchanging information result to adverse events in patient safety. The Joint Commission on Accreditation of Healthcare Organisations (2005) reveals <70% of sentinel events caused by communication failures. Leonard et al. (2004) added that, 75% patients involved in the sentinel events died. Jeffcott et al. (2009) suggest poor clinical handover creates discontinuities in care leading to patient harm. Therefore, Manser and Foster (2011) recommend effective exchanging information is crucial to patient safety. Bosh et al. (2012) emphasised to resolve the problems in information transmission staff should take into account structured communication strategies into practice. Therefore, it is important as a qualified staff nurse to possess a structured communication tool such as SBAR to achieved effective handoffs thereby delivering patient quality and safe care.
The literature review found several strategies that could be used in exchanging information with nurses. Among these platforms includes the Situation, Background, Assessment and Recommendation or (SBAR) and safety briefings.
The Scottish Patient Safety Programme (2012) advocates SBAR as a framework to be used in communicating patient information. The Scottish Patient Safety Programme (2012) added that, implementation of safety briefings is also important to make staff known to patient safety issues on a daily basis. By incorporating safety briefings with work, patient safety is practice constantly.
The focus of this essay is to critically analyse one strategy use in exchanging information which in this case the SBAR. The impact of SBAR on delivery of high quality and safe care are discussed below. Firstly, SBAR is a communication tool used for transmitting information about patient’s condition between members of the healthcare team (Scottish Government 2010). Also, it provides a consistent approach to documentation and providing staff with a focused agenda (Scottish Government 2010). Hughes (2008) state, it is focused that set expectations between members of the team for what will be communicated and how, which is essential for information transfer. In addition, SBAR enables information organised in a clear and concise format (Carroll 2006) point out that, due to the structured approach of SBAR on information, Haig et al. (2006) situational awareness of complex information during hand-offs is improved. Powell (2006) point out, SBAR replaced the checklist platform used by nurses for handoffs. Checklist is considered ineffective due to the fact that contains of the context can be lost (Powell 2006). Thus, Powell (2006) recommends use of SBAR as it provides whole picture and embed important elements of complete information transfer. With SBAR allows sharing relevant, timely and important information (Powell 2006).
The impact of SBAR in nursing practice appears variably across many literatures. Hughes (2008) study suggests, SBAR structure promote critical thinking skills in a way that, prior to report a patient condition, the nurse need to provide own assessment of the problem to identify appropriate solution. This helps towards defining the situation encountered as well as promoting autonomy for nurses (Hughes 2008). Equally, staff members are encourage to recommend their observations, and this assists doctors with situational awareness through the eyes of the bedside staff (Hughes 2008). Through this, staff feel empowered being influenced by their own decisions, thereby improving jobs satisfaction (Haig et al. 2006). The use of in SBAR has improved patient safety by providing clear, accurate feedback of information between healthcare staff. Fewer incidents of missed information during handoffs due to concise format shared (Haig et al. 2006). Haig et al. (2006) suggest SBAR has an effect in accurate medication reconciliation. Findings from Haig et al. 2006 study reveals improvement in medication reconciliation during admission from 72% to 88% and discharge reconciliation improvement from 53% to 89%. Also, a reduction in adverse events was shown from 30%to 17% per 1, 000 patients using with SBAR.
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According to Scottish Patient Safety Programme (2012) SBAR promotes patient safety. In a way that, SBAR bridge the gap between nurses and doctors differences in language used (Guise and Lowe 2006); Verdaman et al. (2012) nurses communicate in detailed and narrative when giving information or conversing. In contrast, doctors communicate briefly and specific on actions (Haig et al. 2006). This disintegration of communication style hinders effective nurse – doctor communication which results on increase errors in patient care i.e. medication errors, increase infections and lengths of stay (JCAHO 2005). Verdaman et al. (2012) point out that, by taking account SBAR in handoff communication, it breaks the gap of the communication styles barrier. The SBAR will create a common language. Through bridging the gap of communication styles, between nurses – doctors communication is enhanced and relationship between these two parties is also improved (Beckett and Kipnis 2009). Schmalenberg and Kramer (2009) emphasised that, high quality nurse – doctor relationship is crucial as these influence the quality of care that patients receive. Furthermore, Hughes 2008) high quality nurse-physician relationship triggers increased satisfaction among nurses and doctors.
On the other hand, the study of Velji et al. (2008) ; Dunsford (2009) suggest that, SBAR shown effective communication tool in acute care settings; to structure urgent communications between doctors and nurses. Guise and Lowe (2006) added that, SBAR allows emergency team members know what is going on and when to come to assist in a critical situation. Thus, everyone has unified information, understanding and actions. As a result, critical situation handling outcomes is improved as well as staff satisfaction is improved (Guise and Lowe 2006). As far as emergency setting is concerned, SBAR also had shown effectiveness in rehabilitation settings. Velji et al. (2008) study in using SBAR rehabilitation in setting reveals, SBAR is helpful in both individual and team communications which ultimately affected perceived changes in the safety culture of the study team. However, the qualitative case study of Verdaman et al. (2012) to 80 mixes staff: nurses, nurse manager and doctors in 2 hospital reveals, SBAR function more than a standardise communication among nurses and doctors. It appears SBAR also aid in schema development that allows rapid decision making nurses, provide social capital and legitimacy for less-tenured nurses, and reinforce a move toward standardisation in the nursing profession.
Despite the studies showing SBAR benefits in exchanging information, Hughes (2008) study highlight that, SBAR could only be effective if the team has a common goal and willingness to commit changes in communication style. This means the team must possess greater emphasis towards patient safety in order for SBAR to take effect (Hewet et al. 2005). Beckett and Kipnis (2009) highlight the need of staff to undergo re-learning process for SBAR. This can be challenging to staff thereby, support is provided during the changing process. Beckett and Kipnis (2009) study emphasise that, SBAR alone could not improve patient outcomes but works effectively on its own in shift reporting / handoff as it provides consistency of information for shift report. Moreover, Haig et al. (2006) Carroll (2006) suggests SBAR facilitates collaboration/teamwork in the workplace if along with educational intervention. Such educational intervention includes communication strategies and styles and collaboration/teamwork strategies. This means that, combination of SBAR with collaboration strategies will caused to create a positive effect on work environments, resulting in improved communication, teamwork, satisfaction, and patient safety outcomes. Thus, Beckett and Kipnis (2009) concluded that, SBAR along with collaborative strategies are best practice. Collaborative communication improved patient outcomes. According to Knaus et al. (1986) study, Intensive Care Unit or (ICU) patient cared for by nurses and doctors who worked collaboratively had lower acuity and mortality rates than patients cared for by less collaborative nurses and doctors. Also, fewer deaths and transfers back to the ICU (Knaus et al. 1986). Baggs et al. (1999) ; Larson (1999) suggest collaborative nurse – physician relationships also lead to better patient and organisational outcomes such as decreased length of stay and net reduction in treatment costs without reduction in functional levels or decreases in satisfaction among patients.
I have learnt that, patient information that I provide to staff and multidisciplinary team members is crucial as this affects patient outcomes. Due to this realisation, I concluded that I must ensure effective exchange of information is performed. In order to do that, I have to implement SBAR when transmitting information at all times.
There are several ways I will apply SBAR in my nursing practice. For example, I will apply SBAR when reporting a patient’s situations to a doctor. Equally, in documenting i.e. admission, I will document patient information in SBAR format under nursing notes so that, the nursing team will be made aware of the framework documented. At the same time, it allows other multidisciplinary team members involved in the patient care gain awareness about the format. In this way, I have introduced SBAR to others directly. Furthermore, I will apply SBAR during shift reporting/handover. I will generate a report in SBAR structure to the colleagues. In doing so, the team members enable to view and listening SBAR structured report. Also, I will encourage colleagues to add input under ‘recommendation’ part of SBAR to increase participation. In addition, I will use SBAR format when moving patient from ward to ward. Moreover, I will secure a pocket guide of SBAR at all times at work to prevent myself not forgetting the framework. Finally, I felt student nurses will benefit vastly if I introduce SBAR. To do that, I will provide a pocket guide or leaflet of SBAR to promote awareness. Also, I will encourage student nurses to put into practice SBAR in documentation and reporting about a patient. In doing so, the SBAR becomes part of their learning and in providing effective communication at early stage of their nursing career.
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